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Permit iexpAi)ke. 7 - / ,i523 a> CITY OF TIGARD MASTER PERMIT PERMIT #: MST2006 -00003 - ^ -, 11,1 1 1 1, DEVELOPMENT SERVICES DATE ISSUED: 2/16/2006 c' i 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S125DA-00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 1,020 sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 0 THIRD: at RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 1,020 sf 94,248.00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: 2 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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: 1 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: 3 SIGNAUPANEL: 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: LANDSCAPEJIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE 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 JAMES MIKAMI GIRARD CONSTRUCTION applicable laws. All work will be done in accordance with approved 9955 SW 65TH AVE 10445 NW OLD CORNELIUS PASS plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, OR 97546 of issuance, or 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 Phone: 503 - 452 - 0312 Contact #: PRI 503 750 - 2514 of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Reg #: LIC 167078 TOTAL FEES: $ 1,659.04 REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) Issued By : 4.1144-17. eA Permittee Signature : 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. ti MASTER P RMIT C I vi OF G A R D PERMIT #: MST2006 -00003 i� DEVELOPMENT SERVICES DATE ISSUED: 2/16/2006 ' 6 �' I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S125DA-00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 1,020 sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 0 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 1,020 sf 94.248.00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 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: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: 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: 1 W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: I SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: 3 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 if SYSTEMS: • This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other JAMES MIKAMI EXECUTIVE CONSTRUCTION & REMODELII` applicable laws. All work will be done in accordance with approved 9955 SW 65TH AVE 10928 NE KILLINGSWORTH plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, OR 97220 of issuance, or 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 Phone: 503 452 - 0312 Contact #: FAX 503 - 762 - 1677 of these rules or direct questions to OUNC by calling 503 - 246 -6699 PRI 503 696 - 9509 or 1- 800 - 332 -2344. Reg #: LIC 119919 TOTAL FEES: $ 1,659.04 REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) Al C Issued By '` _ ' / Permittee Signature Call 503 - 639 -4175 by 7:00 a.m. for an inspection that b iness 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. i ! ,....0 G U !i . CITY o� TI MASTER PERMIT V ( PERMIT #: MST2006 -00003 ����s _��1��� DEVELOPMENT SERVICES DATE ISSUED: 2/16/2006 9 'r' ---- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S125DA-00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 53 SECOND: 961 of GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 0 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BORM: BATH: 1 TOTAL: 961 sf 88.796.40 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: I DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 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: 1 CLOTHES DRYER: 1 FURN >100K: UNIT HEATERS: • HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS A001 INSPECTIONS 1000 SF OR LESS: 0 • 200 amp: 0 - 200 amp: 1 W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADDI. 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC/FDR I SIGN/OUT UN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADM BR CIR: 3 SIGNAL/PANEL: IN PLANT: MANU HM/SVC/FDR 001 • 1000 amp: 001•amps- 1000x. MINOR LABEL o _ 1000• amp/volt : N Reconnect only: PLAN REVIEW SECTION O > 4 RES UNITS: SVC/FDRp =225 A.: a 600 V NOMINAL: CLS ARENSPC OCC: O ELECTRICAL - RESTRICTED ENERGY V A. SF RESIDENTIAL B. COMMERCIAL 1 AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: O BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL• O GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL OTHR O HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: This permit is subject to the regulations contained in the Tigard 0 Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other JAMES MIKAMI EXECUTIVE CONSTRUCTION & REMODELII applicable laws. All work will be done in accordance with approved 9955 SW 65TH AVE 10928 NE KILLINGSWORTH plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, OR 97220 of issuance, or 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 Phone: 503.452 - 0312 Contact #: FAX 503 762 - 1677 of these rules or direct questions to OUNC by calling 503 -246 -6699 PRI 503- 696 -9509 or 1-800-332-2344. Reg*: LIC 119919 TOTAL FEES: $ 1,412.28 • , REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) Issued By : QT Permittee Signature : S.., D p a _1 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. CITY OF TIGARD MASTER PERMIT PERMIT #: MST2006 -00003 I DEVELOPMENT SERVICES DATE ISSUED: 2/16/2006 °'I I+ 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S125DA-00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 1,020 sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 0 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 1,020 sf 94,248.00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: 2 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: Mu 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: 1 0 - 200 amp: 1 W /SVC OR FOR: 21 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: 0 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: 0 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 AREAISPC 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 it SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other JAMIE MIKAMI GIRARD CONSTRUCTION applicable laws. All work will be done in accordance with approved 9955 SW 65TH AVE 10445 NW OLD CORNELIUS PASS plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, OR 97546 of issuance, or 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 Phone: 503 452 - 0312 Contact #: PRI 503 750 - 2514 of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Reg #: LIC 167078 TOTAL FEES: $ 1,860.30 REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) • Issued By : _ .�f /," Permittee Signatu I 1 1..e- cr..-z/ 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. ,I Electrical Permit Applicatio l olr i icr: USE: on , t Received �/_ � s City of Tigard Receiv 2� 'z Permit No.\y / ; � 1K add ds a 13125 SW Hall Blvd., Tigard, OR 9 Plan Revi ie e w� `` ' C : Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit: T I G Iz D Inspection Line: 503.639 / Date Ready/By: Juris: ® See Page 2 for • Internet: www.tigard or.gov Notified/Method: - ri r Supplemental Information TYPE OF WORK PLAN REVIEW • ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure C] Multi - family ❑ Master builder ❑Building over three stories ['Feeders, 400 amps or more ❑ Other: DOccupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park Job no.: Job site address: ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City / State/ZIP: The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total I ** Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 • DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder _ 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less f 80.30 0:30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts • 454.65 2 Reconnect only 66.85 2 City /State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that 1 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 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or ex tension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 ; 0 2 Business name: branch circuit . I B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 l �d gS 2 Address: first branch circuit / Each add'I branch circuit - 6.65 2 City/ State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal: 19 , 5 7 Suprv. Electrician signature, required: Plan review (25% of permit fee): . State surcharge (8% of permit fee): / 7, (D Print name: Date: TOTAL PERMIT FEE y rl , 00 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. 1:\ Building \Permits\ELC- PennitApp.doc 03/23/06 440- 4615T(1 I /05 /COM/WEB CITY OF TIGARD L.....