10765 SW ERROL STREET a
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CITY C)F T!G A R D __ ELECTRICAL PERMIT
PERMIT#: ELC2002-00212
DEVELOPMENT SERVICES DA-1 1: ISSUEU: 5/13102
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S103AA-01703
SITE ADDRESS: 10 65 SW ERROL ST
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT : 002 JURISDICTION: TIG
Protect Description: Install 1 200amp/less service and 2 branch circuits.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPI!RRIGATION:
EACH ADU'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 . 600 amp: SIGNAL/PANEL:
MANF HSA/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amt;: 1 W/SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVCIFDR>=225 AMPS: _ CLASS AREAJSPEC OCC:
Owner: Contractor:
MICHAEL BRANNON WILSONVILLF ELECTRIC INC
10765 SW ERROL ST. FO BOX 845
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503-598-9580 Phone: 503-638-5353
Reg #: SUP 3854S
LIC 75752
ELE 3-307C
_ FEES Required Inspections
Type By Date Amount Receipt Rough-in
PRMT CTR 5/13/02 $93.60 27200"20000( Wall Cover
Elect'I Final
5PCT CTR 5/13102 $7.49 2720020000(
Total $101.09
This Permit is issued subject to the regulations contaMedin the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws
AH work will be done in accordance with appp1��ans Th�permit will expire if work is not started within 180 days of Issuance,or if work is
suspended for more than 180 ays. ATT ENTI Oregon 1�w ret,,rires you to follow rule,,adopled by the Oregon Utility Notification Center Those
rules are set forth in OAR 952 001.0010 th;C'
�OAR 952-001-0080 You a ay obtain copes t tht se rules ordirect questions to OUNC at(503)
2466699 or 1.800-332-2344. _ �J
Permit Slgnatlire:� t � \� __ Issued By: },
OWNER INSTALLATION ONLY
The Installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTAI.LATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: '� S —..
Cali 639-4178 by 7:00pm for an Inspection the next business day
Electrical Permit Application
Date received: -0 Permit not1Z,:
City of Tigard Iroject/appi.no.: Expire date:
CityajTigard Address: 13125 SW Nall Blvd,Tigard,OR 97223 Date issued: Bye 13 Receiptno.:
Phone: (103) 639-4171 ___ —
Fax: (503) 598-1960 Case file no.: Paymenttype:
Land use approval:
&2 family dwelling or accessory U Commercial/industrial J Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Other: __- U Partial
Job address: p '�,'" Cr`tflla ,�r no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: Subdivision: _
Project name: I Description and location of work on premises: LAj 1)g Ae J�,r,M rj.0A►.et
Estimated date of completion/inspection:
(ONTRACTOR
Job no: tee atm
name: t Description Qty. (ra.) 'Iulal no.incp
Business o:
--�� s�]/G- Ne,i residential-single or multi-family per
Address: Pig ,>k si�N eAellhngunit.Includcsattached garage.
City: �, Stale: 7.1 P: ���u I Servitelncluded:
Phone: 6 j .- rix• mail:
` Each additional 500 sq.ft.or p-u1wn thereof'
3
CCR no.: J j j e- EIcc us. lic.no: Limited energy,residential 2
C'it /tri tro .no.: Ara C ' 1 C. �- Limiledenergy,non-residential 2
� -1 3 Hall manufactured home or modular dwelling
/ ature of suriWising cic• nn(r uired) Dale ) ,, ScrvIce and/or feeder 2
Sup.elect.name(print): M Liccuscnno: Ser vices or feedr-ra-Installation,
alteration or relocallon:
2(x1 amps or lest 2
400
Nate a(print): al / (.i k--1— A)N�N 201 amps to 6W amps — 2
401 amps to 6(HI amps 2
Mailing;address: 601 amps to ux)onntps 2
City: State: LI P G� � tT.cr 1(11111 maps o votes - 2
Phone: Fax: E-mail ReconnedOnly
n
i Owns•Installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rem,or exchange according to Installation,alteration,or relocation:
2amps or less 2
JRS 44'',455,479,670,701. 200111 _maps to 400 amps 2
Owner's sl nature: Ditto: 401 to 600 ams 2
Branch Waits-new,alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit rV 2
City: State: LIP: R. Fee for branch circuits without purchase
I ". F.-mail: of service or feeder fee,first branch circuit: 2
Phone:
Each additional branch circuit:
111111AN REVIEW(Please check all that apply) Wt.(Sen Ice or feeder not Included I!
