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Case File k n. f.d GO W 0 z z N E b Ft; 10483 SW 30NAD'2A WY /d.vb' R CITY OF TIGARD BUILDING INSPECTION DIVISION .;� Z,� 24-4our Inspection Linc: 639-4175 Business Line: 639-4171 MST bup —_ — Date Requested—_5. Z Z — AM PM BLD Location O $-3 _5 cvay Suite MEC Contact Person — Ph �7 — PLM -- Contractor— __— _ Ph — _ SWR BUILDING Tenant/OwnerELC Retaining Wall — — — ELR Footing Access: - Foundatior FPS Ftg Jrain SGN - ---_ Crawl Drain Inspection Notes: — - Slat) - ---------- - -- -- SIT Past&f team -- - Ext She ath/Shear Int So,,; th/Shear — — Framing --- __. -- ---- ------------- -_ -- Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm ----- �-._-- -------..— _�� Susp'd Ceiling _ — ------- ---_. ---�_��.---- Roof Misc: / hQ --- ------ - - Final PASS PAR1 FAIL ----- —� PLUMBING Post& Beam ---_—___-- Under Slab Top Out - _ .. ..... _.__ Water Service _ Sanitary Sewer ------ — Rain Drains Final PASS PART FAIL / _ MECHANICAL Post& Beam Rough In -, J Gas Line Smoke Dampers Final — - PASS PART FAIL it Mfikg�l "ftrvice Rough In UG/Slab Low Voltage F' A7- ,SART FAIL SITE Backfill/Grading - - -- Sanitary Sewer Storm Drain [ J Reinspection fr of$ required before next inspection. Pdy at City Hai!, 13125 UW Hall Blvd Catch Basin RE:reinspection i ll f Please call rens Fire Supply line [ J p J Ur able to inspect no access ADA Approach/Sidewalk Datey .o�/�- % Inspector __Ext Other _ Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Lirre: 639-4175 Business Line: 639-4171 _ BUP l Date Requested o?S — AM PM BLD LocationSuite MEC d;01Contact Person — Ph ? t�%j Y /�'� PLM Contractor p SWR UILDIN __. Tenant/Owner _ ELC _ Retaining Wall ELR Footing - Foundation Access: ���� ' FPS Ftg Drain SGN Crawl Drain Inspection Notes: --- Slab - SIT Post&Beam -- Ext Sheath/Shear Int Sheath/Shear ,p Framing 7 { �'�'/ LT jLi > •_ Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm ' -- Susp'd Ceiling < � Roof M' r ---- -- - --1 •�,�I PAS 'ART FAIL ~� 0PLU Ir�G & EiING Under Slab Top Out -- - - Water Service Sanitary Sewer _-- Rein Drains Final — --- -- ------ --- — P SS PART FAIL ANIM Post&Beam f l•"J'Y1 � - -- - __- — --------- aslTne --- -- — — Smoke Dampers A S1 PART FAIL LE RICAL ---- - ---- Service _ Rough In , D UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill/Grading Sanitary Sewer Storm Drain [ J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ ] P ( ]Unable to Inspect-no access ADA Approach/Sidewalk Cf� e Other tInspector — Xt 1L Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD MASTER PERMIT PERMIT#: MST98-00240 DEVELOPMENT SERVICES DATE ISSUED: 6/19/98 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 10483 SW BONANZA WY PARCEL: 2S 114BC-04600 SUBDIVISION: RIVERVIEW ESTATES NO. 2 ZONING: R-7 BLOCK: LOT: 083 JURISDICTION: TIG REMARKS: Alteration to storage space BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: 0 FIRST: 0 of BASEMENT: n.00 of LEFT: r SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 0 of GARAGE: 126 of FRONT: 0 PARKING SPACES: 0 TYPE OF CONST: 