-------..., • , MASTER PERMIT PERMIT #: MST2006 -00003 t . �i�fi DEVELOPMENT SERVICES DATE ISSUED: 2/16/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S125DA -00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 1,020 sf GARAGE: sf FRONT: PARKING SPACES 2 TYPE OF CONST: 5N DWELLING UNITS: 0 THIRD: sf RIGHT: OCCUPANCY GRP: R3 BDRM: BATH: VALUE: 1 TOTAL: 1,020 sf 94,248 00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: 2 WATER UNES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS AMYL INSPECTIONS 1000 SF OR LESS: 0 • 200 amp: 1 0 - 200 amp: 1 W /SVC OR FDR: 21 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 0 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401. 600 amp: EA ADDL BR CIR: 0 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 AREPJSPC 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: DATA/TELE COMM: NURSE CALLS: TOTALS SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other JAMIE MIKAMI GIRARD CONSTRUCTION applicable laws. All work will be done in accordance with approved 9955 SW 65TH AVE 10445 NW OLD CORNELIUS PASS plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, OR 97546 of issuance, or 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 Phone: 503 452 - 0312 Contact #: PRI 503 750 - 2514 of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Reg #: LIC 167078 TOTAL FEES: $ 1,860.30 • REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) Issued By : �., - ,%'; : .r l ;;f /_/ _--7 r te Permittee Signatu i (.e.. 1 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. Inspections Required for: MS 1 2006 -00003 - • .! 1 Code:..j , Inspection: Description ; . :..: . I PASS Date I By 1, MST - Master Permit 1 405 Excavation • 410 Fill `/ fA 415 Grading X 205 Footing L /t 5e D474 1 805 MFG - Structure grading/footing 210 Foundation walls 40 � / . 215 Footing drain j 305 Plumbing underslab 220 Slab �_� 310 Crawl drain 315 Post/beam plumbing 605 Post/beam mechanical 225 Post/beam structural 230 Underfloor insulation X 235 Shear walls /anchorsrj /t 0/Q c X 240 Exterior sheathing "; 44 3 X 242 Interior shear walls 5 u /6 &, 14 245 Firewall 250 Roof nailing 255 Wtr proofing basement walls 265 Masonry 270 Reinforcing steel (rebar) rX `320 - "Plumbing rough -in.. _ . yO 322 Shower pan / 4 lS 610 Gas line X 615 Mechanical rough -in -7 A At/14, 110 Temporary electrical service 4/7/06 115 Electrical service •$ •► • 0 6 G 1. 5.0e- — X 120 Electrical rough -in 1.11. O b GL..) r l X 135 , Low voltage Z b • 11. 0 64.-N) C,L v l , 910 Sprinkler rough -in �� _ . - X 275 Framing i./44/0 ( _ _ _ 810 MFG - Structure set -up 0 L C�0 is (35 = ?i X 280 Insulation ill/O4 C (`k4 t e � a-- t� 330 Water service 1 1 6 -v�.L nn 3 35 Rain drain ``-- L�.... c.�` %..rc."/ 340 Storm drain 505 Sanitary sewer b_ a �_ a–I? 2—/ 350 Septic tank S -31h \ 285 Drywall nailing C W o-0 �Z-e•+ ~' J 289 Approach/sidewalk 295 Misc. inspection: 899 MFG - Structure final 498 Grading final X 699 Mechanical final IP0 E X 399 Plumbing final u �t_�lkD X 199 Electrical final .- 77410 X 299 Final inspection 1: \Building', Inspection Cards \Forms \MST- InspCard- Blank.doc 12/09/2005 , CITY ®F TIGARD eiit MASTER PERMIT ( C PERMIT #: MST2006 -00003 ����,,` DEVELOPMENT SERVIC DATE ISSUED: 2/16/2006 AP---� I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S 125DA -00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 961 sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWEWNG UNITS: 0 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 961 sf 88,796.40 REAR PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: . HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL . RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 • 200 amp: 0 • 200 amp: W /SVC OR FOR: 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: 3 SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 801 • 1000 amp: 601 *amps•1000v: MINOR LABEL: o 1000* amp /volt : Q PLAN REVIEW SECTION Reconnect only: O >=4 RES UNITS: SVC /FDR> =225 A: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY E A. SF RESIDENTIAL B. COMMERCIAL 1 AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: • O BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: O GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: O HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Tigard 0 Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other JAMES MIKAMI EXECUTIVE CONSTRUCTION & REMODELIh applicable laws. All work will be done in accordance with approved IP 9955 SW 65TH AVE 10928 NE KILLINGSWORTH plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, OR 97220 of issuance, or 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 Phone: 503 452 - 0312 Contact #: FAX 503 762 - 1677 of these rules or direct questions to OUNC by calling 503 - 246 -6699 PRI 503 696 - 9509 or 1- 800 - 332 -2344. Reg #: LIC 119919 TOTAL FEES: $ 1,412.28 REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) Issued By : .i.:,.. / i c 'i .,.: , Permittee Signature : _���: „, c :. e. c 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. CITY TIGARD MECHANICAL PERMIT 4 DEVELOPMENT SERVICES PERMIT #: MEC2006 -00292 �r� I! DATE ISSUED: 6/29/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S125DA -00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Installation of woodburning stove. CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Owner: FEES JAMIE MIKAMI Description Date Amount 9955 SW 65TH AVE PORTLAND, OR 97219 [MECH] Permit Fee 61291200E $72.50 [TAX] 8% State Surcha 6/29/200€ $5.80 Total $78.30 Phone: 503- 452 -0312 Contractor: LUDEMAN'S FIREPLACE & PATIO 12675 SW BEAVERDAM RD BEAVERTON, OR 97005 -2129 REQUIRED ITEMS AND REPORTS Contact #: PM 503- 646 -6409 FAX 503- 646 -8034 Reg #: LIC 51469 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and 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 work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: , Permittee Signature: s_.e._, Call 503 - 639 -4175 by 7:00 a.m. for inspections 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. JUNv'.28.2006 11 :59AM 0.980 '.2/3 Mechanical Permit Application l t)l. ()I I I(I 1 SI, (.lMl.1 ` City of Tigard n aY:. % n • ,. , , - - ' Permii No‘ ' _ f e a Gl'4-9, 13125 SW Hall Blvd., Tigard, OR 97223 Pipe Review M Rao re ■ Phone: 503.639.4171 Fax: 503. 598. 1960Q C� P' +r [ns on Line: 503.639.4175 • u a c t r � ` N � ) m em A Y. ©s F1A P� V !,. r -[4.. I �_,, Date Ready/By: SI Se Page 2 for Internet: www.Cltigard.or.us Notified/ Me thod: Supplemental Information JUN 2 g 206 - ____ Tyra - • . r :: COMMERCIAL FEE* SCHEDULE - USE CHECKLIST - - • Mecbanitrol permit fet:s• are based on the value of the work 0 New Construction is A611. . @ai ant performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other. mechanical materials_ equipment, labor, overhead, and profit CATEGORY OF CONSTRUCTION Value S - 1and 2- family dwelling 0 Con m ercial/industrial RE9mI1lY1lAL EQUIPMENT J SYSTEMS FEES* ❑ Accessory building ❑ Multi - family ❑Master builder Pau special on use checklist 0 Other. _ Description JOB SITE INFORMATION AND LOCATION I Q�- I Bo. J Total Hcating/cooli� Job site address: 99$'6" 6.5 7 2V 4a .e. Ait conditioning or beat pump (requires sire plan showing placement) I4 -00 City/State/ZIP: �r f Al c 6, ie 9 7.2/ p Furnace 100.000 BTU (ducts/vents) (ducts/yew y � Furnace 100,000+ BTU (ducts/ve 17.90 Suite/bldg, /apt no.: I Project name: 2 )/ //�g Gas hcatpump 14.00 Cross street/directions to job site - Duct work - --14.00 Wydronic hot wow system 14.00 Residential boiler (radiator or ltydroniC) 14.00 - - - - Unit heaters (ftic1 -typo, not electric), in - wall, in-duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue/vent for env of above 10.00 Other. 1 10.00 Tax map /parcel no.: Other tai appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 ____07.574:?// -� GfOoe.0,are os �r 7• here kcG Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pcl[ot stove 10.00 . • Wood fireplace/insert / 10.00 /a. ad ChimncyAora /13ueJvent / 10.0 i e. e0 ( PROPERTY OWNER J 0 Tg'N Other. 