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12816 SW ASCENSION DRIVE
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
2441our Inspection Line. 639-4175 U: -,iness Lina: 639-4171
BLIP
� c.Date Requested , \c AM PM BLD
Location—) Z o L 1� �r-1V�I S_� Suite MEC _ v
Contact Person _ Ph __.__.��'P ��•� 3
Contra:,tor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Ac FPS
Foundation NOT REQUESTEDFtg —
Drain FOUND DURING RESEARCH SGN
Crawl Drain
CrIn
Slab NO INSPECTION(S) FOUND IN FILE SIT _
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear _
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ---- ---
Roof
Misc: _____ ---------------- - --- - --..
Final
PAS.$.. PAR r FAIL - --- -— �._ -- - — ------ --
U
Post&Beam 9
Under Slab � �r
Top Out (L,
Water Service b'
Sanitary Sewer
Ra mprains
ir,al.) ---
-RAS: PART FAIL
MECHANICAL
Post R t3e;1111 -- -- -
Rough In
Gas Line
Smoke Dampers
Final -- - -- -
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading -- - _ -- - ------------ ---------- --
Sanitary Sewer
Storm Drain j ] Reinspection lee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I 1 Please call for reinspection RF — — --__ ( ]Unable to inspect no access
ADA
Approach/Sidewalk Date Inspector Ext
Other - ------- - ------
Final
PASS PART FAIL_ 00 NOT REMOVE this inspection record from the job site.
IY OF TIGsARD Plumbing Application Recd'1y
�- -�`"
125 3W HALL BLVD. Commercial and Residential Cate Recd Date to P E.
CARD, OR 97223 Date to DST
13) 639-4171 Permit a 63: •� � c f �
Print or Type Related SWR a
Incomplete or illegible applications will not be accepted Called__ 'Y��
Name of DevelopmentiProlect FIXTURES (Individual) QTY PRICE AMT
/ p Sink 9.00
Job �/-le, /;"4 Ne J ar`// _
L 9.00
Address Street Address Suite —
Z'i C Irl r a (J Lor (, l Tub or Tub/Shower Comb. 9.00
Bldg s cayiSlate Zip Shower Only 9.00
i>'Kc Water Closet 9.00 f
Name
Dishwasher - —
hwasher 9.00
MaiMng Address Suite �- Garbage Disposal 9.00
Owner
washing Machine 9.00
City/State Zip Phone / ? Floor Drain 2 9.00
S. 9.00
Name 4' 9.30
Water Healer
"1CC0.11pint MsiYrq Address Suite — 9(10
Laundry Roam Tray 9.00
CityrStste Zip -- Phone Unnal 9.00
Other Fixtures(Speuty) 9.it)
Name
9.00
rintractor .N4a1lw%9d efits's gouag ce ^fi, l�i►a Y �— �— 900 —
_2202-SM-MicbmL.uive 9.00
GtyiState Westk hn.OR 9 one 6 y3� — 9.(,0
Oregon Const.