5N DWELLING UNITS: 0 FINSSMENT: 0 o/ RIGHT: 0 VALUE: S 2.228.00 OCCUPANCY GRP: R3 BVRM: 0 BATH: 0 TOTAL 0.00 of REAR: 0 PLUMBING SINKS: 0 WATER CLOSETS: 0 WASHING MACH: 0 LAUNDRY TRAYS: 0 RAIN DRAIN: 0 TRAPS: 0 LAVATORIES: 0 DISHWASHERS: 0 FLOOR DRAINS: 0 SEWER LINES: 0 SF RAIN DRAINS: 0 CATCH BASINS: 0 TUBISHOWERS: 0 GARBAGE DISP: 0 WATER HEATERS: 0 WATER LINES: 0 BCKFLW PREVNTR: 0 GREASE TRAPS: 0 OTHER FIXTUaES: 0 MECHANICAL FUCL TYPES FUr,N :100K: 0 BOIUCMP<3HP: 0 VENT FANS: 0 CLOTHES DRYER: 0 FURN>•100K: 0 UNIT HEATERS: 0 HOODS: 0 OTHER UNITS: 0 MAX INP: 0 btu FLOOR FURNANCES: VENTS: 0 WOODSTOVES: 0 GAS OUTLETS: 0 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDER9 BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 0 200 amp: 0 0 200 amp: 0 WISVC OR FDR: 0 PUMPIIRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF: 0 201 400 amp: 0 201 400 amp: 0 tat W/O SVCIFDR: 0 SIGN/OUT LIN LT: 0 PER HOUR: 0 LIMITED ENERGY: 0 401 •$00 amp: 0 401 600 amp: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL, 0 IN PLANT: 0 MANU HM/SVC/FDR: 0 901 - 1000 amp: 0 001+ampe-1000v: 0 MINOR LABEL: 0 1000+amplvolt: 0 PLAN REVIEW SECTION Reconnect only: 0 »I RES UNITS: BVCIFUR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELIC rRICAI_-RESTRICTED ENERGY A.SF RESIDENTIAL 8.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEnRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: 0 Owner: Contractor: TOTAL FEES: $ 309.96 ANNA KNEC!1T OWNER This permit is subject to the regulations contained the 10483 SW BONANZA WAY' SIGNED RESPONSIBILITY FORM Tigard Municipal Code,State Specialty Codes and TIGARD,OR 97224 IN FILE all other applicable laws. All work w will be done in accordance with snproved plans Pie permit will expire 9 work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. AT i FNTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rag a forth in OAR 952-001-0010 lhr.tugh 952-001.0080. You may obtain coplos of these rues or d'rect questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Electrical Service Electrical Finalrl/ Electrical Rough In Final Inspection �11� Framing Insp Insulation Insp Gyp Board Ins >i � Issue By : Permittee Signature : �> 1 Call 503 639-4175 by 7:00 p.m. for an Inspection needed the nex&L4( s rla it CITY OF TIGARD BUILDING' INSPECTION DIVISION MSTZ5&�� 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUR _ / IDate Requested AM PM BLD r Location r'��-1 2��� Suite MEC Contact raison �!�/'�D` _l�( �' _ Ph 7vj,� PLM Contractor — Ph _�4qN"j?ft ejy ,. SWR _ Tenant/Owner ELC Retaining Wall ELR _ Footing Access. r Foundation FPS _ Fig Drain SGN _ Crawl Drain Inspection Notes: (�� ' ��U �L,, f' -- Slab ``iso SIT Post&Beam V — Ext Sheath/Shear 01 ' C IWShe /Shear Drywall Nailing _.