10.00 Name: wC 4C cC A. 7 9! iee Av) Environmental exhaust and ventilation Address: 99 SCe J / $ I Range ham:/other kitchen - - e v �/E equipment 10.00 City /State /ZIP: ig, / ,, a/ o 9702/ 9 Clothes dryer exhaust 10.00 Single.duet exhaust (bathrooms. Phone: (5 03 358' 93 78 I Fax: ( ) toilet compartments, utility moms) - 6.80 V APPLICANT 0 CONTACT PERSON Attiderawll race fans 10.00 Other 10.00 Business name: e4. pepC 4 Q, Fuel Mptnkr. , Contact tee: G90,7/ ' " q � c A1r / S5.40 for first four; 51.00 for each additiona Address: /r3 eV 7 5' .04) aS GQdrrdo m Rc _ Ga Ga heat ee p pu:, mp - - L )P u City /StateJZ e'p yrr '7�r7 � �� � 7 odd WalVsttspeadcd/wuitaeater Phone: ( s0.3 ) 0f/6,., 6,5.49 Fax:: (Sea) C. Vdo - d'ta.3 7 WOO* heater E -mail: Fireplace Ran CONTRACTOR _ Barbecue - Business name: 4 M e. Clothes dryer (gas) Address: Other: MECHANICAL PERMIT TEES* City/State/Z1P: _ Subtotal aO DG 1 Phone: ( Minimum permit the (572.50) 7d.3C Fax: ) Plan review (25% of permit fee) 479/Cs, CCB lie.: ! Q - a 83 a- State surcharge harge (8% of permit fee) ,$' TOTAL PERMIT FEE 7 .30 I Authorized signature hue permit application infirm if a permit is not obtained within ISO l -� days offer it ban been accepted as complete. Pr CO /` ` C O I hate& Get. 06 I • fcc nexhodaiogyant by triCouaty Building indusay Service Board Or!i /- Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 1 • Fee for all residential systems combined ... $75.00 Check Type of Work Involved: El Audio and Stereo Systems* V • • El Burglar Alarm - • . El . Garage Door Opener* • El Heating, Ventilation and Air Conditioning System* • E l Vacuum Systems* • El Other. I COMMERCIAL WORK ONLY: i Fee for each commercial V - $75.00 system - (SEE OAR 918 -26Q, -260) • Check Type of Work Involved: ❑ Audio and Stereo Systems • El Boiler Controls ' ❑ Clock Systems ❑ Data Telecommunication Installation . • El Fire Alarm Installation ❑ HVAC • • • El Instrumentation ' El Intercom and Paging Systems ❑ . Landscape Irrigation Control* El Medical V El Nurse Calls • El Outdoor Landscape •Lighting* El Protective Signaling ❑ Other Total number of commercial systems: *No licenses are. required. Licenses. are required for all other installations 1:\ Building \Permits\ELC- PcmitApp.doc 03/23/06 V Barbara Butler - Fwd: RE: MST2006 -00003 Page 1 b 3(05 From: Gary Noble To: Barbara But er Date: 5/17/2006 7:12:01 AM Subject: Fwd: RE: MST2006 -00003 I must say, this is not of my doing. If this guy talked to an electrical inspector, it was Hap, not me. It would appear to me he needs about 17 branch circuits added to the branch circuits and the new 200 amp feeder on his permit. That's all I can see. If this guy Has more questions, please have him call me on the phone. I will talk to him. Gary Noble n " " ,,� 15 7 ,n��� LIP »> Barbara Butler 5/16/2006 4:58:39 PM »> -- -- Gary, I do not know what this man is saying regarding the elec. Can you please help? / _ Y� , Thanks, Barbara /6j1-(*4 »> "Mikami, Jamie" < imikami (c,columbiaforestproducts.com> 05/16 4:38 PM »> No problem. I actually have a list of changes now, so the fee will be much more. I will forward to you so that you can have a heads up before I come into the office. (I plan to stop by on Friday) The Elec inspector mentioned I neede to add a 0 -200 AMP ervice feeder and that I think it was the 1st W/O svc fee er that f dart' eed since I . am moving my existing box and getting a new box. I am not sure what the W/O svc feeder is, but please confirm that for me. He mentioned that we �.1 could swap some of that cost for additional branch circuits for removing „ �/ t f U the W/O svc feeder and that the service feeder might include some J J�/Y' circuits anyways. The total number of circuits I am adding to the new service feeder is: ` Arc 7 1) Heat Pump (220V 30 AMP) 2) Microwave (15 amp 110 V) WU/ cki 3) Additional Lights (15 amp 110V) 4) Garage 1 (20 amp 110V) t i i51 ri 5) Garage 2 (20 amp 110V) `2 ii 6) (20 amp / p 1 20 am 110V) I� \01 'r .�. �� a � 7) Outdoor 2 (20 amp 110V) I 8) Water Heater number 2 (220V 30 AMP) i � 9) Dryer Number 2 (220V 30 AMP) IV 10) Washer #2 - you mentioned as $7.18 (20 amp 110V) �• 11) Tub in master bath (15 amp 110V) 12) Floor heat in master bath (20 amp 110V) 13) Master Bedroom (20 amp 110V) 14) Master bathroom (20 amp 110V) f 4 `� /� 15) Master office (20 amp 110V) T L 1 �' v vet vL � 16) Family Room 1 (20 amp 110V) ,, , i /s 17) Family Room 2 (20 amp 110V) A:1, r I know that is a lot, but I was told that overwired is always better 2 than underwired. Can you please note these on my permit and let me know the total. _ tai" Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY - Received City of Tigard Permit No.: lig v 13125 SW Hall Blvd, Tigard, OR 97223 D an Review Plan Review Other Permit No.: Phone: 503.639.4171 Fax: 503.598.1960 Date/By. T I G n R D Inspection Line: 503.639.4175 Date Ready/By: fun' ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE • ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 _ JOB SITE INFORMATION AND LOCATION Site utilities Job site address: Catch basin or area drain 16.60 City /State /ZIP: Drywell, leach line, or trench drain 16.60 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: 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 . Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer / 16.60 /6. 6U Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 ub hower /shower pan / 16.60 H kt ) E -mail: Urinal 16.60 • CONTRACTOR Water closet 16.60 Business name: Water heater 16.60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 55,2G) CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) a.6 fp Authorized signature: TOTAL PERMIT FEE 86, 84, Print name: Date: I 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: \Building\ Permits\ PLMF- PermitApp.doc 04/06/06 440-4616T(I 0/02/COM/WEB) 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 - l 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 Valuation: Permit Fee: . Storm & Rain Drain - 1st 100' 55.00 $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 Back flow 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 each additional $100.00 or fraction thereof to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 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 Complex Structures Are you capping, adding or replacing fixtures? if "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 - D multipurpose fire sprinkler system. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley -Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i.\ Building \Permits\PLM- PennitApp.doc 07/06/05 Barbara Butler - RE: MST2006 -00003 Page 1 From: "Mikami, Jamie" < jmikami @columbiaforestproducts.com> To: "Barbara Butler" <BARBARA @tigard- or.gov> Date: 5/11/2006 12:41:07 PM Subject: RE: MST2006 -00003 I forgot to mention that I also had to move the existing faucet that was on the front deck; and the existing washer outlet. So both of those have have moved just slightly as well. I think that covers everything now. Sorry to run this at you 3 different times. Jamie Original Message From: Mikami, Jamie Sent: Thursday, May 11, 2006 9:49 AM To: 'Barbara Butler' Subject: RE: MST2006 -00003 Thank you Barbara. Just so we are clear on what is being added and what is in the permit, here is the list of what is going on. Does this match your list. 1) 2 Water heaters are being added (you just did that) I - And I -re should have been the following 5 items in the permit ..(7. / . /. AllanErDryer is being added in the 2nd story. -' 1 toilet is being added in the 2nd story k -11\:-/-61 6 :A 1 bathroom sink is being added in the 2nd story sho , - ith two shower heads is being added 5) 1 bathtub i. being added /6,4 X - 33,ao Jamie Mikami -TA-- bs Original Message From: Barbara Butler [mailto:BARBARA @tigard- or.gov] Sent: Thursday, May 11, 2006 9:25 AM To: Mikami, Jamie Subject: MST2006 -00003 I have added (2) water heaters to your permit. No additional fee. If you should add more fixtures, they would incur additional fees as the min. permit fee has been met. Thank you. Barbara Butler for Mike Sheehan Barbara Butler - RE: MST2006 -00003 Page 1 From: "Mikami, Jamie" < jmikami ©columbiaforestproducts.com> To: "Barbara Butler" <BARBARA©tigard-or.gov> Date: 5/11/2006 9:51:57 AM Subject: RE: MST2006 -00003 Thank you Barbara. Just so we are clear on what is being added and what is in the permit, here is the list of what is going on. Does this match your list. 1) 2 Water heaters are being added (you just did that) And-there should have been the following 5 items in the permit ... 1)'1 Washef /Dryer is being added in the 2nd story. •2) 1 toilet is being added in the 2nd story 3) 1 bathroom sink is being added in the 2nd story 4) 1 shower with two shower heads is being added 5) 1 bathtub is being added Jamie Mikami Original Message From: Barbara Butler [mailto:BARBARA @tigard- or.gov] Sent: Thursday, May 11, 2006 9:25 AM To: Mikami, Jamie Subject: MST2006 -00003 I have added (2) water heaters to your permit. No additional fee. If you should add more fixtures, they would incur additional fees as the min. permit fee has been met. Thank you. Barbara Butler for Mike Sheehan C ITY OF TIGARD MASTER PERMIT PERMIT #: MST2006 -00003 1 1� 't.i.A DEVELOP -639 -4171 DATE ISSUED: 2/16/2006 PARCEL: 1S125DA-00500 SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: 2nd story addition BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 961 sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 0 THIRD: sf RIGHT: VALUE: 8 8,796.40 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 961 sf REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 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: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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: 3 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: > 800 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: W / O I', V , e.g This permit is subject to the regulations contained in the 1 igard Municipal Code, State of OR. Specialty Codes and all other JAMES MIKAMI EXECUT E NSTRUCTION & REMODELII• applicable laws. All work will be done in accordance with approved 9955 SW 