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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: r l-)� -/,I _ 9- P.M. MST:,(, �.3
Location: 1 y ^. � �'�----�
sUP:
Tenant:— Suite: Bldg:? MEC:_
Contractor: Phone: �J PLM:
F`
Owner: _Phone: _ ELC:
ELR:
BUILDING !LUG fton't) PLUMBING MECHANICAL ELECTRICAL SIT SITE
Site Post/Beam Post/Beam Post/Beatn Cover/Service Sewer/Stonn
Footing K UndFUSlab Rough-In Ceiling Water Line
Slab r'ramin Top Out Gas Line Rough-In UG Sprinkler
Foundation Insu ation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Ihywall Storm Furnace Temp Service MISC.
Mi sonry Ceiling Rain train NC UG Slab
SI car/SheathFi_ r_ e SRklr/Alm CrawWoond Dr Heat Pump _ Low Volt
pprovect' Approved Approved Approved Approved
A ipr/Sdwlk o roved Not Approve I Not Approved Not Approved Not Approved
INA FINAL FINAL FINAL FINAL
M Call for reinspectioe D Reinspection fee of S _required before next inspection O Unable to inspect
L, �
lnspector.�—� —_ Date:_ 1 7 9 / Page —of
ii
CITY OF TIGARD 1'i'-43TGR PIFRiMII-
DEVELOPMENT SERVICES Ii FzrIIT #:. . . . , . . : M;T97-04r -
13125 SW Hall Blvd., Tigard, 913 97223 (503)639.4171 DnTF
'faF2CF'i.. : 1.r 1. B;.1-052'00
. 1. 15180 SW GL..ENWOOD (:T
'7'IBD 1.J I S 1 ON. . - FNC1t.EW(lOI) NO. 2' 70N Ir; "1 4.
IaL.Octl. . . . I.-OT. . . . . . . . . . . . . : 1.40 JUR1,3r)ICTION: fI(,
Penarks: Installing a deco
----------------------------------------------•.-------------------- BUILDIFG ----------------------------------------•---------------- -
nr1,SUE; STORIES....... : 0 FLOOR AREAS - -- BASEMENT...: 0 sf REQUIRED SETBACKS—— REQUIRED-----•-------
�S OF WORK.:OTR HEIGHT........: 0 FInST..... 0 sf GARAGE...... 0 s` LEFT........... 0 SMOKE. DETECTRS:
OF USE...:SF FLOOR LOAD....: 0 SECOND_,. 0 sf FRONT......... : 0 PAR'41NG SPACES:
OF CONST.:5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT......... : @
`ffF)NCY GRP.:R3 BDRM: 0 BATT: C TOTAL------: 0 sf VALUE..t: 3500 REAR........,.: 0
--- ---------------------------------------•--------------- PLUMBING --------------------------------------------------- ------------
5.........: @ WATER CLOSETS. : P WASHING MACK.. : 0 LAUNDRY TRq)'S.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
1TORIES.... : 0 DISHWASHERS...: 0 FLOOR DRAINS.,: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS,.: 0
/SHOMIERS...: 0 GARBArE D15P..: 0 WATER HEATERS.. 0 WATER LINE. ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
__ ---------- --------- ------- --- - -- MECHANICAL --------_----•----•-----•--------------••--------------------..-----.
"I_ TYPES------------ FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....; 0 CLOTHES DRYERS: 0
FURN )=M .,: a UNIT HEATERS.. : 0 HOODS.........: 0 OTHER UNI'S...; 0
INP.; @ BTU FLOOR FURNACES: 0 VENTS.........; 0 WOODSTOVES....: 0 GAS OUTLETS...: 0
ELECTRICAL -- ---------------------------- ---------------------------- -----
:SIREN?1AL UNIT--- ---SERVICE/FEEDER---- --TEMP SRUC/FEEDERS-- ---BRANCH CIRCUITS--- --- MISCELLANEOUS---- --ADD'L INSPECTIONS—
19 Sr' OR LESS: e 0 - 200 alp..: 0 0 - 200 alp..: 0 W/SVC OR FD;..,. 0 O-MP/IRRIGATION: d PER INSPECTION: 0
gDD'L 500 .: 0 201 - 400 alp..: 0 201 - 400 asp..: 0 1st W/0 SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
1 TED ENERGY. 0 40, F-00 asp..: 0 401 60Q asp..: a EA ADDL BR CSR: 0 SIGNAL/PANEL...: 0 IN PLAN 0
'IF HM/SVC/FDR: A Gel 1000 asp.: @ 6@i+asps-1000 v: 0 MINOR LABEL -10: 0
100@+ asp/volt.: 0 - -- --.____.------_-------------- PLAN REVIEW SECTION ----____..-----.._---.•--...._______......