— Firewall Fire Sprinkler _ Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post&Beam Under Slab Top Out -- Water Service Sanitary Sewer — j Rain Drains Final — - PASS PART FAIL fios am ugh In e ke Dampers in• - — --- AS PART FAIL ELECTRICAL -- Service Rough In V— UG/Slab —_ Low Voltage Fire Alarm _ Final PASS PART FAIL SITE Backfill/Grading Sanitary Sewer Storm Drain I J Reinspection fee of$ required before next inspection. Pay of('iiy HbIl, 13125 SW Hall Blvd Catch Basin Fire Supply Line i ] Please call for reinspection RE: J J Unable to inspect-no access ADA I Approach/Sidewalk qhkk; Other Dats _Inspector _Ext Final PASS PART F-AiL 1)0 NOT REMOVE this inspectio" record from the job site. \ CITY O TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT .4. . . . . . . : MEC99-0137 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 04/01/99 PARCEL: 2S114HC-04600 SITE ADDRESS. . . 10483 SW BONANZt:. WY SUBDIVISION. . . . : RTVERVIEW ESTATES NO. 2 ZONING: R-7 PD BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :083 JURISDICTION: TIG ------------------------------------------------------------------------------------- CLASS OF WORK. . :OTR FLOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :R3 VENTS W/O APPL.: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUEL TYPES--------------- 0--3 HP. . . . : 0 DOMES. INCIN: 0 :GAS 3-15 HP. . . . : 0 COMML. INCINr 0 MAX INPUT: 0 PTU 15--30 HP. . . . : 0 REPAIR UNITS: 0 FIRE DAMPERS". . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0 NO. OF UNITS---------- AIR HANDLING UN?TS OTHER UNITS. : 1 FURN ( 1.00K BTU: 0 <- 1.0000 cfm: i) GAS OUTLETS. : 0 FURN > =100K BTU: 0 > 10000 cfm: 0 Remarks : Installation of heat I glow gas freestanding fireplace. Connecting to existing gas piping. Owneri --------------------------------------------------------- FEES ANNE KNECHT type amount by date recpt 10483 SW BONANZA WAY PRMT $ 25. 00 DEB 04/01/99 99--314169 TIGARD OR 9722+ 5PCT $ 1.. 25 DEB 04/01/99 99-314169 Phone #: Contractor: FIRST CALL MCCALL_ HEATING R COOLING -------------------------- 1.650 -----------------------1.650 NE L.OMPARD # 26. 25 TOTAL.. PORTLAND OR 97211-4798 'hone #: 231 '11 Reg #. . : 102030 ----- - REQUIRED INSPECTIONS _. This permit is issued subject to the regulations contained in the Mechanical I n s p _ Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection applicable laws. All work will be done in accordance with Final Inspection approved plans. This permit will expire if work is not started J_ within 1Bf days of issuance, or if work is suspended for more than ILW days. ATTENTION.- Oregon law requires you to follow rules _.. adc,,ted by the Oregon Utility Notification Center. Those rules are _ set forth :n OAA 052-M-WO through OAR 952-M-M. You may obtain copies of these rules or direct questions to OUNC by calling _ t3e312�6-918T. Issue By : Permittee Signature : i - +.+++++++++++++++++++,++.++++.++++++++++*+++++++++++++++++++++++++ra•+++++++++++++-+ Call 639--4175 by 7:00 p. m. for inspections needed the next b-sinus day +4+++++4...............................+++++++++++++++++++++++++++++++*+++++h++ 11/04/98 WED 09:31 FAX 503 598 1960 CITY OF TIGARD X1002 RECEIVED CITY OF TIGARD Mechanical Permit Application ;gid /7,1 13125 13125 SW HALL BLVD.A�R (, 1 lqy(fommercial and Residential Date Recce TIGARD, OR 97223 Date to P.E. (503) 639-4171, x304OMMUNITY DEVELOPMENT Date to DST Print or Type Permit If Incomplete or illegible applications will not be accepted Called Name of Devebp nwWrgjW Description Table 1A Mechanical Code QtY price Ant Job SfeerAddm° surwr �- A) Permit Fee 10.00 Address ) ..