65TH AVE 10928 NE INGSWORTH plans. This permit will expire if work is not started within 180 days PORTLAND, OR 97219 PORTLAND, 97220 of issuance, or 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 Phone: 503 452 - 0312 Contact #: FAX 503 762 - 1677 of these rules or direct questions to OUNC by calling 503 - 246 -6699 PRI 503 - 696 - 9509 or 1- 800 - 332 -2344. Reg #: LIC 119919 TOTAL FEES: $ 1,412.28 REQUIRED ITEMS AND REPORTS Bolts in concrete Special inspection (see plans) Issued By :172 /4 c1'. Permittee Signature : _ .e, P1,0• Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. I 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. Building Permit ADDIic_ rIVE,® FOR OFFICE: USE ONI.Y City of Tigard �� o i By. i 3 0 � W67A _d 3 Perm No.: 13125 SW Hall Blvd., Tigard, OR 97223 � Plan Revie Phone: 503.639.4171 Fax: 503.598.1960J A .. U ' . AA I '�' Date/By.. /l/1 V 9 - /(� - Other Permit: Inspection Line: 503.639.4175 _ ' _I_I „ Date Ready/By: _ luris El See Attached Checklist for Internet: www.ci.tigard.or.us G , rY G G T�IG SON Notified/Metho� 'd � �, Supplemental Information evil rnN N e lm. 0 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. Indicate the value (rounded to the nearest dollar) of all q [ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application 15S,714 Valuation: $ 14 1- and 2- famtiy dwelling ❑ Commercial /industrial 'a� -- ❑ Accessory building ❑ Multi - family Number of bedrooms: 1:1 Master builder ❑ Other: Number of bathrooms: C JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: ! s e k New dwelling area: ,ia C? /square feet City /State /ZIP: c9e• iltti ) e ) / Garage /carport area: -3— square feet Suite/bldg. /apt. no.: Pr6ject name: ),-, , 111d `4--t , Covered porch area: square feet Cross street /directions to job site: Deck area: , IX, 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. Valuation: $ / Existing building area: square feet New building area: square feet 151 OWNER I ❑ TENANT Number of stories: Name: , /1/ t k ,' v � Type of construction: Address: A Occupancy groups: City /State /ZIP: 5 '44 Existing: Phone: ( 505) L1 ) — b 3 J) Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: 1` ' c L 4. ,,e_ (1)r 4...L. r > „„ti All contractors and subcontractors are required to be Contact name: /` . 5 ��� 7- l [- — % . q / 2 - ) licensed with the Oregon Construction Contractors Board 1 under ORS 701 and may be required to be licensed in the Address: /09./ 8 NE /Kt I1 i S jurisdiction in which work is being performed. If the City /State /ZIP: ��, '� /� v ►/I 4�y ��� applicant is exempt from licensing, the following reasons / /`) ` - . 1 ,� — apply: Phone: • g 19y ���✓ J L� Fax: : ( 505) ) - /6 *7 7 E -mail: CONTRACTOR . Business name: v v 1- 1 ,, C_,,,� BUILDING PERMIT FEES* Address: /0 C/ 2 8 /14 k. /y, i..„,,,r Please refer to fee schedule. City /State/ZIP: ,.} i,_A alt. G 7 1..)-C, ,�[ 'c° 1 _ 1 Fees due upon application /(' Phone ''3 eft- yS 07 (S03) 7 4, 1 - /6 77 CCB lic.: i i eiCif Amount received Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: / /2 lob * Fee methodology set by Tri- County Building Industry / Service Board. i:\Building\Pertnits\B - PemtitApp.doc 03 g 1/ 19 440 -4613T(I I /02/COM/WEB) One- and Two - Family Dwelling Building Permit Application Checklist FOR 01.FICF USE ()NL1, City of Tigard Received `1 Date Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 �I I ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us ❑ Other. THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ 0 ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 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- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state El ❑ ❑ 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ and location. 13 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. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ 0 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- ❑ ❑ ❑ 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ over 10 feet long and/or any beam /joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ 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 ❑ , , ❑ ❑ architect licensed in Ore • on and shall be shown to be ...livable to the sro'ect under review. - .IURISDIC'FION/ \L_. SI'L_CIFICS 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 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be 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. ❑ ❑ 0 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. I:\Building\Permits\BUP -RES- PermitApp.doc 2 11 Building Fixtures Plumbing Permit Applicatio � E® City of Tigard ' and Ct Receied 1� `J �+ Dd v rJB y. I / 0 �Q Permit No.: - moo 3 13125 SW Hall Blvd., Tigard, OR 52E3 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 r. n ')(16 //4r ;, _ I ,I Date/By. Other Permit No.: 24- Hour Inspection Line: 503.639.4175 f\ • J ' �I �„ ___, Date Ready/By: ' - El See Page 2 for T Internet: www.ci.tigard.or.us , nF IGAR Notified/Method 11C• Supplemental Information TYPO(I VvQRIDNIS' FEE* SCHEDULE bi';�, ❑ ❑ Ne construction D emolition For ecial information use checklist Description I Qty. I Ea. I Total Addition /alteration/replacement ❑ Other: New 1 - 2 - f= wellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION ` ' :711 1- and 2- family 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 INFORMATION AND LOCATION Site utilities Job site address: 9 9 s 5 . t) G 3 ,} -vC... Catch basin or area drain 16.60 City /State /ZIP: per a yys et CS _ 9 7 - I 'I . Drywell, leach line, or trench drain 16.60 / '/ Footing drain (no. linear ft.: ) Page 2 Suit /bldg. apt. no.: b L , I Project name: / "I / / 0 Manufactured home utilities 110.00 Cross et /directions to jo nn 1_. site: 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 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 ^ Backwater valve 16.60 Clothes washer I 16.60 Dishwasher 16.60 tf Drinking fountain 16.60 PROPERTY OWNER. I ❑TENANT Ejectors/sump 16.60 Name: ] c,xe5 M , fr! / Expansion tank 16.60 Address: 9 5 S 3 t 74 Fixture/sewer cap 16.60 City /State/ZIP: POie rR ry v J / - 9 7 02 / I . Floor drain/floor sink/hub 16.60 Phone: 663 ) 4! ,..5 -. 0 3 /j . Fax: ( ) 144- . Garbage disposal 16.60 ,APPLICANT ❑ CONTACT ..PE Hose bib 16.60 Ice maker 16.60 �_�� n n Q Business name: (lil g/)7l J i'r R Gi AJIX 111 lM Interceptor /grease trap 16.60 Contact name: i3c�) `f Medical gas (value: $ ) Page 2 Address: ) O , / G3 fJJ' C ` - St Primer 16.60 City /State/ZIP: / P R 7 V 7 o Roof drain (commercial) 16.60 Phone-i41-71 Q Fax: ( 7 6 - l6 7 7 Sink/basin/lavatory 1 16.60 e 4L Tub /shower /shower pan 1 16.60 _ E -mail: Urinal 16.60 CONTRACTOR Water closet I 16.60 Business name: 0E. „) ,� 4. N Water heater 16.60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 , Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: I Date: 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:\ Building \Permius\PLMF- PermitApp.doc 06/05 4404616T(10/02/COM/WEB) 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $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 Back flow 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 Complex Structures Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity_ by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 - D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor p Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: _ plumbing permit can be issued. i:\ Building \Pennits\PLM- PermitApp.doc 07/06/05 Tr a io�� \IE I Electrical Permit A rOR OFFICE ('SEONLY City of Tigard � - / T� 2 OO Date/B . 1/704 Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 I A1 o Plan Review Phone: 503.639.4171 Fax: 503.598.1960 A. ` I `., Date/B . Other Permit: Inspection Line: 503.639.4175 CITY OF TIGABD 4 :..i p - ! __„ Date Ready/By: >1. VI See Page 2 for Internet: www.ci.tigard.or.us RIJILDING DIVISI� t' Notified/Method: / /Ca Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ddition/alteration/replacement Please check all that apply: El Demolition 12 Other: ['Service over 225 amps, com'l ❑Hazardous location OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential I- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories 0 Feeders, 400 amps or more ['Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION UlEgress/lighting plan RV park Job no.: Job site address: ! 75 j, (Ai 6 4-(f-c, ❑Health -care facility ❑der: Submit 2 sets of plans with any of the above. City /State/ZIP: Pop - D / 07X — 9 -7.2 I - The above are not applicable to temporary construction service. A r le n L FEE* SCHEDULE Suite/bldg /apt no.: Project name: ` � ]ir'1/' ppe,;ption 1 Qty. I Fee. I Total Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less I 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion / 33.40 1 Limited energy, residential I 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 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 . 