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CITY OF TI' GARD
DEVELOPMENT SE=RVICES
13123 5W Hall Blvd., Tigard,('!1 97223 (503)639.4171
rl.,: Re�t1•'.
BUILDING
(TORIES........ c FLOOF AREAS--•_._____._ DAS KE`1T.... r 5F
EIGHT...,., .: 0 FIRST....s 0 sf GARAGE..,.. : C ;f LEFT..........:
C' '100R L^flD.... . 40 "COND.... 0 if " "',......., - --
OF CONST.:IN � .,' ,•,". FINB NT; 0 of MH .... 2
^""'fir, y 5K.:R; �lr, ��'�. 2 0 sf VALL'F..4:
PUMBINB
WATER CL077�.. ' WA"*MING NFC(`... 0 L*.',,PY TRAYS.. 0 RA I N D�'';N ft
M1 i/.Yl.r..NM �. MY.uNIM..rM I FLON DRAINS..: 0 SEWER LINE ft: 0 Sr RAIN rASI&,. d
NATFR HFA!I:RS.: P (AVER LINT fI: R KVr_6' : _ _... . ,
-
__..._.........__..._...__.._..._... MECltW]rAl _ ....
2 BOIL/CIS' i 3NP: 0 VENT FANS r.., c 1O76 DRYERS: Z
a .,,IT HEATERS... Q W+VD5......... . : r,';CR Ik;IT ... . e
0 F?'' �"-MR rURt,ACIS: 0 VENTS.........: a WOODD,TOV7S.... : 2 ;A5 7iITLET'
_..... ELECTRICAL
Sv.7 -CF - --T'-Mn SP',CirEEJE'RS--- -- DRANCH rIRC.1I'y- MITFL�tkw-MI'S- -r?uD'l. IN"
LM alp... 0 tc"0i alp... G W15UC ^1P FDR. r'U'W ,RRIrig TIOJ: C tR Tjr", !uJ;
'01 M yap..: 0 LICI - 400 amp..- 0 lst W'0 SVC`1R: I SI' rR UOUR..
00i 6Rt" aap., : 0 +0i 6VQ app.. EA O - [R IP: ;i
. '
Al !Kv dry,. : 0 6Plfalps-1000 0: 0 MI`:ri,
tDDr.e; ;.NDSC I.T:
RITE^;,TI'1E GIG'
1 THP;
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Plan Check 0
If OF TIGARD Residential Building Permit Application Recd By
SW HAIL. BLVD. New Construction Additions or P.Iterations Date Recd
.ARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E
1'3-639-4171 Date to DST O / -2 el-i i
13-6847297 Permit a ;41
Print or Type Called&Pel f -Incompleteor illegible applications will not be accepted
Jab [Name of prolec Name
I , ,
address Site Address
Architect Mailing Address
Name City/State Zip Phone
Owner Maiung Address Name
{
CtyrState En Meer Mailing Address
p
Name
City/State Zip Phone
General / ,l=.a nl (� t�ssrnbewom New u Aamtion v Ailefatiun iL Repair O
Ontractor Mailing Address to be done.
Additional Description of Wotk:
Cayistate Zip Phone
Oregon Const.Cont- Board Ltc.M Exp. pats �.•�.
tach Copy of
Current COT Business Tax o:Metro K Exp. Date PROJECT
LicrMnsea _ _ VALUATION $
Narnt+
Ichanical NEW CC1t45TRUCTlON ONLY: _
Sub- Mailing Address �� Sq. Ft House: Sq. Ft. Garage
ontractor Comer Lot YES NO Flag Lot YES NO
C.ryrState Zip Phone (check one) (check one)
Oregon Const Cant. Board Lic 0 Exp.Date Restricted Audio/Stereo Burgla
lath Copy of Energy System Alarm _
Current COT Business Tax or Metro a Exp pate — Installation y Garage Door MVAC
_1conses Opener Systems_
NameOpener
all that i.3ther ��
'lumbing apply)
Sub- Mailing Address Will the electrical subcontractor wire for all YES I NO
:)ntractor restricted energy installations?
prrstaro Z. ahona Has the Subdivision Plat recorded? NIA YE5 NO
gon CdnSt.Cont. Board L,c e I Exp. Date ReISSUe of MST# Solar Compliance
•�ch Copy of (Calculation Attached)
Current �F�lumoing L,c a �TExp Oate I hearby acknowledge that I have read this application, that the
tenses Information given is correct, that I am the owner or authorized
COT 9us�ness'ax or Metro d Exp Date agent of the owner, and that plans sutmltted are in compliance
------
.'4ame — with Oregon State laws.