Coon�t.Board Lic.s Exp.Date (�Q 9.00
fteA Co"of 11, "".3G- - _ 9.00
cyrrom Pturnrting Lic.9 Exp.Date Sewer-1 st 100* 3000
Sewer-each additional 100' I 25.00
COT Business Tax or Metro¢ Ezp.Date Water Service- 1 st 100' 3000
--- 1 `y--- --
Name Water Service-each additional 200' 25.00
vchitect Storm S Rain Drain- 1st 100' 30.00
Mailing Address Si.to Storm S rain Crain-each additional 100' 25 00
Or Mobile Home Span 2500 —�
.ngineerC tyi5tate Gp Phone Commeroat Back Flow Prevention Device or Anti- -' 25.00
Pollution Device _
*so wrrt '4ew O Addition O Alteration O Repair 7 Residential Backflow Prevention 7evice' 1500
A done Residential O Von-residential O Any Trap or Waste Not Connected to a Fixture 900
ndlbortal desvtpt:on of worst Calcn Basin
9.00
Insp cf Enisung Plumbing L 40 00
�- perihr
---- I Speaaiy Requesled Inspections 40.00
'^0 use of l _ oerihr
finq or Drop"— ----- — i Rain rain,single family dwelling �I 30.00
nosed use of Grease(raps goo
ding or prop"__� QUANTITY TOTAL
e yoc gypping. moving or replacing any fixtures? Yes O No L-3
Isomeric or rasa siagram a reouretl R Cua^ey Total u >9
yes see back of form) 'SUBTOTAL ISr
reby acAnowledge:Pat I ha•.e read this acplicabon.that the information ---- --- - —
,n s;orrect.:nat I am the owner or authorized agent of the owner and �5% SURCHARGE
it c bmrtted ate n camcltance with Cregdn State Laws. —
ature of —'gent Data PLAN REVIEW 25% OF SUBTOTAL
Imured only!'hire city !0121!1>7 __
TOTAL—
ntact Person Name Phone L -- - I —
'Minimum permit fN is 525- 5"L surcharge.except Residenuat Backflow
Prevention Cevice.which.s S15 • 5:5 surcharge
--- i:%dstslplmaop doc SM
eLEASCOMP_LIL AS APPROPRIATE TQ PRO, CS:
Fixtures to be capped, moved or replaced Qty
Sink _ _
Lavatory _
Tub or Tub/Shower Combination
Shower Only —
Water Closet _
Dishwasher___
Garbage Disposal
Washing Machine_
Floor Drain 2"
4"
Water Heater
Laundry Room Tray
Urinal _
— _
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 972231 (503)639-4171
CERTIFICATE OF
OCCUPANCY
PIERMIT #. . . . . . . 2 MST96 -039 1
DATE ISSUED: 01/27/97
I.ARCEi. - 2S104BC-05000
ITE ADDRESS. . . 1,,,816 SW A93CENSION DR ZONING:R -7 PI)
�UBDI V ISION. . . . HILLSHIRE WOODS
%LOCK. . . . . . . . . . c LOT. . . . . . . . . . . . . 3 61
,LASS Of" WORK. cNEW
!YPE OF USE. . . s 9
iyfD,E Of- CONSTRc5N
,)CCUPIANCY GRP. cR3
)CCUPANCY LOAD 9 a
?elark s :
1wners
-'HFLB(JRNE DEVELOPMENT
7008 NW NYBERG RD
iIJALATIN OR 97062
Ohone #o 692--b-�83
"3HELBURNE DEVELOPMENT
/Moo 9W NYBERG RD
rU,4LATIN OR 9706-?
on 692- 6383
Reg #. . : 42388
ab V t i On
This cev-tjfjc.-.-ate ovp referenced bUildit�14 Qv- F PO
ti-,Qveof and confirms that the building has bred irjjpe(:ted fot, complianrp with
the .�-tc - c)c.,c.,j.tpjknc:y9 and use undev
State of Oregon Specialty Codes for the Ur0�
which the referenced permit was issued.
BI D-1-N-0 —1 N--S"-P"E*-C,-T,0-F'7 BU11-DING OFF IC [AL.
U
poc',j IN CONSPICUOUS PLACE
I'll . .
CITY OF T I GARD DATE .D: 08122,196
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 9722308199 (503)639.4171 �:'ARCEL:
�iL-L4ij I Q I b 1 ON. HiLLzF4IRE WuUDS ZONING: R-7 PID
131_(X.11'. . . . . . . . . .. , I-OT.