401 amps to 600 amps 160.60 2 Name: •Ifil Ng (e Z — 601 amps to 1,000 amps 240.60 2 Address: 99 s oh) j (/� Over 1,000 amps or volts 454.65 2 y 1(' - � 1 Reconnect only 66.85 2 Cit /State/ZlP: P,o 21 � � r F � relocation amps Phone: (�� 3) 4-3—.2 -0 2 - D___ Fax: ( ) 200 00 amps or less 66.85 1 Owner installation: This installation is being made on property le yei--- 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 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ,PPLICANT II ❑ CONTACT PERSON A. Fee for branch circuits with C c Pi - keilt -e eve branch or feeder fee, each Business name: 6.65 2 ���t c J branch circuit � � B. w ee o ur se v cir f e d Contact name: �{ without service or feeder fee, 46.85 2 Address: / o 9 o k_g Ate K " At--. first branch circuit Each add'I branch circuit '5 6.65 2 City /State/ZIP: flQ_ 4 - 9 __ Miscellaneous (service or feeder not included) - Pho^ ' ` [. Fax: ; (�3) 7 _ Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: Investigation per hour (I hr min) 62.50 Industrial plant per hour 73.75 Phone: ( ) Fax: ( ) ELECTRICAL PERMIT FEES* CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date:. • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. i:\ Building Wenni6\ELC- PennitApp.doc 12/03 4404615T(I0/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: itESIDErrrIAL WORIZ 0"NLY: - -- -- —, 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: 1 COMMERCIAL WORK ONLY: Fee for each" commercial system $75.00 (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 ❑ Instrumentation ❑ Intercom and Paging Systems • ❑ Landscape Irrigation Control* • ❑ Medical ❑ Nurse Calls ' ❑ Outdoor Landscape Lighting *. ❑ Protective Signaling ❑' Other f. Total number of commercial systems: *No `licenses .are required. Licenses are required for all other installations is Building \Permits\ELC- PamitApp.doc 04/03 . Mechanical Permit-Application icat onr FOR OFFICE USE oNLI City of Tigard � ® IL _41.4... N p iRevBy id. ►) Permit No.: L— 13125 SW Hall Blvd., Tigard, OR 97223 © -' -,4_ �� lan Phone: 503.639.4171 Fax: 503.598.1960' +. i, C� 41 P ., Other Permit: . Inspection Line: 503.639.4175 � rx ' ` . � 20 1) ' i Date/By. ='I� Date Ready/By: ® See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: liN Supplemental Information RIM nlN►G nluiSlON • T OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition Cher: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES' ❑ Multi - family 0 Master builder For special information use checklist. ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling �L Job site address: 7 5-5 G S q u P Air conditioning or heat pump (requires site plan showing placement) 14.00 City /State/ZIP: P6R 0 b - C / l • Furnace 100,000 BTU ( ducts/vents) 14.00 A ^ Furnace 100,000+ BTU (ducts/vents) 17.90 Suit Idg. /a�3t. no.: La V Project name: Al L Gas heat pump 14.00 a Cross street /directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue/vent 10.00 PROPERTY OWNER I ❑TENANT Other: 10.00 Name: �� M f p � 1 •i Environmental exhaust and ventilation l� l.L /�,, �� l— Range hood/other kitchen q Address: ! S S t t.J 6,.,,s-- .24 equipment 10.00 City /State /ZIP: p v-7 6 • _ a) `� Clothes dryer exhaust 10.00 !l ! Q '7 Single -duct exhaust (bathrooms, Phone: (5o7J) 4 S a — O 3 ( Fax: ( ) �/741 I toilet compartments, utility rooms) _ 6.80 ❑ APPLICANT ❑ CONT CCT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: _ ( gyp Fuel pip Contact name: � 'u ,, � —_ /` /�� ' / Q � (/f �f — - $5.40 for first four; $1.00 for each additional Address: / o ? a GP ccia C - Q/ t Furnace etc. /" Gas heat pump City /State /ZIP: PAf2 rarA-A ` p / _ 7 2 - 0 Wall /suspended/unit heater Phone Fax: : (50S ) 76 G z - / 6 '7 17 Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES" City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: permit application expires if a permit is not obtained within 180 ,.• days after it has been accepted as complete. Print name: 4 M/ / Date: l ff j • Fee methodology set by Tri County Building Industry Service Board i:\Building\Permits \NEC - PermitApp.doc 12/03 440 -4617T (I1 /07JCOM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information - Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 • Minimum fee $72.50. . $2,001.00 to $5,000.00 $72.50 fir the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. • $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00: . $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or . fraction thereof, to and. including . $50,000.00.. . V $50,001.00 to $100;000.00: $771:50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including • $100;000.00. $100,000.01 and up $1,396.50 for. the first $100,000.00 and .$1.10 for each additional $100.00 or fraction thereof. V Note: All new commercial buildings require 2 sets of plans. V V • • • • • • • i:\ Building \Perrnits\MEC- PermitApp.doc 12/03 2 • , ( 4 ,,,, 541 CITY OF TIGARD RESIDENTIAL PERMIT APPLICATION REVIEW GREGON Permit Number M _.(ryQ3 Lot No. i nane Subdivision Address y9$3 $W `s** A ttM** 97As, Contact Name ‘kt Business CkLcv►'raVt Cb'$'r. . Street ADIPZ g .: kar lt. :A/as wt N r City muw,vtf I state I bQ .I Zip I ' ) ,e' • As required by the 1999 Legislative action (Senate Bill 587), your residential permit • application and plans have been reviewed to determine if it is complete and if the plans are deemed "imple" or "complex" as defined in ORS 455.467 and 455.469. The application is complete. The application is incomplete for the following reason: $EAM CALLS • The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and/or approved. The submitted plans cannot be reviewed until.the above information has been submitted and/or approved. • The plans are deemed "simple ". The plans are deemed "complex ". If you have any questions, please call Chad Williams at (503) 718 -2708. MAC/ 1 3 — Name of Plans Reviewer Date . .131.25 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772 Permit #: H 427--9-000P - ooco 3 Address: 9955 bW 1 4 t' q Issued by: ,, , , . ,,, ,., Date: ca‘LikAle 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 he filed with the permit. Fill in the appropriate blanks andririitfaTboxes_I and. , and either box 3A ors ), . I own, reside in, or will reside in the completed structure. ,,,, V1,„-2 - . I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (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 Construction Responsibilities on the reverse side of this form. permit 3 1 7 - L ( CS`' 6, (Signature of p app icant) (Date) (White copy to issuing agency permit file, pink copy to applicant) dliufc Imat on 'Not ce to Propel y Owners About y Construction -?� s ; s r C '^ ,� �;JC�i� iii,.�;.h • Note: This Jnformootion Not/cc' to Property Owners about Construction Responsibilities lye's developed by he Construction Contractors Bo(ir.d 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 RESPONSIBILITIES: 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 he 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 ifyou 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 Department at 378 -3524. Workers' compensation snnstarannnce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. Ifyou fail to obtain workers' compensation insurance, you May be subject to penalties and will be liable for all claim costs it'oneofyouremployees 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 Revenue Service: As an employer, von must withhold federal income tax from employees' wages. You will be liable for the tax payment even i f you didn't actually withhold the tax. For more in ormation. call the Internal Revenue Service at 1 -800- 829 -1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the perm it holder for this project, you are responsible For resolvinganv fai iure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see ifyou have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, tire, 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. I fyou have additional questions, write or call the Construction Contractors Board (P0 Box 14140, Salem, OR 97309-5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. pro p- own.pr4 1/94 , • ArTidemark Advantage [BarbaraAutler.T.B1:11 ' • - ' - r _1611X1 File Edit Options Window Help 0-4 0 0 1:21 ttili d Exit New Open Task List OBE GIS E3 2 In e a 1 ;1;1 0 ffgi V4P , ` CI ral Ci i Close Edit Project Group Add Clone Parcel Activity People Fee: Valuation Condition.; Cate Note.; Tag:. Document:. GIS Case Master Permit -- MST2006710,4173. CqgiD`32 ! _ 101 1 Name:JAMIE MIKAMI Updated: 5/11/2006 BB Geheral 1 — ----- Address:09955 SW 65TH AVE Jur: TIG Description: Master #IMST2006-00003 Project: IMIKAMI Building 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. Mechanical ,____. Plumbing Sinks: fl Floor Drains: I Backflow Drains: E Lavatories: F1 Water Heaters: F3 ;' Traps: T Electrical Tub/Showers: J 1 Laundry Trays: n Catch Basins: r _____...