U
Service ovet 225 augn-conuuercral U lic;dth carefncnlii, Each pump on irrigation circle 2
U Service over 320 amps-ruling of 11 2 U HornrdoushKation Each sign or outline lighting 2
family dwellings U Building ov-,P10H)square k-1 four or Signal circuil(s)or a limited energy panel,
U System over 60()volts nominal more residential units in one sticture alteration,atexteminn' , J 2
U Ruilding over thrte stories U Feeders.4(X)amps or marc •D scri tion:
U(kcupant load over 9')persons U Manufacluted structures or RV path FA:h additional In-pecdon mer the allowable In any of the above:
U Egress/ighthngplait U otherPen i.pcol m _-E7=
Submit sets of plans r nth any of the above. hnvestigalion fcr
The above are not applicable to temporary construction service. other
Not all)unsdlc0nns accept credit cants,please call)utinliction for mem In6x7nmion Notice:'Ph9E>is permit application Permit Ice.................. ) $
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ $ _
credit c,sd number _ _. _ within 180 days after it has been State surcharge(9%) ....$
accepted as complete. 11Q
Nara.of cardholder as shown on cnedh cam
t•ardhol r signmlure Amount 4.10-4615 1WWOW
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
p Restricted Energy Fee...................................................... $75.00
Number of Inspcziions per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq ft or less $145.15 4 Audio and Stereo Systems
Each ar' Ilional 500 sq ft.or
portion thereof _ $33.40 1 Burglar Alarm
I-Imiled Energy $75.00
Each Manuf d f Jume or Modular Garage Door Opener'
Dwelling Sera ce or Feeder $90.30 _ 2
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,ahnration,or relocation
200 amps jr less $80.302 Vacuum Systems'
201 amps to 400 amps $106.85_ 2
401 amps to 600 amps $160,60 2 a
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2 — - ---
Reconnect only $66.85
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation
200 amps or less $66.85 2 Fee for each system......................................................... $75.00
201 amps to 400 amps $100.30 — 2 (SEE OAR 916-260-260)
401 amps to 600 amps _ $133.75 2
Over 600 amps to 1000 volls, Check Type of Work Involved:
sh Circuits"b"above. F-1Audioand Stereo Systems
Branc
New,alteration or axtension par panel L Boiler Controls
a)The fee foi ororich circuits
with purchnse of service or
feedor fee. Clock Systems
Each branch clicull $6.65_ 2
b)The fee for branch circuits Data Telecommunication Installation
without purchase of service
or feeder fe,a. Fire Alarm Installation
First branch circud $46.85
Lach additional branch circuit $6.65 _. ❑
HVAC
Miscellaneous
(Service or feeder not included) Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40_ _ Intercom and Paging Systems
Signal circuit(s)or a limited energy
panel,alterrdlon or extension _ $7500
Minor Labels(10) $125.00 Landscape Irrigation Control
Each additional Inspection over Medical
the allowable in any of th^above
Per Inspection _ $c7`-^ _
Per hour �.� $62.50_ Nurse Calfs
In Plant $73.75 ❑
Outdoor Landscape Lighting'
Fees:
Protective Signaling
Enter total of above fees $
Other
85;State Surcharge $ _
,f%Plan Review Fee Number of Systems
?e"Plan Re.fe N"section on $ I ' No licenses are required Licensees are required for all other installations
I.mt of application _
Total Balance Due $ Fees: -
Enter total of above fees = ,_
El Trust Account N_ -___
_ 8%Slate Surcharge $�
Total Balance Due $�
i:\dsts\rorms\elc-li cs.doc 10/091+.10
CITY OF TIG ARD 24-Hour
BUILDING r-ispection Line: (503)639-4175 MST —
INSPECTION DIVISION Business Line. (503)639-4171
BUP
Received _ Date Requested �_�AM - PI0 BUP — _ --
Location --- Z C 7 6' .5 ��L - � Suite MEC
Contact Person -'t-� Ph( ) PLM
—�i.-'�� --
Contractor — Ph(--) ` ' 3 'Z SWR
BUILDING Tenant/Owner ____�_- {�. ELC
Footing ELC -
Foundation Acc3ss:
Ftg Drain � - O-Jr-fy O F� 0 0 N Q_ � ELR
Crawl Drain SIT
Slab Inspection Notes , ,L r -
Post&Beam
Shear Anchors
Ext Sheath/Shear L-A-6. -
Int Sheath/Shear
Framing --- -- ------..--__- -_ ---Insulation
Drywall
Drywall Nailing - - -- �- -----"-
Firewall _____- — --
Fire Sprinkler --� 1-1--1
Fire Alarmw
Susp'd Ceiling `1
Roof
Other ----------Final
PASS
PASS PART FAIL
PLUM_BIN_G -
Posl& Beam
Under Slab - -- ----
Rough-In
Water Service - --- - --
Sanitary Sewer
Rain D•ains ------� `--
Catch Basin/Manhole _
Storm Drain - --- -- —
Shower Pan
Other.