� -'/ i 1) Furnace to 100,000 BTU ei-) Cxyisu1c includingduds 3 vents 6.00 T- 2) Furnace 100,000 BTU+ including duds&vents 7.50 Name(or none of buskieu) 3) Floor Furnace /1 /� Includingvent 6.00 (?Weer /T��?'z ,I f -� 4) Suspended heater,wall heater MakV ae Addre or floor mounted heater 6.00 r ti t, 5) Vent riot included in appliance permit C /State LpPrnM 3.00 % T'.3 c' lr CHECK ALL *Boiler Heat Air N me(or nam or busiwsa) ' TKNT APPLY: or Pump Cond Qty Price Amt Com 6) 'JHP;ab3orb unit to Occupant Mallln0Addfus 100K BTU 6.00 7)3-15 HP;absorb unit CMY/Sude Zip Phone 100k to 500k BTU 11.00 8)15-30 HP;absorb Contractor unit.5-1 mil BTU 15.00/ 9)30-50 HP;absorb unit 1-1.75 mil BTU 22.50 Prior to permit Mo"Address 10)>50HP;absorb unit issuance,a copy / ' J" Q.L,fir[�T7 >1.75 mil BTU t 37.50 pp j of all ieenses c Lp 11)Air hanuling unit to 10,000 CFM I. are required it t'i'Z—lesril!� �1�11/ �tl 4.50 expired In COT 0mgan cons.Cant.Board L" EXP.D&A 12)Air handling unit 10,000 CFM+ database ' " '-�Q - 7.50 Architect Nara 13)Non-portable evaporate cooler 4.50 or MaUIng Addreu 14)Vent fan connected to a single dud 3.00 •15)Ventilation system not included in Engineer G' "'° Ph0^a appliance permit 4.50 16)Hood served by machanlal exhaust Describe work to be done: 4.50 17)Domestic Inclnenldra New o Replace with 7.50 Reser Corn mercial O like kind. Yes u No O 18)Commercial or industrial type incinerator _ 30.00 Additional information or description of work: 19)Repair units L 4.50 e?s 20)Wood stove e!.`��CL '?c�/i'S �/I'✓� let l>� 4.L0 21)Clothes dryer,etc. _ 4.50 Type of fuel: oil O natural gas LPG O electric O 22)gMer units get 4.50 I hereby aduwwledge that I have read this appika tion,that the Information 23)13as piping one to four ouNts given is correct that 1 am the ov nor ur authorized agent of 2.00 the owner,that plans submitted ur r in compliance with Oregon State laws 24)More than 4-per outlet(each) Signab re of OwnedAgent Date :=3 1--- MiniinumPermit Fee$25.00 SUBTOTAL C� r 5%SURCHARGE Conbd PerM Nome Phar PLAN REVIEW 25%OF SUBTOTAL Z_-Z/llli 161 —Required for ALL comMemial permib Only TOTAL - 'State Contractor Boiler Certification required 1 j r, /i ..� Residential AIC requires site plan showing placement of unit CITY 4F TIGARD MAf:,TsR PET ITT DEVELOPMENT SERVICES C'FRIIIT i:1. . . . . « 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE T SSLIED; TTA" ADDRESS. . . . 10487, S14 I1DNA11gZA Wy L.113I)T.VI SICIN, . . : RIVERVTF.W 17 TATE'3 NC). 2 IUNIIUE,: R--7 PID I_0GN. . . . 1-07'. . . . . . . . « . . « . 0 B emarks: Alteration to storage space _._.... ----------------------------- BUILDINt ---------------------------------------------------- STORIES......... -__-.--_--_-------_-__....___-_------___-.-_-_..._STORIES....,..: ! FLOOR AREAS--..