Permit �� CITY OF TIGARD MASTER PERMIT
Ill I COMMUNITY DEVELOPMENT Permit#: MST2015-00050
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2015
Parcel: 2S114BA08500
Jurisdiction: Tigard
Site address: 16400 SW WOODCREST AVE
Subdivision: COPPER CREEK STAGE 2 Lot: 25
Project: MALA
Project Description: Replacing existing deck with a larger 300 sq.ft.deck.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $6,372.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0 ins:
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add.'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 1
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
MALA,DANIEL J&LAURIE MANGHELL OWNER Required Items and Reports(Conditions)
16400 SW WOODCREST AVE DANIEL J MALA
TIGARD,OR 97224 16400 SW WOODCREST AVE
TIGARD,OR 97224
PHONE: PHONE: 503-869-5937
FAX:
Total Fees: $385.32
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the - -dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy oft direct questions to OUNC by calling 50 -32.1987 or 10.332.2344.
Issued By: .rte .`.-. _ �- Permittee Signature: A / ,/
` Call 503.".4175 by 7:00 a.m.for the next available inspection date. gr
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 Application
'Residential I(I It (t i I I t I I ',I ()\I Received City of Tigard
cNv J K I IS �i Permit No.: II , S .•111 II • 13125 SW Hall Blvd.,TFax: OR 97• Plan Revi�1 1
Phone: 503.718.2439 Fax: 503.598. **el Date/B : `II Other Permit:
I I:;:�I.I Inspection Line: 503.639.4175 1 Date R :.y :y: Lurie: See Page 2 for
Internet: www.tigard-or.gov APR 1 ..„- otifted/Method: 7 /3/ _ • 'i(p Supplemental Information
W
TYPE OF W(N Ur REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction
4054%;IT/ Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
dAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ /
F1-and 2-family dwelling ❑Commercial/industrial
10 ��
m
❑Accessory building ❑Multi-family Number of bedrooms:
13 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /4 0 SW wood -e f f 4 v e * New dwelling area: square feet
City/State/ZIP: , ,,,i ! ° Cj . Zz61 Garage/carport area: square feet
Suite/bldg./apt.no.: ! L� �' Project name:6 Covered porch area square feet
Cross street/directions to job site: Deck area: Sj r x tx i square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: l Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rotnded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application. _
((���G(\,' Valuation: $
ItJ .
Existing building area square feet
New building area: square feet
.a PROPERTY OWNER 1 ❑ TENANT Number of stones:
Name: Asti e,I [ it4 4,i4 Type of construction:
Address: /a Yoe) $ZA Veodere5I five Occupancy groups:
City/State/ZIP: Gv re) l oft g 7 u" Existing:
Phone:(Sa3) 0 i, — 51 37 Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(likens refer t fee sphe 4e) ,
Business name: Gvf„,. Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address: /
Total fees due upon application:
City/State/ZIP:
Phone:( ) per::( ) Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
•Business name: D V„ii e'tom-. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees): .
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: Total fee due upon appication: $201.60
Authorized si ature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
y *Fee methodology set by Tri-County Building Industry
Print name: ( Date: ! ���� Service Board
I:1Building\Pe i 1BUP-RESerm' :doe /2 11 4404613T(11/02/COM/WEB)
C.vl,t �,
Building Permit Application Checklist .
One- and Two-Family Dwelling FOR OFFICE USE ONLY 4
City of Tigard Received
IN 13125 SW Hall Blvd.,Tigard,OR 97223
= Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T I G A K D 24-Hour Inspection Line: 503.639.4175 Cl Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 es No NSA
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. ❑ ❑ ❑
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 ❑ ❑ ❑
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- ❑ ❑ ❑
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 he shown to be licable to the ro'ect under review.
23 Three(3)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. ❑ ❑ ❑
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 trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature 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:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application + _� _, av fuk tIt I I( I I ',I I1∎I 1
• City of Tigard �, %i\ ', Received •
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /157.M2:21 r�
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 APR 1 2015 Ready Date/By: to See Page 2 for
T I i.,A 1:I i Internet: www.tigard-or.gov Notified/Method: EMI Supplemental Information
TYPE OF WOIllan O% 1161 .
,r [ PLAN REVIEW
❑New construction ❑Addition/alter a � �gr �y �7�0 Please check all that apply(submit a sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
/ ❑Addition of new motor load of system.
Job#: Job site address: !V hiDO SIN. wapJCV)I /1-v 100HP or more. ❑"A'. 'E","l-2",°I-s",
City/State/ZIP: 4/ ,, J 2 Z ❑Six or more residential units. occupancy.