----------- . _. --__- -
Othe ---.-
Final
PASS PART FAIL ----_- - _- _- — - -
MECHANICAL
Post&Beam
Rough-In - --- - ------
Gas
----Gas Line
Smoke Dampers ------- -- -- ---- -
Final
PASS PART FAIL 1 ---------
ELECTRICAL _ -- -- __------- - -- - -
Service
ab
Low Voltage -------- - ---- ---- -
Fire Alarm
F
jnpL u Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_ PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
DA DeAPPoech/Sidewalk Et---
Other:
Final DO NOT REMOVE this Inspection r000rd from the ddb sRn.
PASS PART FAIL
� C o�'Y �J� T I��R D CERTIFICATE OF OCCUPANCY
PERMIT#: MST1999-00271
DEVELOPMENT SFIVICES DATE ISSUED: 09/09/1999
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: LS103AA-01703
ZONING: K-4.5
JURISDICTION: URB
SITE ADDRESS: 10765 SW ERROL ST
SUBCIVISION: ECHO HEIGHTS FILE
COPY
BL0C:K: LOT:002
CLASS OF WORK: NEW
TYPE OF USE: Sr'
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME
REMARKS: S F PATH 8 - Final Building Inspection and Certificate of Occupancy Approved 4/4/00 by Ken
Schriendl, Building Inspector
Owner:
POLLOCK, DONALD F
1834 SW 58TH #202
PORTLAND, OR 97221
Phone:
Contractor:
FISH CONSTRUCTION NW INC
1834 SW 58TH AVE
SUITE 206
PORTLAND, OR 97221
Phone: 503-292-9891
Reg#: LIC 118233
This Certificate grants occupancy of the above referenced building or portion thereof and
confirms that the building has been inspected fnr compliance with the State of Oregon
Specialty Codes for the group, occupancy, and use under which the references! permit was
Issued.
;
r
BUILDING INSPECTOR BUILD0W OFFICIAL
L,
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION C-�' 1f?q7CO2 7�
24-HOUr Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested. AM PrA BLD _
Location Suite MEC _
Contact Person Ph PLM
Contractor Ph SWR
ILDI Tenant/Owner ELC
R uninq Wall ELR _
FO ^q Access:
Fou ation IK FPS
Ftg in SGN
Craw, rain Inspection Note —
Slab
Post& a - - ----- SIT -
Fxt She / ear
Int S'ieat ear L-7
Fram�� �
/Ia
ili
-. ----------
ler
ling
PART FAIL -- ----- ------- - ---—.-.- --
I'LUMBI
Pos!& Beam __-r_-__---
Under Slab
TopOut - ------------ ---------------------_-..---•------_.-_...--
ktMer Service
Sanitary Sewer - - -"-
R n Drains
C1 10-9 1
PART FAIT. _
CHANICAL --
Post& Beam -- ----•------ _-__- _._.-.-- __-_-.___-._-------..__-- -
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 [ ]Reinspection fee of$— — _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RF. _ .___- _- __ [ ]Unable to inspect no access
Fire Supply Line
ADA 7 ^ 5
Otheoach/Sidewalk Date G Inspector f i(,/T� _Ext.