Reconnect orly.: 0 )=4 RES UNITS..: SVC/FDR`=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
----- _ _ - ---- -- ....---- -------- ----- ELECTRICAL - RESTRICTED ENERGY -.---_--._--_.___-.._.-----------------------------..._
SF RESIDENTIAL--------------------------- B. COMMERCIAL------------------------------- --------------------------
"10 1 STEREO.; VACUUM SYSTEM..: AUDIO I STEREO. : FIRE ALAR"I.....: INTERCOMIPAGING: OUTD04R LNDSC LT:
,GLAR ALARM,.: OTH: BOILER........... HVAC........ ... LANDSCAPE/IRR1G: PR01E'.T1VE biuNl:
'CAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL......... OTHR:
......,,,,,; DATA/TELE COMM.: NURSE CALLS..,.: TOTAL # SYSTEMS:
err -..___ -..______---_---.. --_._..-...._.._.Contractor: ___.__...----_-_-___ _.-_-•.- TOTAL FEES:1 75.66
.A LETT RICK'S %STOP rEN('ING This permit is subject to the regulations contained :
'580 SW GLENIIOOD CT 4543 SW TV OIGHWA',' Tigard Municipal Code, Staia of Ore. Specialty Codes and a'.
ARD OR 91223 HILLSBORO OR 97123 other, applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
-;ne #: Phone #: 640-5134 not started within 180 days of issuance, or if the work is
Reg #..: 00N5@0 suspended for sore than 180 days. ATTENTION: Oregon law
___.____. ...._..___._._... . . ..__.....--__----_---.-.. _..___.__.__ requires you to follow rules adopted by the Oregon Utility
`ification Center. Those rules are set forth in OAR 952-001-0018 through %I 952-001-0@80. You say obtain copies of these rules or
oect questions to ODIC by calling (503)246-1987.
---------------- ------------------ RFM!IRF.D INSPECTIONS --•-----------------------------------------------------
)ting Insp
:ndation lrsp
awo Insp -
ilding Fina;
+:ed By : 1.�'1, '�_ _ f�ermit:t., o- igtat �.:r
(7 11 6:79 4175 r y F,. m. 4r, inspect ion needed the next L)1.:S i
Plan Check# ' f
CITY OF TIGARD Residential Building Permit Application Recd By '
13125 SW HALL. BLVD. New Construction Additions or Alterations Date Recd_ a •1
TIGAR. , CSR 972;3 Single Family Detached or Attached (Duplex) Date
V 503-639-4171 Date to DST Z 3 'y 7 Z
F 503-684-7297 Permit# ;J
Print or Type Called I - 41
Incomplete or illegible applications will not be accepted
Name of Project —� Name
Job V ),r 501 �c
((r!!
Architect Mailing Address
Address Site Address
lis-90 SW city/state Zip Phone —
Name 't
)S A- — `_ Name —
Owner Mailing Address /
City/State p 7 Zip Phone 7 Engineer Mailing Address
Generai
Na City'State Zip Phone
Contractor ` , . ` y« Describe work New u Addition O Alteration 0 Repair 0
Mailing Address �jj to be done_
Prior to penrnt 3 5I< ,y, Additional Description of Work:
1s3uance, a copy Cil /$rm t9 Zip P one
of all licenses r t 1 Y�O>, I; Yo-!4 7 y
are required if Oregon Const.Cont.Board Exp.Date PROJECT I
expired in COT Lic# VALA_T
database 3 (✓�f����-=
m-ChanicaI Name NEW CONSTRUCTION ONLY:
Sub- Sq Ft. House: Sq. Ft. Garage
Contractor Madrny Address _
Prior to permit Corner Lot YES NO Flag Lot � YES NO
issuance, a copy City/State Zip Phone (check ore)_ (check one) �_
of all licenses _ Restricted Audio/Stereo Burglar
are required if Oregon Const. Cont. Board Exp. Date Energy System _ Alarm
expired in COT Lic.# — --- —
database Installation Garage Door HVAC
Plumbing Name - Opener _ Systems
Sub- (check all that Other
Contractor Mailing Address apply) —Will the electrical s0contractor wire for all YES NO
_restricted energy instaiiations?
Prior to permit City/State zip Phone
issuance,a copy Has the Subdivision Plat recorded? N/A YES NO
of all licenses are Oregon Const.Cont.Board Exp Date — 1
required if Lic.# Reissue of MST# Solar Compliance
expired in COT _ _ (Calculation Attached)
database Plumbing Lic.# — Exp Date I hearby acknowledge that I haveread 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
with Oteg5Ln State laws
Electrical Signet of Ow�rr t Date
Sub- Mailing Addrese• — - —__ /� - i'/
Contractor — Conta )T-Cue-
rson Narnq Phone#
City/State Zip Phone T-Cue _ `_ !P S Y T `I
Prior to permit FOR OFFICE USE ONLY: _
issuance,a copyr _• Plat# ..� J E+ MeptTLX: I
of al,licenses are Oregon 7 mt.:nnt.Board Exp. Date � 1
required if Lic.# Setbacks. Y Zone: , Solar:
expired in COT I
dat.,base Ele,t,.cal Lic.# Exp.Date I Engineering Approval. Flenn n9�lpprovel: TIF:
I:F�FREM.DOC (DST) 4/97
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