Remarks: Path I
------------------------------------------------------------ BUILDING ---------------------------------—--------------------—------
REISSUE: STO"IES....... E FLOOR AREAS---------- BASEMENT...; 0 sf REQUIRED SETBACKS--,-- RE(AJIRED-------------
C'—ISS OF WORK.:NEW K'GHT........ 31 FIRST....: 1368 sf GARAGE.....: 420 sf LEFT..........: 18 SMOKE DETECTRSi Y
TYPE OF USE...:51' FLOOR LOAD....: 40 SECOND...: 1316 sf FRONT.........: 20 PARKING SPACES: I
TYPE OF CONST.:5N DWELLING UNITS: I FINBSMENT: @ sf RIGHT.........: 5
OCCUPANCY r7RP. IR3 bDRM: 3 BATH: 3 TOTAL--------: 2684 sf VALUE—$: 180729 REAR..........: 48
----------------------------------------------------------------- PLUMBING ---------------------------------------------------------------
SINKS.......... I WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS, : I RAIN DRAIN ft: 0 TRAPS........ : 0
LAVATORIEF....: 4 DISHWASHERS...: I FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAIN A I CATCH BASINS..' 0
TUB/SHOWERS...: 3 GARBAGE DISE..: I WATER HEATERS.: I WATER LINE ft: 100 KKFLW PREVNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
--------------------------------------------------------------
MECHANICAL -------------------------------------------------------------
;UEL TYPES----------- FURN ( 100K 0 BOIL/CMP ( .*: I VENT FANS.....: 4 CLOTHES DRYERS: 1
/GAS/ i FURN )=I@OK I UNIT HEATERS,.: 0 HOODS.........: I OTHER UNITS...: I
."Ai. INP.: BTU FLOOR FURNACES: @ VENTS.........: @ WOODSTOVES.... 0 GAS OUTLETS...: I
---------------------------------------------------------------- ELECTRICAL ----------------------------------------------------------
UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/PEEDERr--- ---BRANCH CIRCUITS--- ---MISCELLANEGUS---- --ADDL !NG _pFrTl'.
INS
IM SF OR LESS: 1 0 - 200 alp.. : q, 0 - 200 am.: 0 W/SVC OR FDR.,: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 501015F.: 5 201 - 400 amp..: 0 elill - 400 amp..; 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.; 0 401 - 600 amp..: 0 Q1 - 600 alp..: #1 EA ADDL BR CIR: 0 SIGNALIFWL...: 0 IN PLANT......: 0
"ANF HM/SVC/FDR: @ 601 - lm amp.: 0 601+a1ps-II00 v: @ MINOR LABEL -I@j I
1000+ alpivolt.: It ----------------------------------- PLAN REVIEW SECTION -----------------------------------
Reconnect only.: 0 )=4 RES UNITS..- SVC/FDR)-225 A.: ) 680 V NOMINAL: CLS AREA/SPC OCC:
---------------I-------------------------------------- ELECTRICAL - RESTRICTED ENERGY ---••----------------------- ----------------------
A.
-------------------
A. SF RESIDENTIAL--------------------------- 8. COMMERCIAL-------------------------------------------------------------------------
AUDIO I STEREO.: vACULIMI SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOMiPAGING- OUTDOOR LNDSC LT:
BURGLAR ALARM..: OTH., :1 X BOILER.........: HVAC...........: LANDSCAPE/IRR]b: PROTECTIVE SIGNL:
GARAGE OPENER..., CLOCK..........: INSTRUMENTATION; MEDICAL........: UTHR:
WVAr...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL 4 SYSTEMS:
UW.'r - --------------------------------------Contractor: -------------------------- TOTAL FEES1 460.46
SHIELBURNE DEVELOPMENT SHELBURNE DEVELOPMENT
7008 NW NYBERG RD 7006 SW NYBERG RD
TUALATIN OR 9796c' TUALATIN OR 97662
4: 69e-6A3 Phone #: 69C-4383
Reg #..: 42388
-ii: permit is issued subject to the regulations contained it the Tigard Kunicipal Code, State of Or-@. _4Decialty Codes and all ot,e
applicable laws. All work will at done in accordance with approved plana. This permit will expire if work is not started with:,
days of issuance, or if work is suspended for @are than iB@ days.
------------------------------------------------------ -- REGUIRED INJECTIONS ----------------------------- --------------------
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Erosion Control
post./Bede Strict Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
Post/Beat Mechan Electrical Servi _7 replace I _P Rain drain Insp Mechanical Final
LinS
Crawl Drain Electrical R gh as Lin Water Line Insp Plueb Final
I,,e V-Iff i t t 0 e S i QT'lat I.We L S..'j P IJ 13
C":'k I i/f o t- inspection --- 639- 4175
Iz.J'K I']L
PEkj - -V #
s�. . . . . . .