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION �)���
24-Hour Inspection Line: 639-075 Business Line: 639-4171 -�
/J BUP
Date Requested_ `7 —AM_- PM V BLD
Location L� � ;' ^I�� ��" Suite MEC
Contact Person TL}�T _ Ph PLM — —
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS —
Ftg Drain SGN
Crawl Drain Inspection Notes: —
Slab — -- - _-----.... SIT
Post& Deam —
Ext Sheath/Shear
Int Sheath/Shear --
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _— 1
Root
Misc —
Final
PASS PART FAIL — --
PLUMBING
Post& Beam
Under Slab
Top Out -- -..----- ---------------
Wate, Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post& Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service _
Rough In
UGtSIab
Low Voltage
Fi Alarm _
PASS P RT FAIL —.--
sw
Backfill/Grading -- — ---+ -
Sanitary Sewer
Storm Drain ( )Reinspection fee of$--__ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RF;— — — ( Unable to inspect no access
ADA
Approach/Sidewalk Date Inspector Ext
Other __
Final
PASS PART FAILJ DO NOT REMOVE this inspection record from the job site.
FOR DEG USE ONLY
LAND USE COMPATIBILITY STATEMENT
FOR ON-SITE SEWAGE DISPOSAL SYSTEMS
APPLICANT'S NAME MAILING ADDRESS PHONE
�g02D `ay �UA�SNA,l��o�l 'Rf �7� - 07- 2
PITY—
STATE,06
ZIP
TOWNSHIP RANGE SECTION TAX LOT OR ACCT NO
0 to
2 5
1 �✓ 3 AA /703
0 C — — BLOCK CtUNTY
P A .;UBDIVISION/PROJECT LOT
E T
R 1 r G H N� i cil� ��'�Tio•. pflTL />�H/i✓IrTC�N
T o
Y N
PROPERTY IS A LOT OF RECORD CREATED BEFORE AUGUST 1, 1981.
PROPOSED LAID USE /
STATEMENT OF COMPATIBILITY FROM APPROPRIATE I,AND USE ATITHORITY
PROPERTY'S ZONING DESIGNATION
THE ABODE PROPOSAL HAS BEEN REVIEWED AND FOUND TO BE:
-�OMPATIBLE WITH THE LCDC ACKNWLEDGED CONSISTENT WITH THE
In ❑ STATEWIDC PLANNING GOALS
COMPREHENSIVE PIAN
OR
NOT COMPATIBLE WITH THE LMCNOT CONSISTENT WITH THE
❑ ACKNOWLEDGED COMPREHENSIVE PLAN ❑ STATEWIDE PLANNING GOALS
REASOINFfOR FINDING INDING Of COMPATIBILITY / INCOMPATIBILITY
Zone allvw:� S'n�je I•"'���'ly res ��n`��,I �5�
PRUPERTY IS LOCATED: (Check ane) INSIDE URBAN GROWTH BOUNDARY OU�DEBAN
❑ INSIDE CITY OUTSIDE CITY LIMITS ❑ GRIOARY
LAND USE AUTHORITY
F O11-12 q
DATE /
S l CANED
❑ CITY/COUNTY CONCURRENCE IF INSIDE URBAN GROWTH BOUNDAR'
TITLE DATE
SIGNED
(3/21/90)
MASTER PERMIT
CITY OF TIGARD PERMIT#: MST1999-00271
DEVELOPMENT SERVICES ORIGINALATE ISSUED: 09109/1999
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639 4171
SITE ADDRESS: 10765 SW ERROL. ST PARCEL: 2S103AA-01703
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT:002 JUF ISDICTION: URB
REMARKS: S F PATH 8
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 20 FIRST: 610 of BASEMENT: of L.FT: 31 SMOKE DETECTORS: Y
TYPE Oc USE: SF FLOOR LOAD: 40 SECOND: 718 of GARAGE: 324 of FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DW:LLINO UNITS: 1 FINBSMENT: of VALUE: $100,30C.48 RIGHT: 5
OCCUPANCY ORP: RS BORM: 3 BATH: 3 TOTAL: of
REAR: 99
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100
TRAPS
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: 2 GARBAGE DISP: I WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL --
FUEL TYPES FURN c`100K: I BOILICMP<3HP: VENT FANS: a CLOTHES DRYER: 1
GAS FURN>•100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOORFURNANCES:
VENTS: WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT. SERVICE FEEDER TEMP SRVCIFEEDER9 BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FOR: 1 PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 800SF: 2 201 400 amp: 201 4011 amp: let W/O 9VCIFOR: Or: 910NIOUT LIN LT:
PER HOUR:
LIMITED ENERGY: 101 •800 amp: 401 800 amp: EA ADDL OR CIR: SIONAUPANEL:
IN PLANT:
MANU HMISVCIFDR: 8111 1000 amp: 801•amDe•t000v:
MINOR LABEL:
10004 amp/volt: PLAN REVIEW SECTION
Reconnect only: >.4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
ELEc rRICAL•RESTRICTED ENERGY
B.COMMERCIAL
A.SF RESIDENTIAL
FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIONL:
GARAGE OPENER:
CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
TOTAL r EES: $ 3,953.33
Owner: Contractor: This permit is bubject to the regulations contained it the
POLLOCK,DONALD E FISH CONSTRUCTION NW INC Tigard Municipal Code,State of OR. Specialty Codes and
1834 SW 58TH 0202 1834 SW 58TH AVE all other applicable laws All work will be done In
PORTLAND,OR 97221 SUITE 206 accordance with approved plans. This permit will expire If
PORTLAND,OR 97221 work is not started witho 180 days of issuance,or If the
work is suspended for mc:a then 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to rollow rules adopted by the
Oregon Utility Notiflcat'.n Center. Those rules are set
Reg 0: LIC 118233 forth In OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion 844-8444 Post/Beam Mechanical Mechanical Insp Shear Wall Insp Appr/Sdwlti Insp Building r. :dl
Sewer Inspection Underfloor Insulation Plumb Top Out Gas Line Insp Electrical Final
Footing Insp Crawl Drain/Backwater Electrical Service Insulation Insp Mechanical Final
Foundation Insp Fooling/Foundation Dr1 Electrical Rough In Rain drain Insp Plumb Final
post/Beam Structura. PLM/Underfloor Framing Insp Water Line Insp Final Inspection
Z07'e-F�--
Issued Permittee Signature
Call (503) 6394f 5 by 7:00 p.m. for an inspection needed the next business day
CITYOP TIGARD Residential Building Permit Application � -
cPlan Check,
13125 SW HALL BLVD. New Construction Recd By
rIGARD, OR 97223 Single Family Detached Date Recd
Date to P.E.
V 503-639-4171 Date to DST�J
F 503-684-7297 Lel I- ( Permit# , 7.7(
Print or Type celled 1S=/1-44
Incomplete or illegible applications will not be accepted
Name of Project < Name
Job cpc A,0 A-I 4 f ? -----
Address Site A
-- - Architect Mailing Address
�� ddrs -i✓ n L S City/State Zip Phone
Name
420�'
1VAOILP E PSL c-4G K __. Name
Owner Mailing Address rA4
1`s
City/State
. Zip S Ahone Engineerineer Myiling Address
'7? LT tate
Zip Phone
General Name
Contractor V Describe work New I Addition O Alteration O Repair O
Mailing Address to be done:
Prior to permit Additional Description of Work:
Issuance,a copy City/State Zip Phone
of all licenses
are required If Oregon Const.Cont. Board Exp.Date PROJECT
expired In COT Lic.#
database VALUATION Is = -�—
MechanicalName NEW CONSTRUCTION ONLY:
Sub- 7 eb Sq. Ft. House: Sq. Ft. Garage �l
Contractor Mailing Address .3 L
Prior to permit Indicate the restricted energy installation by the electrical
issuance,a copy Clty/State Zip Phone subcontractor In the follow areas
of all licenses Restricted Audio/Stereo
are required if Oregon Const.Cont.Board Exp.Date Energy system _ Alarms
expired in COT Lie.# Installatiom. Vacuum Irrigation
databaseS stemS stem
Plumbing Name (check all that Other:
Sub- I F� /�, apply)
Contractor Mailing Address Number of Units In Building / Unit Number Designation
Has the Subdivision Plat recorded? NiA I YDS NO
Prior to permit City/State Zip Phone x
Issuance,a copy ----of all Huenses are Oregon Const.Cont. Board Exp.Date
required If LlcA
expired In COT _
database Plumbing Lie.# Exp.Date I hearby acknowledge that I have read this application,that the
Information j,,Iven Is correct,that I am the owner or authorized agent
of the owner,and that plans submitted are in compliance with
Name/7 Oregon State laors. _
Electrical 7- 61211/ Signature of wn .r/A ant D e
Sub- Meiling Address �+ L
Contractor
Contact Person Name hon #
/: -o L,t.