_
Signature of OwnerfAgent Date
(ectrical
Sub- Ma-11T9 Address Contact Person Name Phone#
intractor
C,rytSrate Zip — Phone— — FOR OFFICE USE ONLY:
Plat w Map TL#:
Cregon Const. Cont. Soaro Lc0 Exp Date j l- ) G v
+ch Copy of � Setbacks: I Zone , Sol��:
Current E!ec'ncai L-c +M I Exp Date
tenses Engineenng Approval: I Planning -p—prroov-al: TIF
COT 3:1siress ax or Metro e I Exp Date
10L DCC (OS.) Si97
Permit aY Acct. Descntpion GO I WACGI Amount Amt. Pd. Bal. Due
e5+ MST Permit (BUILD) (UBUtLD4
LV
Plumb. Permit (PLUMB) (UPLUMB) 1
Mech. Permit (MECH) (UMECH)
ELC/ELR Permit (ELPRMT) (UELNMT) 5 U, S C�
� 3 ; b
State Tax (TAX) (UTAX)
BLDG: _ J L)
PLUMB
MECH:
ELCIELR:
Plan Check
MST. (BUPPLN) (UBUPLN)
Plumb: (PLUMB) (UPLUMB)
Mech:
(MECPLN) (UMEPLN)
CDC Review(BUILD) (CDCBLD) (UCDC)
CDC Review(PLN) (CDCPLN) ,V/A
Sewer Connon (SWUSA) (USWUSA)
Reimbur. District
Sewer Inspection (SWINSP) (USWINS)
Parks Dev Charge (PKSOC) N/A
Residential TIF (TIF-R) (UTIF-R)
Mass Transit TIF (TIF-MT) (UTIF-M)
Water Quality (WQUAL) (UWQUAL)
Water Quantity (WQUANT) (UWQANT)
Erosion Control Pmt (ERPRMT) (UERPMT)
Erosion Planck/USA (ERPLN) (UERPLN) _
Erosion PlancklCOT (EROSN) (UEROSN) - '----`�
Fire Life Safety (FLS) (UFLS)
TOTALS:
I'3FREMtit_00C (JST) M7
Y
1,
1
^�
Address:
u .F' Issued by: � 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 tale
following statement before a building pertnit can he issued. This statement a required
for residential building, electrical, ►nechanieal, and plumbing permits. Licensed
architect and engineer applicants, exempt,from registration tender ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Dill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
® 1. 1 own, reside in, or will reside in the completed structure.
P2. 1 understand that I must register as a construction contractor if the structure N sold ur offered for sale
before or upon completion.
t�l 3A. My general contractor is
tr I (Name) Contractor regis #
I will instruct my general contractor that all subcontractors who work on the structure must be
registej A with the Construction Contractors Board.
OR
® 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If 1 change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCA and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certif;o that the above information is correct and that I have read and do understand the Information
Notice to Prope ty O ners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency per►nit file.
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
r.
I'.:.0 I? J,ff11`�,..11: ! j r _ ,_115 Ui `.G , ii)I,I•,,I11,: il.'. r11•I: illtIll.: il1C i, •.�I l.la.
E:Ity PLOYER RESPONSIEIIL TIC-S.
rt ., .11�.ITIhn t., )rll5• � ,r1 ,1.,. .. ,iy, ,.,Il.l,�.t , ,;. „ � ,;�•, -�„�! ,.,�..�. .I. !,I.
V'-) ) t I, ,r,! lnt it,., ! .•i I, ,�,Itli'lll`` ('tit'!I if V Ili,11,U1�1 1, :,f.)II�; �V�,i7i1,�11E lip,t;lk tfnT11 1r.tp'I`at!(+1
I!! I; i,�o ;•(,r, t h �'I I t Il.".c'!111t' .tr '•t'� ;<(l�ll
1 sTr.'rill,ln5! ,
11; 01ilion ill di'.; 1)0palil)lt:rl 4A FJiml a 1 0'`
�'�,Irht r-s' l'.;llaltt•rl.:,lra�u tr4��ltl.,r'rk l • ! , � t7, ,, �� . . . , ,,�.., � � nhi:el
,� n.� .. i• It t { ii 1 11117`'{ Sm v;ir 179k~
S. fillet nal 1,4 Low. .`ll'C S ltt': I: IZ r
:i _ I_{• 1� 11�'lTlt'ir1.;'/`��
)i'lhic Illtthl r.).�
itt 1 8(04t29. IIt=11).
OTHER RESPONSIBILITIES AND ARE.raS OF CONCERN:
t trtll'1'fIr1T111#.tlPr, 'Il l 'I1,'t l:', (L,_1„_,�„ ,, ,' '�" ��t''�, I ,. I�_ 1';II1'.111� r;1;11sL ;l•ITI+'CIS ''I. _ i! „ n l_,
11ut1 n1.15 I,t ,rt'u' h: ,I , , ,:1' �Hn ntil nl !llr�,l l:;l� isr,la ,i;,rll.
t.iahilit; and ltrupt:rtr dainirue instirancv; C0111,1l,t`l)IJI Il leitM31II.iC it kill(ItI PtC tf yt'+u 11.1\;.'.,►dequd! IIiSUIill 10 III!
it,,,:ldt:llti :Ind (11111ti'ilUll.> IUt11 e0 kA1111tfl', licd` Uvej�ptat). %lI,awl lliliilave hurll Pip: pultltit es, to VI '�,Ilf). I'rl.%( 117 I
fC-li1�aU.