------- BASEMENT...s 0 sf REQUIRED SETBArXS---- ASS OF WORY.:41_' HEIGHT....,...: 0 FIRST....: 0 sf GARAGE.....: 126 sf LEFT.........,: 0 5NNE DETECTRS: t'DE OF USE...:SF FLOOR LOAD..,.; 48 SECOND...: 0 sf FRONT,...,.,..: 0 DARKINU SPACES: ME nF CONST,:SN DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT.........: 0 _7CLPANCY SK.:R3 BDRk: 0 BATH: Z TOTAL---.: 0 sf VALUE..I: 2.26 REAR..........: 0 ______—_.------------------------------_-__-___- PLUMBING -------- ——--------------------------__------ 'wS........., 0 WRTER CLOSETS.: 0 WASHING MACH .: 0 I.PUMIRY ?PAYE.: 0 RAIN DRATN ft: 0 TRAPS...... ... 1VATORIES.... 0 DISHWASHERS...: 0 FLOOD DRAINS.,: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS,.: 0 1B/SHOWERS.,.: 0 GARBAGE DISE..: 8 WATER HE.ATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS.. : 0 OTHER FIXTURES: ^ ------------------------- _11- _._ -----.-.GEL 'YPFS-------- FURN t 100K ,,: 6 BOIL/CMF' ( 3HP: 0 VENT FANS,....: 0 CLOTHES DRYERS: 0 FURY )-I00H ,.: 0 UNIT HEATERS.,: 0 HOODS.......... 0 O'TNER UNITS.,,: @ x THP.: 0 BTU FLOPIR rtl"r.FS: 0 VENTS.......... 0 WOODSTOVES...,. 0 GAS OUTLETS...: 0 ELECTRICAL. ___..-..__. RESIDENTIAL UNIT-..- ---SERVICE/FEET)ER--- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS-__ -.._--NISCELLANEQUS---- --ADD'L INSPECTIONS Me SF OR LESS: 0 0 - M alp.. : 0 0 - 200 alp..: 0 W/SVC OR FD'-'...: 0 /IRRIGATION: 0 PER INSPECTION, 0 a ADD'L 5W.: 0 281 4" alp.,: 0 201 - 400 alp..: 0 Ist W/11 SVv/FDR: I SIGN/OUT LIN LT: 0 PER HOUR......: Q MITED ENERGY.: 0 401 - E00 asp..: Q 401 - 800 asp..: 0 EA ADDL BR CM 1 SIGNAL./PANEL...: a IN F'LANT....... 4F HM/SVC/FDR; 8 601 - 1000 anp.: 0 601�asps-INM v: 0 MINOR t_t!BEt. -10t 0 I000+ asp/volt. : 0 --- --- ....... PLAN REVIEW SECTION --_-.,_...____..._.... ..-_-.._..__..__.... Reconnect orly.: 0 )=4 RES UNITS.,: SVC/FDR)=225 A.: ) 600 V NRINAL.: CLS AREA/SDC DCC: EI-ECTRTCN:. - RESTRICTED ENERGY ------------- SF _-_ __ __5"F Rf5IDKNTiAI_____.__._.__..___.__-_--_-.--- B. CmRCIR'1.--_---------------_._-------------------------.-_-__-,...__..----______..____.._ !DIO R STEPM VACUUM SYSTEM,,: AUDIO d STEREO,: FIRE AL.ARtM.,.,, : TNTFRCLV+/PAGING: OUTDOOR LNDSC LT, ,RiBLAR ALAR",.: OTH: t: BOILE'R........... MVAC.,.........: LANDSCAPE/IRRIGt PROTECTIVE SIGR_ =!tA6E OPf PR R.., ri.00if.......... , I%TAtMDATION: MEDICAL,........: OTHR: AC.,......,.,: DATA/TELE COPS',: NUM CALLS....t TOTAL N SYSTEMS: 0 ner; -____..___ _ _._-...._. ..__-.__--.__._..Contractor: _- -.._-_. 'OTAL FEES:4 10'.46 -AA XNECHT OWNER This permit is subject to the regulations contained in the '4A3 SW AONAN7.A WAY Tigard Mur;icipal Cede, State of Ore. Specialty Codes and all "OARD OR �3i?2E other applicable laws. All work will be done in accor•dam with approved plans, This peroit will expire if work is 'one 1: 624-ARI Rhone M: rot started within 180 clays of issuar.rr. if the work is Reg e..: 080000 si:spended for more than t8@ days, Oregon law ___.__.... .____..------..._......_..___ _..__....._...._... . _.._ .