City/State Zip Phone
Prior to permit
Issuance,a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const.Cont.Board Exp Date pet#: Ma RL#:
required If Lie# p
expired in COT C/,U fl 11�� G`Jr � ;.51 , 34 - Q/7u 3
database Electrical Lie.# Exp Date Setbacks- Zone:
�? U
Electrical Supervisor Lie.# Exp Date Engineering Approval: Planning Approval: TIF:
WistsVormsWd-new doc 11120/98
I
WASHINGTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
SITE EVALUATION REPORT
(not a permit for construction)
CR#: 9v31-5 Dates of Inspection: G -7 Z — 19 cl
4pplicadon Date:
Tax Account #:
TOWNSHIP a�i� RANGE SECTION.� T.L. # G� .�
Applicant: A —) Saoer a'c rS Parcel Size/Dim.: 10i c.
J ___ __ Type of Dwelling: c!~•
Water Supply: _
An approved site evaluation indicates the above described property is adequate for the installation of one on-site
disposal system in accordance with ORS 454.605 through 454.755, the Administrative Rules of the
Environmental Quality Commission promulgated thereunder, the Washington County Code, chapters 12.12 and
12.16
An approved site is given on the basis that the lot or parcel described above will not be further partitioned,
divided or altered in any manner as prohibited by the Statutes, and Ordinances listed above. Any such division,
partitioning or alteration voids this approval.
„-&PPROVED� This location is acceptable for an on-site disposal system. See below for conditions.
Conditions of Approval: ,�
,;
DISAPPROVED: This site is unacceptable as inspected on the above date because of:
( ) Insufficient effective soil depth ( ) Excessive slopes
OAR 340-71-220(1) a OAR 340-71-220(1)d
( ) Pertnanent water table location ( ) Disturbed soils
OAR 340-71-220(1)(b) A OAR 340-71-220(1) e
( ) Temporary perched water table location ( )
OAR 340-71-220(1)(b) B Y.
Sanitarian's Signature: t'ti f'��Cc,r Date:
J:\..\env\wpshare\lindn\bsreport.dn�'(0-01-97,revised 06.04-98
WASHINGTON COUNTY
OREGON
June 30, 1999
A-1 Sewer Contractors
2207-A SE 135"' Avenue
Portland, OR 97233
RE: Your Proposed Septic System Installation
2Sl-3AA-1703
SW Errol Street
Dear Owner:
Recently, a sanitarian with our Department visited your building site to evaluate it for the
placement of an on-site sewage disposal system. As is indicated on the attached reporting forms,
the site was found to be in compliance with the Oregon Administrative Rules (OAR Chapter
340-Divisions 71 and 73), and as a result, a system may be installed on your property. System
specifications are listed on the attached report. Since this is not a permit to install your system,
information has been attached on how to obtain this permit. No system construction is to take
place until a permit has been obtained.
A couple of words of caption, developing a site for a residence usually involves heavy
equipment and considerahle earth moving. The area you proposed to install your septic system
should be kept free of this equipment and must not be altered in anyway. The proper operation
of your septic system is dependent upon this. You should also be aware that unless you install
your own system, your septic system installer must be licensed with the Department of
Environmental Quality, Our Department can supply you with the name and phone numbers of
those installers who work in Washington County.
Included with the approval report is a Land-use Compatibility Statement form. You must
complete this and have the appropriate land-use authority sign it before a permit will be issued.
If you have any questions regarding your approval or septic system in general, please feel free to
contact our office at 846-8722.
Sincerely,
Gerhard Matheis. R.S.
Environmental Health and Sanitation
GM:lye
F:\...\pmgnon.0indi0sitcmm.doe
Department of Health R Human Services
155 N First Avenue. MS 5, Hillsboro. OR 97124-3072
WIC Nutrition Pian:(5031848.8555 Adr -nistration&Planning:(5031848.4402 M.(5031848.8601
HeFthn Services:(503)8464M 1 Fax:Clinic(503)846-4522/Administration(5031846.4490 Environmental Health:(503)846-8722