CITY OF TIGARD D�IT�-' 13 LD: 08/23/5&
COMMUNITY DEVELOPMENT DEPARTMENT I.-IARCEL: 2S104bC:--HWV.iL,l
�31 M-"pall Bfvd Tigard,Oregon 97223961Q9 (503)6�"
ITI)R
JBDIVIS10N. . . . : HILLbHlRE WOUDS ZONING: R--7 P,D
t-OLK. . . . . . . . . . : 1_01.. . . . . . . . . . . . . .61
----------------------
I ENANJ NAME. . . . . :
ijSPi NO. . . . . . . . . . : FIXIURE UNITS. . . 0
L.LASS, OF* WORK. . . :NE-W DWELL I NIS UNI l 5. . I
TYPE OF LISE'. . . . . *SF NO. OF BUILDINGS: 1
INISI'ALL 'I-Yf-,E. . . . :BLJSWR Ilyll-,ERV SURFACE--. 0
ReMar'ks : f-'ath I
0 1
wrier, FEES
I
SIALL-SURNE DEVELOP'MENI" type amol-11-ft by date r,ecpt
7008 NW NYBERG RD P,RMI 2200. 00 CJS 0P,/1=3/96 96-28.3138
315- 00 cis lb!?123/96 96-2631
11A)LHIIN OR 9706LE,
Phone #: 6W-6383
CON iR(:4(,,-r0R NOT ON FILE
$ 2,R:35. 00 TOTAL
Re q #.
REUUIRED INSPECTIONS
This Applicant agrees to comply with ail the rules and regulations hewer Inspec-tion
of the UnifiW Sewage Agency. The permit expires IN days from
the date ,ssaed. The total amount paid will be forfeited if the
pereAt cxptres. The Agency does not guarantee the accuracy of the
side sewer ater&ls. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions free
the distan--t qisen. If not so located, the.' er/shalljp�chase
41"c y I instal
a "Tap ann Side Sewer" Permit and the located, the.'
I instal i
.k e d B y
Cal I for- inspection 639-4175
Plan Check
ITY OF TIGARD Resident a! Building Permit Application Recd By
:3125 SW HALL BLVD. New Construction Additions or Alterations Date Recd
]GARD, OR 97223 Single Family Detached or Attached Date to P.E. lr '
d3 639-4171 Date to DST
Permit# 't 1 9-C j L
Print or Type Called
Incomplete or illegible applications will not be accepted _
Name of Subdivision _ Lot# - Name
Job llillshire Woods _ ( ''G1, A//
Architect Mailing Address
Address Site Address ? r- r, 6t/ 2j
City/Slate _ Zip Phone
Name ,[/UK T /rJ �j�-C/�/
Shelburne Development
Name
Owner Mailing Addressr �
8 s-W- I1vb Engineer Mailing Address
Gty/Stale Zi Phone g
P u a l a t i n 9 7 0 6)_ 6 9 2—6 3 8 3 City/State Zip Phone
---- . Name 12 32_
General Shelburne Development Describe work new 1K addition O alteration O repair O
to be done:
Contractor Mailing Address -_
7008 S.W. _Nybe r Rd. Additional Description of Work:
City/slate Zip Phone
Tualatin 97062 692-6383
Oregon Const.Cont. Board Lic.# Exp Date -- - -
Attach copy of 042388 11-8- 96 Project
Current COT Business Tax or Metro# Exp. Date Valuation $ /�:I
— Licenses^_ 00003412 11ZI97 -- NEW CONSTRUCTIONONLY:
Name
Mechanical Oregon Comfort Heating Sq.. t. House: Sq.F.G age:
Sub- Mailing Address - —
Contractor 11.0. Box 355 Corner Lot Yes No Flag Lot Yes No
citylstate Zip Phone- (check one) (check one) X
Eagle; Creek 97022 655-0221 Restricted Audio/Stereo Burglar
Oregon Const.Cont. Board 6c t Exp.Date Energy X System X Alarm
Attach Copy of 042519 2-24-97 _ Garage hoot J:SLsterns
VAC
Current COT Business Tax or Metro# Exp. pa a installation 9
Licen4tes 00001313 3 j.l f 9 7 X Opener X
Name --V� (check all that F Other:
� Plumbing C & K Contracting, Inc .