____. Water Closets: [7 Sewer Line: 1 T ---- Grease Traps: Electrical Dishwashers: E Water Line: 1 ----- Other Fixtures: r Garbage Disposals: E. Rain Drain: 1 _ Restricted _ ._.. Elecrical . Washing Machines: [ SF Rain Drains: F 'Residential . ..1 I I I 11 • • i Ready 4: Start! Ila Tidemark Advantage ... « 0 o 4:35 PM ..„ , / e._4_ ) -: 0.-- .,L ..' CITY OF TIGARD - SITE PLAN RI' v Ii N% 1 , i .. , •---- ■ BUILDING PERMIT NO.:\, 9,41, -,,,, * ' L PLANNING DIVISION: ,..... Required Setbacks: 04 Approved 0 Not Appro‘ et! Side: 5— Street Side: .2........ ....,;.. ',I ..Y L. ; , , - .., .1 From 4211_ Garage: .. 0 Rear: 4- Visual Clearance: ErApproved 0 Not Approved Vlaxinium Building Height .3a feet CWS Service Provider Letter Required: 0 Yes Crirlo i 0 • Recsived • 4 ' f %kcal' . 1.- N Date: .._., l ENGINEERIN DEPARTMENT: Actual Slope:_% 0 Approved 0 Not Approved Rr Site Plan: ErNpproved 0 Not Approved B _:„. I Date: MAY 2 6 2006 Cl ')1 OF flulAis,L Bijj.,,fliNir 72'. TTQ01\ .4 Allik _I r i gl ii i i lo ,..„ . . , -..........- a. ' 11 11.0111 1 ............. . I - , 1\119 1 . . 'illir all - V I 4 - - - -- _ - - k I I i I - - - ------- - - _ - 11 r v*-6' 4 +! .4... 1 11 , . MN . • .*: : '.. LI .. ' ' I .4 e ' ", . 4f 44 1 i i , • ii1111111111 MIMI= „ mom # :Ft I / 11111.11111111 r, : room k i MP i mon .,, v.— 1 — ommo I I II Al L . ............-......... ... OM. - - ... . A .'!, - ftl i Vir 41,1 - .. .. , O , . 111111111111111 '' / ! LI 11.- I I .,. ' IWISTON 15 Feet to Edge of Deck 21' 4" to Edge of Garage CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200G -00003 13125 SW Hall Blvd:, Tigard, OR 97223 DATE ISSUED: 2/16/700$ Phone: (503) 639 -4171 i Inspection Requests (24 Hrs.): (503) 639 -4175 ZilliV . INSPECTION WORKSHEET FOR DATE: 8/9/2006 TIME: 7 PAGE: 5 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: 1 SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5/06 OWNER: MIKAMI, JAMIE PHONE #: 5034. - 0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503-750-2514 Inspection Request Scheduled For: Date: 8/9/2006 Pour Time: Code # Inspection Description Confirm # tact # Message 322 Shower pan 034665-01 503 -490 -3970 Y Corrections /Comments /Instructions: I /'►i \ Z �. - - w - _Ai_ �/ . %r c -4. / OP ,. I �i' � 0 — PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: - 77K ° Date: . / •/ Phone #: (503) 718 - -24( CITY OF TIGARD BUILDING DIVISION • PERMIT #: MST2006 00003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1612006 Phone: (503) 639 -4171 Vit Inspection Requests (24 Hrs.): (503) 639 -4175 s .. INSPECTION WORKSHEET FOR DATE: 8/8/2006 TIME 7:06AM PAGE: 1 :i SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/2812006: Added (1) 200 amp Temp Service. 5111/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5/06 OWNER: MIKAMI, JAMIE PHONE #: 503.452- 0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 -750 -2514 Inspection Request Scheduled For: Date: 8/812006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 034581 -01 503 -490 -3970 N Corrections /Comments /Instructions: / le /_ _ ��,,,_ _ _ . ._ 9 , . - -- /� /. /JS //� .I _. _ - /_i ../ Ale i r ' 'idPi i '/. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 ! v ' Dater 64 Phone #: (503) 718- a 13/ CITY OF TIGARD il • BUILDING DIVISION PERMIT #: MST20(J6 -00003 '.I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1612006 Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 :� ' I � .. INSPECTION WORKSHEET FOR DATE: 8/1/2006 TIME: 7 :02AM PAGE: 1 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26107, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6006 OWNER: MIKAMI, JAMIE PHONE #: 503 -452 -0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 - 750.7514 Inspection Request Scheduled For: Date: 8/1/2006 Pour Time: Code # Ins. - on Description Confirm # Contact # Message 115 Electrical service 034186-01 501 -490 -3970 V Corrections /Comments /Instructions: ---V; ON 5.) \ p -r A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G • (N OQ Le • Date: 8 • 1 ' O 4 Phone #: (503) 718 - 2.44 MP • r 1 _ _ i . __:, z' ! - ----= , '--J-- I :" 7' 1 i I 1 I ; I ‘,.. ..< >.) ... 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DR I , I I I r ; I i 1,, I 1 I _ -1 :- - - . • . 1 \&) -4-L Cjt) t L- ` 1)‘Ckri Z-40 el° 2 \16-zr"\ 132Ly - 0 efo , CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006- 001)03 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2//612006 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/11/2006 TIME: 7:00AM PAGE: 8 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/26/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5106 OWNER: MIKAMI, JAMIE PHONE #: 503 - 452 - 0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503-750-2614 Inspection Request Scheduled For: Date: 7/11/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 115 Electrical service 032919-01 503-490 -3970 N Corrections /Comments /Instructions: PKovti c> 'i g6 t ` C� cl4Z. wg ftonfN. 6`12 , EvA6 AL, c zobv 0(x.5 "l ax) ® s - v c t � ( �N c . C-r30 0 c` ' m(LS '1 o ze (N.) k r,ac./116,14 ---- ezri-NOUNCA ‘21.b ❑ PASS S rA nTIAL Ar'PROVAL ❑ CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v ' 1\ Date: J I I ok) Phone #: (503) 718- 24(1.4 CITY OF TIGARD BUILDING DIVISION PERMIT #: M Sf2006 -00003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1612006 Phone: (503) 639 -4171 �A Inspection Requests (24 Hrs.): (503) 639- 4175 INSPECTION WORKSHEET FOR DATE: 7f11/2006 TIME: 7:00AM PAGE: 1 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3128 /2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5/06 OWNER: MIKAMI, JAMIE PHONE #: 503- 4510312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 - 7!i0 - 2514 Inspection Request Scheduled For: Date: 7/11/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 032919.02 503 -490 -3970 N Corrections /Comments /Instructions: �(•\ p(L 1 0 :, 1-061 R Qi -IN) aN 5 u G� dalb EL-c-.1 c PASS - El — PARTIAL APPROVAL El CANCEL El NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED c Inspector: �' N66 ' Date: 91 6i 66 Phone #: (503) 718-144C • • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200( -00003 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2//6/2006 Phone: (503) 639 -4171 ili Inspection Requests (24 Hrs.): (503) 639 -4175 -__.. INSPECTION WORKSHEET FOR DATE: 7/11/2006 TIME: 7:00AM PAGE: 6 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 312612006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5/06 OWNER: MIKAMI, JAMIE PHONE #: 503"452 -0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503'754'2514 Inspection Request Scheduled For: Date: 7/11/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 032919 -03 503 -490 -3970 Y Corrections /Comments /Instructions: K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 \/66 Date: 1 l I 0 Phone #: (503) 718- VILA CITY OF TIGARD BUILDING DIVISION PERMIT #: KIM-2006-000M 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2//612006 Phone: (503) 639 -4171 • Inspection Requests (24 Hrs.): (503) 639 -4175 ...'ill.. INSPECTION WORKSHEET FOR DATE: 615/2006 TIME: 7 :02AM PAGE: 10 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/28 /2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26107, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. OWNER: MIKAMI, JAMIE PHONE #: 503 -452 -0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503760 -2514 Inspection Request Scheduled For: Date: 6/5/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 03110E -01 503-490-3970 N Corrections /Comments /Instructions: Q c-bmaP L. AL-I-- s) 01\0 6(t-0011,5 `Ill 1(J a Li t 1 AIN Pact. Iftti F.(L. "Nor •Lk `P.V ./504b S su m w, Q. i T OA,C, U �C . I C3� (st a,Lk...., �' Qo S p.,6 0 \< c.:■1,)- isT Vk 016 3 v.-Ns• Ph 110.2 ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS Xq FAIL X] CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G Ni be ` Date: 6 '6 O C Phone #: (503) 718 - 2-'INC CITY OF TIGARD 0 B c ^ r r BUILDING _ U ING DIVISI PERMIT #: ;�,.,; ��;,.,�,:?^,,,; 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ;yJ1e Phone: (503) 639 -4171 igagp • Inspection Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: (/;/7('QS TIME: 7 :O3AtyM PAGE: 3 . SITE ADDRESS: Q;95, Sit €1511-I AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MI IKAN DESCRIPTION: 1tt , t.ory addition. ':.'42)3000:,:i: Atid ,;' ( ) 200 :?inpr Sv.•tvic E411106 (d (2) viztes i n 4 f.:12( 117, `d <.:!inq (1) 200 ,'.ira;p `.°ico 13.', (17 m c;r0 br rsdi cif[ ;�.:il . (i) cla_ tees w 'u.- iiC•'-r <I. (1 ) tub. OWNER: MIK#.MI, _A MR PHONE #: S03 CONTRACTOR: C,IRARC) 0ON TRUt: - ;ION PHONE #: 103.150 - i•1 • Inspection Request Scheduled For: Date: 6.1 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 • tfi%.; s? fou ji -ir 030! 39.0 1 603490-3910 Y • Corrections/Comments/Instructions: • QrobU • C kept/ '3 x F a (v uMi3t V6� cN ® t &s Aso 1:1() IcT PA el 0 kria) ogi 0 0 c s, .w t kuL —x NT , is . 