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CITY OF TIGARD
DEVELOPMENT SERVICES MASTER PERMIT
PERMIT #. . . . . . . : MST97--007.:"'
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 04/17/97
SITE ADDRFSS. . . : 1 i;�100 SW CENTURY nAK DR
41+k PARCEL: 2S 1 1 1 CC-04200
SUBDIVISION. . . . :SUMMERFIEL_D 'A ZONING: R-7 PD
BLOCK. . . . . . . . . . I_OT. . . . . .. . . . . . ., . :6,S ,%JURISDICTION: TIG
Resarkst 21 sq. ft. bathroom addition
--------- ------- ----------�--_-------------- BUILDING --------------------
REISSUE: STORIES.......: 1 FLOOR AREAS-------- BASEMENT...: 0 if REQUIRED SETBACKS..-•-_ RE(?UIRED--------------
CLASS OF WORK..-ADD HEIGHT........: 8 FIRST....: 20 if GARAGE.....: 0 if LEFT..........: 8 SMOKE DETECTRS:
TYPE OF USE...-SF FLOOR LOAD....: 40 SECOND...: 0 if FRONT.........: 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 0 FINBSMENT: 0 if RIGHT.........: 0
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 1 TOTAL------: 20 if VALUE..1: 1338 REAR..........: 8
---------------------------------------- ---- ------------ PLUMBiNG --------------------- ------------------------
SINKS.......... 0 WPTFR CI.OSFTS.: I WASHING MACH..: 0 LAUNDRY TRAYS.: 0 PAIN DRAIN ft: 8 TRAPS.........: 0
LAVATORIES....: 1 DISK441FPS... : 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF PAIN DRAINS: 0 CATCH BASINS..: 0
nJB/SHOWERS...: 0 GARBAGE D1SG.. : 0 '.TATER HEATERS.: 8 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
------------------------------- ----------------------- MECHANICAL --------------------------------------------—.�--_--
FUEL TYPES---------- FURN ( IMW ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 1 CLOTHES DRYERS: 8
FURN )=100K ..: 0 MIT HEATERS—! 0 HOODS.......... 0 OTHER UNITS...: 0
MAY INP.: 0 BTU cLOGR FURNACES: 8 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 0
------ ELECTRICAL ------------------------------------ ------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---• --TEMP SRVC/FEEDERS— ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1000 SF OR LESS: 8 0 - 280 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIBATION: 8 PER INSPECTION: 0
FA ADD'L 5808F.: 0 201 - 400 amp..: 0 201 - 408 amp..: 0 tit W/O SVC/FDR: 1 SIGN/OUT LIN LT: 8 PER HOUR....... 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIA: 0 SIGNAI_1PANEL...: 0 IN PLANT....... 0
MANE HM/SVC/FDR: 0 601 - 1000 amp.: 8 601+81ps-1808 v: 6 MINOR LABEL -let 0
1000+ amp/volt.: 0 ----------------- PLAN REVIEW SECTION -----------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
---- --
---------—------------------------------ ELECTRICAL - RESTRICTED ENERGY ------------------------
A. SF RESIDENTIAL-------------------------- B. COMMERCIAL-----•-_.-_----------------------------------------------------------------
AIIDIO I STEREO.: VACUUM SYSTEM..: AUDIO a STEREO.: FIRE ALARM...... INTERCOM/PAGINB: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGN_:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: :•
HVAC............ DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMS: 0
Owner: -------------- _ ___-------------Contractor: ----------------------------- TOTAL FEES:1 185.58
MURRAY CHANDLER OWNER
10t" SW CENTURY OAK DR
TIGARD OR 97224
Phone !: 620-5130 Phone t:
Reg C.:
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 18P
days of issuance, or if work is suspended for more than LBO days.