apply) centra]. vacuum
Sub- Mailing Address Will the electrical subcontractor wire for all Yes �No
536 N. E. 63rd restricted energy installations?
Contractor _ Has the Subdivision Plat recorded? N/A Yes No
City/State r ° c, X
Salem 9Jli01 39-3539 —_
Oregon Const. Cont Board Lic K Exp Date Reissue of MS r# Solar Compliance
Attach copy of 065015_ ____3-l_'_97, _ _ (Calculation Attached,
Current Plumbino Lic # xp ppat I hereby acknowledge that I have read this application,that the
Licenses 24-r97 PB -31- 7 information given is correct that I am the owner or authorized agent of
COT Business Tax or Metro X Exp. Date the owner, end that plans submitted are In compliance with Oregon
Y _ State laws. _
_ Name Signature of Owner/--4ge;t Dale
Dryer & Sons ElectricElectrical
_ Contact Person Natne Phone
Sub Mailing Address —_ —
Contractor 5536 SE Woodstock _ FOR OFFICE USE ONLY:
City/State Zip Phone Plat# MaplTL#:
Portland 97206 774-1606 C 1
Oregon Const. Cont.Board Lia# Exp Date
Attach Copy of 001114 11-23-96 Setbacks Zone: Solar:
Current Electrical Lic.# Exp Date 0�_
Licenses 26-43C 10-1-96
COT Business Tax or Metro# Exp. Date Engineering Ap roval: Planning Approval: TIF:
00003046 _ 12-1-96 -{c (A_ 1 /�
4it_'4nstspp doc
FermiL# Agcount Descriatkm Amount Ate_ dd Bal. D.J.
g,,5/y , MST. Permit (BUILD) ?tee 3S,
Plumb. Permit (PLUMB) •�� ,� a�,
Mech. Permit (MECH) %, •'' Iq w
ELC/ELR Permit (ELPRMT) ,2 7s
State Tax (TAX) `�� , 2
5q, 03
Bldg: ��/, fib'
Plumb:
Mech:
ELC/EI_R: 137S
Plan Check
MST: (BUPPL.N) /,j .1 S`� �� j v
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS) �) c�
Ou I i +. 11 Sewer Connection (SWUSA) U ��
Sewer Inspection (SWINSP) 3 J� .>j
Parks Dev Charge (PKSDC) so / USy
Residential TIF (TIF-R) 157 J 74
Mass Transit TIF (TIF-MT) / 0.6)
Water Quality (WQUAL.)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erasion Planck/USA (ERPU\N) 7'
Erosion Planck/COT (EROSN)
Fire Life Safety (FI-S)
'TOTALS: , AV. v �
II i
i
10T V
Ec. . �ty
\07- 1651.. St4CK
FErgC- \�
� 1
/S L) \ 1
M \
QT
\ I Ir
v �
Ilk
-7 U. 86
_FL 3o
7~'AX Lo7- ZSIoyBG 05000 _ �r
/2816 K
L O T 6 INiL G SN/R S OOOOS S S
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone 639-4171
Footing Rain Drain Cover/Service L:
•
Foundation Water Line Ceiling Plumb.
Framing ec
post/Beam Mach. Shear/Sheath g -Elect.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation
Post/Beam Struct. Mech. Rough-in Gyp. Bd. ( .
Gas Line I
San. Sewer Appr/Sdwik
Other "
A P.M.4Enoy---- +�
Date:
Address: 2
Ste:— MST: Io
Tenant. -.- ---- BI IP: -
MEC -.
Con/Own:.--- -- --..- - PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: ---
`[_,�(, Date:
In a-tor. - " --
PPROVED DISAPPROVED/CALL FOR REINSP. I CF) CO