6F ..6 cod S Q s. Vg(v1 1'■1\ 41 c,E (B Ns 6n" . Q • k 0611^1 6 •RLg AO MV. O U S I -"C ❑ PASS ❑ PARTIAL APPROVAL ❑; CANCEL ❑ NO ACCESS FAIL • XCALL FOR INSPECTION ❑ ADDITIONAL. FEES ASSESSED • Inspector: • ° ' , " O " ` "" D ate: v � ` I �Q 6 Phone #: (503) 718 -Zg Cicuit Layout - MST 2006 -00003 I Cicuit Position Existing Amps Volts Notes Cicuit Position Existing Amps Volts Notes *Furnance 1 Rewired 60 220 New Unit *WH 1st 21 Rewired 30 220 New Unit *Furnance 2 Rewired 60 220 *WH 1st 22 Rewired 30 220 *Furnance 3 Rewired 30 220' *WH 2nd 23 New 30 220 New Unit *Furnance 4 Rewired 30 220 *WH 2nd 24 New 30 220 *Heat Pump 5 New 30 220 New Unit *Dryer 1st 25 Rewired 30 220 Moved location *Heat Pump 6 New 30 220 *Dryer 1st 26 Rewired 30 220 *Range 7 Rewired So *36" 220 Rewired *Dryer 2nd 27 New 30 220 New Unit *Range 8 Rewired �• tr 220 *Dryer 2nd 28 New 30 220 • *Microwave 9 New 15 110 Broke out of kitchen (old wiring) *Washer 1st 29 Rewired 20 110 Moved location Refrigerator 10 Existing 20 110 Also Basment light *Washer 2nd 30 New 20 110 New Unit Dishwasher 11 Existing 20 110 Floor light? *SpaTub 31 New 15 110 2nd Story Bath . Kitchen 1 12 Existing 20 110 Includes SD *FloorHeat 32 New 15 110 2nd Story Bath Kitchen 2 13 Existing 15 110 Floor light? Master Bath 33 New 20 110 Art Lights 14 New 15 110 Master Bed 34 New 20 110 New LivingRoom /ROF 15 Existing 15 110 (Removed Garage /Microwave) Master Office 35 New 20 110 New Bathroom /Master 16 Existing 15 110 Includes Hall /Entry FamilyRoom N 36 New 20 110 Includes Patio Light Bedrooms 17 Existing 15 110 1st Story FamilyRoom S 37 New 20 110 Includes Deck Garage Tool r 18 New 20 ,. 20 110 N Outdoor Pon 38 New 2 110 Garage €mil liA,1 44 19 Ni .261, 110 an INCL 'Sc. Y 39 110 Outdoor xmas 20 New 15 110 jJd l { . > 40 \ tJ 9,P 110 *Dedicated Circuits 1 t .. it CI e f 0 15 AMP singe I I 6 $ 54 20 AMP Single Al I, 3 8 $ 52 30 AMP double 7 14 8 $ 56 60 AMP Double 1 2 12 $ 12 Total 0 l O $174 t 2 C ' C 0 3 - C � Existing 13 18 l.. New 17 20 Tt ` 'S ;tcl eh L ��S r � CITY OF TIGARD tad OA ��� � y BUILDING DIVISION PERMIT #:IfV(�D�� 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 "It .. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: R - ! (, A Q � • CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: n �+ OWNER: �/ PHONE #�SUi3) 4O – 35 CONTRACTOR: �rvi f 0' ���IKA PHONE #: Inspection Request Scheduled For: Date: 4 7 —o cl. Pour Time: Code # Inspection Description Confirm # Contact # Message 1 /5 S tom c–CL Corrections /Comments /Instructions: 7 KPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS / ❑ FAIL ❑ C LL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: Date: 41'11060 Phone #: (503) 71820/ 0 .- CITY OF TIGARD ` BUILDING DIVISION PERMIT #: MST20O&.O0003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1 Phone: (503) 639 -4171 A ,--- - Inspection Requests (24 Hrs.): (503) 639 -4175 ' °'I 11 .. INSPECTION WORKSHEET FOR DATE: 8/11/2006 TIME: 7:06AM PAGE: 13 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd gory addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/2&07, A +' i • 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tuna. 6/5/t16 OWNER: MIKA ,r_ PHONE #: 503 -4a'2- 0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503.750 - 2.514 Inspection Request Scheduled For: Date: 81'1'1 /2006 i Pour Time: Code # Inspection Description Confirm # Contact # M: sage ( 280 Insulation 034835-01 503 - 400 -3970 Y Corrections /Comments /Instru tjns: aim, ■ Q j 0 .A...A..):4- Ck t -i-t--(0 S (2)-7) ,e mss. el.,-:,, C_-,r ■k3 ew S n .:1 T N) 10 --- T -- U--( Ots\Ni9Jc --- ( j( --A - --7. ZC .gS4..__Q -- k --- =6--0-_,A__ . Mir jillffIll IV PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED � k a 42._ Inspector: 1V/ Date: / �° Phone #: (503) 718 -� y . . . _ CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST200&- 00003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/16/2006 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 `__ INSPECTION WORKSHEET FOR DATE: 8/4/2006 TIME: 7:04AM PAGE: 6 SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: !VIIKAMI DESCRIPTION: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26107, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5/06 OWNER: MIKAMI, JAMIE PHONE #: 5O3 -462 -0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 -750 -2514 Inspection Request Scheduled For: Date: 8/4/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 034415-01 503 - 490.3970 N Corrections /Comments /Instructions: ( 3 ( F-RA P e b (R ) • Lbw pEKT Tc3 c4 , NW C -- (t3(4,.5 ,6V--- l S or p._ . ill f Jr .- .... mb > —� W / VI ' . - VW , 'W, *Os ' rl ;.o ❑ PASS ' ' " ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL I I CA FOR INSPECTION ❑ ADDIT ONAL FEES ASSESSED vw, /�/ y Inspector:` /�� Date: ) ' ^P Phone #: (503) 718- 2,12Z.-27 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006 -00003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2 Phone: (503) 639 -4171 AV I Inspection Requests (24 Hrs.): (503) 639 -4175 _ -' q 1I I.. INSPECTION WORKSHEET FOR DATE: 7111/2006 TIME: 7:00AM PAGE: h SITE ADDRESS: 09955 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/28/2006: Added (1) 200 amp Temp Service. 5/11/06 add (2) water heaters. 5/26/07, Adding (1) 200 amp service & (17 more) branch circuits, (1) clothes washer & (1) tub. 6/5106 OWNER: MIKAMI JAMIE PHONE #: 503452 - 0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 - 750.2614 Inspection Request Scheduled For: Date: 7/11/2006 Pour Time: a Code # Inspection Description Confirm # Contact # i - ssage 615 Mechanical rough -in 032919 -04 503 - 490 -3970 Y - P 4telA Corrections /Comments /Instructions: _ ..,L.._c a- ‘ A ., , - e - P ..._ &A . A .A....... * ..11 &_it. C v \ ce..�,� el- CA-c---- .. u ..A9-1 .) . , .: _ - ArIMEIMMIlla ,_ Z .,/,„,id ,-,,\ C . • r/, P' SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS A FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: _ Date: 7 /‘ ' / ' Phone #: (503) 718- Z(f Z 'CITY OF TIGARD ' ' ..,,, BUILDING DIVISION P ERMIT #: WiS : ?.006- 00iIL?,3 13125 SW Hall Blvd., Tigard, OR 97223 a.,.-- ..� DATE ISSUED: . ?l16")0 Phone: (503) 639 -4171 A � T� li � ' Inspection Requests (24 Hrs.): (503) 639 -4175 R !�i __.. INSPECTION WORKSHEET FOR DATE: 7 / 2006 TIME: ' 7:00A(b1 PAGE: 17 • SITE ADDRESS: 09985 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story! accdit.iort. 3/28/2006: Added (1) '.10 amp Tamp Scr . cep. 5/11/06 add (2) water heaters. 5/26!07, Addin5l (1) 200 amp se; Lice & 17 ore) branc i circuits, (1) clothes vttasher & (1) tub. 615106 OWNER: IvIIKAMI, JAMIE PHONE #: 503 - 452 -0312 CONTRACTOR: GIRARD CONSTRUCTIOc' PHONE #: 503 -750 2514 Inspection Request Scheduled For: D. e: 7/11/2. ,' Pour Time: Code # Inspection Description y, Confirm :. Contact # e sa e g 615 Mechanical rougt•rin 32919 -0' 503 - 480-39 ( y Corrections /Comrpents / /Instructions: . , i, ■Q''' — J'---c ' IL6-e-----/Q-_ ' &....... .,0 :::... -- y- .:•:. 1 i % !:, . _ . . I LA......„ '- / . , raw. - ...a...k.e_-- ...1 4+ , , 1 .) l • • A / kid L \ C 9--d In) 3 4‘___,,f .kVevt--Q . _.,. /-1., 2) 1© PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS fl FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: e (_ Date: 7 / 1 V 67 Phone #: (503) 718 - --2--(12--C( • Main Office 110. Salem Office Bend Office P .O. Box 238140 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 Carlson Testing Inc. Phone (503) 684-3460 Phone (503) 589 -1252 Phone (541) 330-9155 FAX (503) 684 -0954 FAX (503) 589 -1309 FAX (541) 330 -9163 May 12, 2006 T0601764. CTI Permit No. MST2006 -00003 FIELD INSPECTION REPORT DATES COVERED: April 28, 2006 PROJECT: Mikame Residence — Remodel ADDRESS: 9955 SW 65 Avenue — Tigard, OR INSPECTOR: J. King — COP #729, WABO #KIN821850, OBOA#416, ICBO #1084544 -85 04 -28 -06 - Proprietary Anchors 1 As requested by Brian, CTI representative was on site for proprietary anchor continuous inspection, and the following was noted: Observed the installation of 5/8" threaded rod into clean, proper diameter /depth holes in concrete, for 10 holddowns. Epoxy used was Simpson SET -Pac ER N 5279, batch N 189444H, with expiration date of 05/2007. Installation conforms with engineer drawings dated 04/15/06 and ER requirements. *** CHECK ONE BOX ONLY *** YES NO 1. This is a preliminary inspection only. — OR — ❑ 2. The work inspected conforms to acceptance criteria listed above. If "No," the portions of the work that are non - conforming items are clearly stated above and will be added to the NCL. • Remaining portions of the work, which are not preliminary in nature, are to be considered as ® ❑ conforming. Our reports pertain to the material tested /inspected only. Information contained herein is not to be reproduced, except in full, without prior authorization from this office. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully bmitted, CARLSO ESTIN -, INC. Ja - . F. Hietpas O, a - ations Manager • ck c: Girard Construction — Brian Girard City of Tigard Building Dept Cascade Design Professionals Inc — Paul Kluvers o_:,e r FROM :Cascade Design Professionalot FAX NO. :503-652-9091 ii ay. 05 200E 04:11PM P2 - )1 / 1 0 - k,4004 . Ref. 1 4),e- 570 e, / Ae_l_Ai dook- 006,ac e g yaspt4 -._ ■ h* '0 571 /d i * st a-s . 