- ----------------- ------------------------ REQUIRED INSPECTIONS
Footing Insp Mechanical Insp Insulation Insp Building Final
Foundation Insp Plush Top Out Gyp Board Insp _
Poit/Beam Struct Electrical Servi Electrical Final _
Post/Deas Mechan Electrical Rough Mechanical Final
PLM/Underfloor Framing inip Plumb Final _
Perm i t t e e S I ti at I-Ire : / �"`— J ow•c. I s m�_i e d B Y-sJ —�._
Call for inspection — 639-4175
Plan Check w ,
.-ITY OF TIGARD Residential Building Permit Application Recd By
x'125 SW HALL BLVD. � ew Const,-uction Additions or Alterations Date Recd
OR 97223 ��L�' �ry �/,`Ulti Fa ilv (3 or more units) Date to P E '�
503) 639-4171 I, r.�` Date to Dsr / -
' �J permitM f
�}} ' �, Print or Type called -Q
Inco PIG or illeg i applications will not be accepted 3 4 7 n
Name of Protea Name
Ru
Job /1. 04
Address s,te Address Architect Mailing Address
1f/0G S W ("ate,}.-y �? k I)+ /
Name �.I C� City/State Zip Phone
Owner Marling Address Name .-
City/state Zip Phone Eng
Name' ineer Mailing Address
97 j2 Geo 5/jU 4/�I(k– City/State Zip Phone
General u/1k P r Describe work New O Addition Alteration O Repair O
.ontractor Mailing Addross to be done:
`fir Type of Use -
City/State Zip Phone 4
Typo or ConstructionOregon Const.Cant.Board Lic.0 Exp, oats _ rj
,ach Copy of Occupancy Class
Current COT Business Tax or Metro 0 Exp Date
Licenses Will it be sprinklered7 Yes❑ No
f lame If Yes,separate FLS plans and
�Chanicalo�„� Sr /f �rt ,ry application to be submitted
Number of Stories
Sub- Mailing Address –
:Ontractor Proposed Use
City/State Zip Phone
A..,,,,taa If Previous Use r..
Oregon ConsL Cont.Board Lic.M Exp. Date
+:tach Copy of luation a �.
Current COT Business Tax or Metro M Exp Cate /rf� !
ticens" NEW CONSTRUCTION ONLY:
NiR1e Building ID
Plumbing f� —ty.r:,iMt l
Sub- Mailing Address Unit Types sQuare ft. M of units
:ontractor A)
C tyf5•ate 210 Phone B.)
Oregon Const Co )nt Boaro L c it I Exp Care D
,:ach Copy of
Current Plumbing Lac. >< — WIII the electrical subcontractor wire for ail restnced Yes
_ic
Current
p Date enem- iy nstallations7
Hao the Subdrvrslon Plat recorded? N/A NO
COT Business Tax or Menu: Exp Cate
-- I I hereby acknowledge that I have read this application. that the
Name information given is correct.that I am the owner or authorized agent of
lectrical f"'`� the owner.and that plans submitted are in compliance with Oregon
Sub- Mailing Address State laws.
.nntractor
Signature of Owner/Agent Date
C-tyrState Zip�Phone nn'tact Pe on Name Phone
Oregon Const.Cont. Board L cI i p Daie
;�k:n copy dr FOR OFFICE USE ONLY:
Current Exp Dake Mapm#:l'' Mrn.R Zone
- =�
ucenses I» wit III '
COT Business Tax or Meiros Exp Date ErVineeApproval { f . a Planning `TIF f tt
rnslaop doc
;h1
un Amt.
Account Descriotis2lr � �- '-
MST. Permit (BUILD)
�.
_
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT) J r
State Tax (TAX)
Bldg: ►
r.
Plumb: ` ✓
Mech:
ELC/ELR:
Plan Check
(BUPPLN)
MST:
Plumb: (PLMPLN)
Mech: (MECPLN) _
CDC Review (LANDUS)
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) _ _ __--
Parks Dev Charge (PKSDC) _ -
Residential TIF (TIF-R) _
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT) —
Erosion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) —
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS:
c y:t\n vapp.Coc ~
Rei 'v!
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit # . . . . : MST97-0072
Date Issued . : 04/17/97
Parcel . . . . . . : 2S111CC-04200
Site Address : 10100 SW CENTURY OAK DR
Subdivision . : SUMMERFIELD
Block . . . . . . . . 1,ot. : 65
Jurisdiction : TIG
Zoning . . . . . . : R-7 PD
Remarks :
20 sq. ft . bathroom addition
Your company has been indicated as the electrical contractor for the permit indicated above. In
order for the electrical permit to be valid, the signature of the supervising electrician
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be authorized until
this completed fo,-m is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: ELECTRICAL CONTRACTOR:
MURRAY CHANDLER OWNER
10100 SW CENTURY OAK DR
TIGARD OR 97224
Phone # :
Reg # . . : 999
x
Sig4t re of Supervising Electrician
Please return this completed form to the address above.
ATTN: Building DePt.
If you have any questions, please call 639 41 71 , ext. #310
Permit#:
Address: ZO/vv
e'. Issued by: C Date:
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 and initial boxes 1 and 2, and either box 3A or 313:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as it L'OwO uction 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 Coniiartors Board.
OR
4 3B. I will be my own general contractor.
If I h;.• 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 informatimi is c4wrcct and that I have read and do understand the Information
Notice to Property Owners about Constructiom Respomsibilifies on the reverse side of this form.
• — '' ---
311319,7
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
JM
EMPLOYER RESPONSIBILITIES.
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