�I hL.�Y� Q Z 1 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: /A d& ❑Hazardous locations. ❑Supply voltage for more than
"^� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: _ FEE SCHEDULE
Description I Qty. L Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 l
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 00•40.t .I J. 04 1/ 200 amps or less 100.70 2
Address: I6 li Q 6 ski WQ a C6-P51 4 v 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 44.-7 / Oft_ / 7'z -N 601 amps to 1,000 amps 301.04 2
Phone:(56) g6 - 59 3 Fax:( ) Over 1,000 amps or volts 552.26 2
I Temporary services or feeders installation,alteration,and/or
Email: An o. a ft /3 0_q,./.14;i , C 0 M relocation
Owner installation:This installation is llling made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease, ent,o xch e,accord' g to ORS 447,449,670, 7 1. 201 amps to 400 amps 125.08 2
Owner signature: L/` Date: ! /C 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PE Branch circuits—new,alteration,or extension,per panel _
A.Fee for branch circuits with
Business name: L r above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first r 56.18 2
branch circuit /
City/State/ZIP: Each add'!branch circuit 7.42 2_
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder _
Email: Reconnect only 67.84 2
• . - CONTRACTOR Pump or irrigation circle 67.84 2
Business name: e! Sign or outline lighting 67.84 2
t�t -
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min) 90.00/hr
ELECTRICAL PERMIT FEES -
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permi ts\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440.4615T(11/05/COM/WEB
4
Electrical Permit Application—City of Tigard •
Page 2—Supplemental Information `
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00
Description I Qty. I Each 1 Total I -
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kvaorless 100.70 2
5.01 to 15 kva 133,56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
El Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit. I
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
City of Tigard
~ COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R(� Building Permit Review — Residential
Building Permit #: 7`a()/,--r050
Site Address: /60o C.,A,e,f-
Project Name: ntict. Ac. Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: ArESP- f L ksC1r,4ort-,
erify site address/suite#exists and active in permit system.
❑ River Terrace Plan District: ❑ Yes No
Site ' . Elements: — /
I! •e(3)copies of site plan Long structures on site
L' . e plan must bb on 8-1/2"x 11"or 11 x 17"paper L3'Footprint of new structure(including decks)with finished
I Df wn to scale(standard architect or engineer scale) floor elevations
L7No arrow ❑Utility locations(required for new,may apply for additions)
�, �tute�e address,project or subdivision name and lot number ❑Location of wells/septic systems
I_IV6licant information(name and phone number) ❑Erosion control(including drainage-way protection,silt fence
❑Lot dimensions and building setback dimensions des' ,location of catch basin,etc.)
❑Lot area,building coverage area,percentage of coverage and ireet names
impervious area(applicable if R-7,R-12,R-25&R-40) 0 Street tree size,type and location
❑Property corner elevations(2 foot contour lines if more than ❑Existing trees to be retained with drip line,and tree
4 of differential) protection measures
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified o Received: ❑ Yes ❑ No
Public Facilities Improvement(PH)Permit
Required: ❑ Yes,applicant was notified )<No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: /v/�
Zoning. /E'- 145 PD
Setbacks: Front )G Rear /5' Side 5 Street Side Garage
❑ Landscape Requirement:
❑ Lot Coverage Maximum:
❑ Building Height: Maximum Height (0 Actual Height
isual Clearance
asements
,ensitive Lands: ❑ Yes ❑ No Type
❑ Urban Forestry Plan
❑ Conditions"Met"prior to issuance of building permit
Notes:
Approved By Planning: 'p' Date: `
j /)'
Revisions(after Building Sub al only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:1Building\Foims\BIdgPernnitRvw_RES 031015.docx
4 . .
Building Permit Submittal
Original Submittal Date: y///6—
Site Plans: #
Building Plans: ICYE
Building Permit#: nter building permit#above.
Workflow Routing Wolf ng gineering Etlermit Coordinator EiHrtiilding
Workflow Sign-off: ign off for Planning(include notes from planning review)
Route Application Documents: CI„,..Engineering. (1) copy of permit application,(1) site plan, (1)building plan and
original plan review routing form.
laiuilding. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: -----..r Date: ///5"---
Engineering Review
❑ Slope at building pad:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility: N, .Q
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
P
Approved by Engineering: —• Date: ./ ./5-
Revisions(after Building Submittal on ) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
MPIIMPIIINIIIIMY
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
K to Issue Permit - AI
Approved by Permit Coordinator: !/ ' . Date: 5 /'Lc
1:1Building\Forms\Bl dgPermitRvw_RES_031015.docx
1
M ,
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
1 I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
)ice( J , 0461, m
Pri t Name of rmit Applicant
Si nature of Per it App nt Date if(( //'
Permit#: 1\-1.5-1—CiRig/ 5-OC.r)50
Address: 16(100 ot� La+xk a��e'' � ��'��-.,�
.'E`
Issued by: t -7Th Date: 4//s/j5 IT-i-1-
This Copy for Permit Offices
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16400 SW WOODCREST AVE, TIGARD, OR,
97224
Residential - Master Permit
299 Final inspection
FAIL
MST2015-00050
David Young
Provide railing to code at mid level stairs. R311.5.6.2
Provide landing to code at bottom of steps to bring step height into code compliance.
R311.5.3.1, R311.5.4
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16400 SW WOODCREST AVE, TIGARD, OR,
97224
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2015-00050
David Young
Correction complete.
Violation Summary:
Inspector Contractor