0_ ..______ — — 7 r _ 4 "N: Z '-P •n \ \,...1 % a. E . : \ i • ' e ui 0 I C P '141' , • i ' 5 a r 3:f&3/5 • V , 03 .c ci En --4 /34o psi, ed) it w /cis frkfc 1 , 54'4,11‘44 i e z ,./.S /4 p/ ...1 F. 0 ill i 4 > C U'll- ■.■ % fre/Sed Coeds . I 1 /f;(49h ' did i ' .1 e j rOfSalA 01. 14 1 7 9 / 0, 1 e1/ 4 , 1 i1 1 4 - leil IOW Or li T1, f 7 e do e.) p r6 7 - net /4 Xel. . 01 . 0 C TUA It OPROf ,e 4 0N;t e ( 44 . / 45 ,,,...- • .„, c--,-- 4, 011EGON ; 0 7 ti 16 KLt ‘■& EXPIRATION DATE: • 4 , Z 64 ell id i dop;mogryu,sti‘,./> fr / .6, 0 , ..,,,, e ) . " CITY OF TIGARD BUILDING DIVISION PERMIT #: MS r20t)u•C.uJ3 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7116/2006 Phone: (503) 639 -4171 Al 4 . Inspection Requests (24 Hrs.): (503) 639 -4175 _2 INSPECTION WORKSHEET FOR DATE: 6//1/2006 TIME: '7:00A 1 PAGE: 66 SITE ADDRESS: 09965 SW 66TH AVE CLASS OF WORK:. SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/20/2006: Added (1) 200 ramp Temp Service. OWNER: MIKAMI, JAMES PHONE #: 503 -462- 0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 Inspection Request Scheduled For: Date: 511112006 Pour Time: Code # Inspection Description Confirm # Contact # Message 242 Interior shear walls 0296132 -02 603 -75U 2514 N Corrections /Comments /Instructiop — - r \-^ - %. ( S 5-�T� (,-, Q vLe {--e 0 -----v.___.... SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS . ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: \4; (fe—■--- Date: (V\ �/U Phone #: (503) 718 - –2--`-(2,-.c f CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST2OC)5•00003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1 €.4200:.; Phone: (503) 639 -4171 1 Inspection Requests (24 Hrs.): (503) 639 -4175 2 "'I� INSPECTION WORKSHEET FOR DATE: 5/11/2006 TIME: . 1:00AM PAGE: 57 SITE ADDRESS: 09956 SW 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd story addition. 3/20/2006: Added (1) 200 amp Temp Service. OWNER: MIKAMI, JAMES PHONE #: 503 -462 -0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 503 Inspection Request Scheduled For: Date: 5/11/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 029682-01 503 - 750.2511 N Corrections /Comments/ Instructions: -ji/Li.j( -- el 4-1) S --- ' -- L e-- - e n,/- C._..---e— C--eAr r Cti\A--- CiA -e-eS 1 PASS -0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v` D ate: -.. ` / 3 4 Phone #: (503) 718- � � 2 ' ` CITY OF TIGARD BUILDING DIVISION PERMIT #: M 3120t.),;.00O03 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/16/200(; Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 "'I �.. INSPECTION WORKSHEET FOR DATE: 5/11/2006 TIME: 7:00AM PAGE: r SITE ADDRESS: 05055 SW 65TH AVE. CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKAMI DESCRIPTION: 2nd :Ion/ addition. 3/2B/2006: Added (1) 200 amp t omp Service^. OWNER: MIKAMI, JAMES PHONE #: 503- 45"2.0312 CONTRACTOR: GIRARD CONSTRUCTION PHONE #: 50:3-750 2514 Inspection Request Scheduled For: Date: 5//112006 Pour Time: Code # Inspection Description Confirm # Contact # Message 250 Roar nailing 029612 -03 503450-2514 I Correct /Comments /I structions: • • • • .• • • ‘• • • • •. • l v V 7 ❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS • • Li FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ( �k• . Vi a (� 718- Z�Z Inspector: Date. Phone #: 503 718 CITY OF TIGARD s BUILDING DIVISION PERMIT #: MS1'200S 060 )3 J is SW Hall Blvd. Tigard, 97223 DATE ISSUED: J1t.;2ilt):= 13125 gard, OR 9722 Phone: (503) 639 -4171 AA, Inspection Requests (24 Hrs.): (503) 639 -4175 ' 4. 'I 11 .. INSPECTION WORKSHEET FOR DATE: 5/10/200(3 TIME: 7:02AM PAGE: is i I . SITE ADDRESS: 09955 Std/ 65TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MIKA,MI DESCRIPTION: 2nd story addition. 3121312U06: Added (1) 200 arnp Temp Service. OWNER: MIKAMI, JAMES PHONE #: 603 -, CONSTRUCTION 503-696-9509 CONTRACTOR: EXECUTIVE & REMODELING PHONE #: Inspection Request Scheduled For: Date: 5/10/2006 Pour Time: • Code # Inspection Description Confirm # Contact # Message • Shear s /:.,- r 029501= C - �03- 750 -251�i N 235 I�.cl� WWII ,<.a.l tf�.�ls ,- Corrections /Comments /Instructions: • • • • • • • i • A ASS El PARTIAL APPROVAL ID CANCEL ❑ NO ACCESS n FAIL n C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ,1 Date: S /X9 Phone # :. (503) 718- 2-4-44- Main, Ofce --'Salem Office Bend Office P.O. Box323814 Hudson Ave., NE P.O. Box 7918 . Tigard, Oregon 97281 . .,alem, ORi97301 Bend, OR 97708 Carl Testing, hone (503) -3460 ; 'Phone (503) 589 -1252 Phone (541) 330 -9155 4 ng, Inc. Inc• Fax (503) 684 -0954: I Fax (503) 589 -1309 •• Fax (541) 330 -9163 Special Inspect / (7' {} Page / of • (� : : :: := F., -r DAILY MELD REPORTS , Project: ../a/)Cr �wr e /�✓ .J , c-c' Date: 6-,/ „7--r -C > ,- . Job Address: '/ q f c, ) <1 . S 7-4 �a , . 4j /-1-- CTI Job No. i( /—F °c> - : =� Permit No.: rt t 1 T . r,� #4 - r n. o Z\ ? Type of Inspection: 1 ,rJ�u - Field or Fab'Shop Weather: / / * (� :---/ r/i 4.. 0? I Inspection Notes :(include location, testing data, substitutions /deviations, materials and methods of construction, non - conforming items, acceptance criteria, corrected non-conforming items, a { tc.): ,( � C/'J / ° •, '° / \• . , - }.� s. ° lam _ r1 "c f. . / <f. `,� r ``//'77Z /r /�< �° /� �.��_ i r� /n �. tiCU r• ' rf` ii (� lr.Sr� vG��"/' i2i�i (/l�• f - / c - / rJ , - t , L,-. �fiv�c / O / : , . , - 7 , . . / ( 1 , , , ,.r C�%S /r, C,1,. ... ;r, . C < .7r • /fr / K �I, -= % .e M1 fc C `r / j-q /L /G // //./ r x _ , o. c” /9 7 . - f ,f ,,, ›. ed 2 64. 11 C4 r 6r(1 C 71, , f f-• . L7 J g d/ : ' 7 E -.. ` a . ° "�. R , K.. _ r r ..., , i ! / y - r " { f C / * ** CHECK ONE BOX ONLY * ** YES NO _ L 1. This is a preliminary inspection only. - OR - 1 ❑ 2. The work inspected conforms to acceptance criteria listed above. If "No," the portionsof the work that are r ,non- conforming items are clearly stated above and will be added to the NCL. Remaining,portions of the work, which ip ❑ are not preliminary in nature, are to be considered as conforming. ;' Inspector: - 7 - i' - Certification No.: 7� / /t Use of the information ncb twined in'this'report constitutes a )tance of all terms on the reverse of this form and Carlson Testing, Inc.'s General Condition onditions. " . - Information contai d herein is not to be reproduced, ex n full, without prior authorization from this office. Terms: Client recognizes that construction observation and/or testing services provided by CTI are techniques which may reduce the risk of construction defects, deficiencies, or omissions arising during or after con- struction. Services performed by CTI do not constitute a warranty or guarantee of any type. Even with diligent construction monitoring and /or testing by CTI, construction defects, deficiencies, or omissions in the Contractor's work may exist. In all cases, Client and /or the Contractor shall assign the Contractor the responsibility for the quality and completeness of the work and for adhering to plans and specifica- tions. CTI's work or failure to perform same shall not in any way excuse any contractor, subcontractor, or supplier from performance of its work in accordance with the contract documents. CTI will provide its professional services to Client with that degree of care and skill ordinarily exercised under similar circumstances by members of its profession. This representation is in lieu of other warran- ty or representation, either expressed or implied. It is also understood and agreed that statements made in CTI reports are observations based on technical judgments, and should not be construed to be con- clusive representations of fact. If conditions different from what are indicated in the reports come to Client's attention after receipt of the reports, it is recommended that Client contact CTI immediately to authorize further appropriate evaluation. CTI's work shall not include determining, supervising or implementing the means, methods, techniques, sequences or procedures of construction. CTI shall not be responsible for evaluating or reporting job con- ditions related to health, safety or welfare. CITY OF TIGARD BUILDING DIVISION PERMIT #: :2190 4,-490003 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 i ¢ fll Inspection Requests (24 Hrs.): (503) 639 -4175 �_' - - a a t INSPECTION WORKSHEET FOR DATE: 1/ PAGE: SITE ADDRESS: 9 9 � 51-4 Ave- CLASS OF WORK: SUBDIVISION: ` LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: C OWNER: 7 PHONE 0 3) 41 / 70 CONTRACTOR: ,J (Xi PHONE #: Inspection Request Scheduled For: Date: Ai --JO — Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: Vik,_ A 4 4 - C - INI - 1 1111 _:#1. 1 1 111'.---7:— eC5 --- i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL U CALL FOR SPECTION ❑ ADDITI NAL FEES ASSESSED 40 147 Inspector: Date: ,!: "� Phone #: (503) 718 - z4---Z3