__... . '-quires you to follow rule; adoptee; L., Oregon Utility itificat:on Center. Those rules are set forth in OAR 952-001 X10 through OAR 552-001-2'.a9. Yoa1 say obtain copies :+ these rj es c" rect questions to 01M by ra'ling 'WIP46+ 1587. ----------------.----_-___..__.. ----—-------------—_. . AMIRED IttS';CCTIONS - --- __-.______..-_---____-.-----------_-_.--______.._ ec+,Tical Servi Elertriral 'Final ectri �' r Igh Final tnspect:on aging Insp fly -i- t 1 1 9 ,TY OF TIGARD Residential Building Permit Application Rec'd By &J ` 13125 SW HALL. BLVD. Alteration - Interior Remodel Only Date Reda r 61 t TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. V 503-639-4171 Date to DST 1L F 503-684-7297 Permit# -00-4-4D- Print ZPrint or Type Called Incomplete or illegible applications w"111 not be accepted Name of Project Name / Job �c�C Architect Marling Address Address Site Address I ,/ City/State "Lip Phone Name L/ �✓ Name Owner Mal�Iiln'Address City/ tate Ip on Engineer Mailing Address Ph General Q ' City/State %f Zip Phone Ne Contractor Describe work New O Addition O Alterationr Repair O Mailing Address / to be done: O Prior to permit /' Additional Description of Work: issuance,a copy City/State Zip Phone of all licenses are required f Oregon Const Cont hoard Exp Date PROJECT expired in COT Lic.# VALUATION database Mec'ianical Name —�� _— NEW CONSTRUCTION ONLY: Sub- Sq. Ft. House: Sq. Ft. Gare a Contractor Mailing Address -- _ /alp /7• _ Prior to permit _ Corner Lot YES NO Flag Lot YESI NO issuance,a copy City/State Z Phone (check one) (ch.ck one) of all licenses Restricted Audio/Stereo T Burglar are required if Oregon Cons ont.Board Exp.Dat© Energy System _ _ Alarm expiredin COT Lic.# Installation Garage Door HVAdatabaC Plumbing Name Opener _ Systems Sub- (check all that Other: Contractor Mailing Addmas apply) Will the electrical subcontractor wire for all YESNO restricted energy installations? Prior to permit City/State— Zip ore Has the Subdivision Plat recorded? N/A YE.S NO Issuance,a copy of all licenses are Oregon Const.Cont. Exp.Date — — required if Lic.# Solar Compliance expired in COT Calculation Attached database Plumbin c.# Exp.Date I hearby acknowledge that I have read this application that the information given is correct,that I am the owner or authorized Name — agent of the owner, and that plans submitted are in compliance wit;i Oregon State laws. Electrical ECS U��t/E�� gnature of Owner/Agent Data Sub- Mailing Address �y% -- e , d Ar Contractorp Contac Person Nam- � Phone City/State Zip Phone ,�•�`�� Prior to permit FOR OFFICE USE ONLY: issuance,a copy Plat#: (� Map/TL#: of all licenses are Oregon Const.Cont.Board Exp.Dale r - ` /61M required if Lic.# Setbacks: Zone Solar: expired in COT 1, C, ��`f- 0 R , database Electrical Lic.# Exp.Date Engineering A rdval Planning Approval: TIF: O� I:SFREM DOC(DST)5/1/99 Permit#: Address: ,o _S_GS .GWj2A_- /,rJi9 y_— i " J•' Issued by: _ Date. Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction pe,-mit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can he 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 3B: 1. I own, reside in, or will reside in the cornpleted structure. 2. 1 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 ------ (Na Contractor regis. # I will instruct my general contractor th subcontractors who work on the structure must be registered with the Construction CorKractors Board. OR �- 3B. I will he my own general contractor. If 1 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. '0000, ------ __4:- 2 -`fig W (Signature of permit applicant) (Gate) (White copy to issuing agency permit file, pink copy to applicant) Tnformation Notice to Property Owners About Construction Responsibilities ,�oJC. •1 Jif> !l1�,%%)J)t1('i'7! ',,:�fll."i J�1 Pi,'�u,� + lit 1.Iti l.. r., tllft'w i't itNi?[I( Jlott tfrt.'1Pon iirc fS if'1`'1'�'jlrl"1�'t�M. iq' C�(3!i 11�T1( 1)11 ( 1'�i7ll(:i! li f�Uil+rl ill rig 'r� i'1?�) 7(,/ 0 . EMPLOYM; RESPON"S181U t rtit; r. (,)�`e'lllni iioletyl�lint�t,l•. I,ict:, �•, u. „�, tl,. . ,t 1�l i�Ilt;r1,!• t'1,r Ih ' t;+v i', • �,. ,,!„ i ,,. Illi;1►1!i. IV 'i i' .1+111 1 Il (ti t l Id c" Ill!t' :Ii 1'i11`11't181+ .11 4 ids '{'�.'•.1 1�nrll.el��:' (•+mt1►cnticltii►n also!.n+c+': , (�I�(,IIIi .,+�I�t•IS . �'tlt�S:ll.!ht'•P IIf`1,llltl" " '� , '.� I' " �' `I�;.!Ilt „ige,1 '. IIIi14.�D, 19{ttl! illi !'h.".111+ICM il�11t•i1�lltlk'S�ltltl 1` 1111E IV;11�1,' f��f:111'�1,i11'll.�^•I� li ' • Imo;ftl!Ilii`tl t"l ifli'I"11 1��`I'llltl''t' 1i�!1' c',111 the W,tlk,,'I C'IitIlp. I Ii-• ti. 11igy 7fi R. Iliter 11al Revenue S('ryit:v: ph)'rl'i.V11.tLI IIIUli I,Iv {cI',!11 °tell'In,t't'•.' \\;1,1"t' vt'+ iIi11111' 111tthc 1Llh 11i1Vt'l1t:11t(",'C'fl t! ..+ .�;I!tlf!i;1..i'. !II• ':�'?In1(1 ftlC t.', I �! ! ��, .• I ti ;�'1.,'� �,! II1i' L1. ,;� .1 i;; 1i I;in at I X'10-82Y-1040. t4U. OTHER RESPONSIBU'ri::S AND AREAS OF CONCERN: codccF►mpliarlive: Ayllit' A°ti1111 �11+11 It'll +' II11'.1ni1i" {,bf+1i:1 'It"1'+1i1 1111('IIKIC'+11\111'1 101 .i!!IVIh't+ 11 FC tCIHII'I"11'1!111 I! '!?'' 1 1 111ill I11J\ I'L' i11!111J!11t to "(1111'illlct1111ti) 1111('11"'Ji 1114111 C11+N1� 1.fU111111 And property damage 1t1`UP:Iilt.c.- C ULILIL•t)tlUiIll%UtitllCl'Ak4C111 It you lea c i'U.iel.lUtllC ut�urutict. �+1\+'I11+_ 1t+t IIli! oilll"''I1111.`. `,UC11 t1" Ii.tll:llg to il" Ililitlt 1I\Ci'y(11i!\, \:i1't ;i,i iull ? 1"Ypfll (filly, Vlitll•tures, tut'. of Work Illtll tiiw�l hu 11i►ll' tn .'i11►i•I'tkv cul pltlli'4.%: Iwtat.-' �!!!i• \rU 1C!'.:' ,!Illlt ,•„i 111111• t.• �!1•...! ! .t' All c111111,�°.t'c' F'.R'p[`t't1�C' ��rt t` tilt i"�'(711 11.1'JC tltl'Ck�l'111 ti'I t 1 t1l't.'1'•`:t111f(1(Ctl!',Ch1•(IIi C('+ttt t A('1ilt Yry�"i1(t(fItT1:111"1111 vVi't� it(1'ltlli�h !U Jttt!t!i11 d, , + + c 1 C � nth r'r tnr(`1! itt. PrUI n . (! t.� "• ,!Ike 1f1 11111111' hi 110111P ►•1(!t"i;115 'at Iitl` ;i11(iti1111-i;lte tiitlt �!� t tl1: `< ('N11 rl t'F t7 l CI (v II `u li.l\t' :tIJt111R ttFll it111.4tP+11•., \ti11C i11 lilll 1111' ( 11Iltiitlit'tion( ontCI1GtUIS 11(lalit 11'I 1 Box 111111. slileill OR I �� �f 1 Iiv.Itli !� t,�<�ule(I :It ?t)tl �urtullrr tit. NI'. tiuile _(K), m Salem. ..I le h!i�lrt,uu i�nr1 1 1,l -- ,L aft 1 _ Ltn w _ ' o o N fAOpNI� -- --- •- - �.v-U-_.fit,_ :_.. . ---- �,��Or� I I I