Time l0 %upt 1'lkv vlll )lo) .CUS: ADAC .1,1:.' ,,;,tl 1liiv0 •,IIt1i4i ill titnt' to "(lij1vt1 illi' \11111 elllvltilyv',S
V+tpt>t`;v.- MAt•im n-viae, o l:r!lli qf"l 1 rlt•'t nti Vow(')vrt gerieTr 11 crrniratetor,'tOcr+oHinavl,the wtltk of rrltlnh-iii and tinkl:
li:tdt- :11111 to 11001v f:Iriltltnp-tlfflc•ink At th0 apptoprithle 11mok so thev con poffomi tho fegttired ih4pectinng.
II}rt�tl hast . dlliti�trull ►lacstil,rl•. �1rrtc)Ir�a11 tl�r ( f,nsUuctit,n C'urnrac!or', t r.ard(N.) 13t,x 1,114(.),Salem
O?,r�1�i <>r}'1 1. The lir,:lyd I. If,rnit'tl ilr "t►O 5urnmrr St NF Sutte 3(X), in Salem.
�tn�•cllVtt.(1tT1•t
1/44
k
Permit k
Address:
l0
Issued by: , 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 they
following.statement before a building permit can he issued. This statement i.s required
for residential building, electrical, mechanical, and plumbing pertnits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Dill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
I I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
` before or upon completiou.
(� 3A. My general contractor is —
L—J (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board,
OR
3B. I will be 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 CCH 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.
( uture of permit applicant) (Date)
(White copy to issuing agency per►nit file,
pink copy to applicant)
I
Information Notice to Property Owners
About Construction Responsibilities
�r,ll i lil,' ill; r'h, life ,��;1111'. !N ��'�„� .1,11 , ., 1:1'1'11. Ir ,,h ;Irrr; bl Ir `i; fii11 C'.5
"' 11. '! ji 'r 111• /ti. ' I;'.fill; �1 r!, � 'f' : ��• ill. 1.. _ll�i i,/1 !'• rl��l ..
I,Itlt lil+ I � f.lt' i',,�,IAN�,rt. •.IiLI,� ��IP � I,1, ,- .�;:tlh�tl,ri '. .. IC! tl't'.;!'•. ul ��'1,.�f1'
EMPLOYER HIESPON,`IHILI l'WS:
11 I
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' I ill' Il;ltil: til It 11 t� �:�\ 11.i',1111•111 ,'�' '.1 II �..11. �!1!Il.' 'l I' III` 11 it ti Ali `Ili
II'111
I'orl I kot til,Rol virlilt, At Ill`'-rUCll
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: .;rl(; y1i,'ti nil I-,, nt,�..t. ! f. il!. . 1 ;, ,. �i .� I. � ;1•'1l',,111 ,! i �, i:� 1
rt+ltlis* t➢',,,i{ ,j: ,:1.111
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i1f Bill
t ..`). IIItC'1'fIJI ,tlCll'WICStr)ItL. , �1 I I•• ,� Ir, In.,'1 ,
It tilt lilt 1,1%, tl;Ic1111.11; , "1•I,, 1 :n . 1'1, :11111 tti till
(3T1-If_H FSC::;Ftl,,it 511311 i*fF; AND AR A( OF (,.ONCEf-4tj.:
1
II:..I 11.,1, I. �'1•I11,�1,1 ' .1 I 1 ,
I ,11, .;,III111�� ,,,;.It I.,_.I,, • , 11�.
I labilit;i 'mild prupertl damage iuvuralue; t',Iltlll"t I I tilt Ili",U1.111o,ai",ill W ler I Yt if I1.t11 :IClCtilldtti: Illtitil lilt
lilt '11, 111] 01111Sy11111', lliClt dS l:tllll)r 11•)14, I)MIlt U)'C'r41')Ii11, Noiir tlall ov IIC1ilI lilIle I?lllh.tUrC>. Illi l'1 Nif 'IL:1 '11'.I�1 I't
li 1.11'1 n.'• '
14114.'1?, SIff,cl'V141'CrI111111.1 4: INIAC SUrI.' )1111 IGIC'' ` IItI: wnt Iinw U` III`,I'\l t' 1ollf,('1111)1"1!`C4
UNpertisv: Make ziirevonhhrrIheokrieiiket,fm,iwl yottrown genua)contractor.rntoort4imtsthe%v,Irk(if nmph-ill anti tin! II
II I tt-, ,Inti Io nolily h)nitline Ilfrtcittla at the appropriate lima so they cam pet`rmrm the 1N"t�trirt ti inkrrl ttr,nv
Ir t.l lu Il.n.' cllhJrtir.n;tl c�uctitit)n4• )t rite of (:aii the Corle',ruction Contrac:lt,r5 ltoclrt.l wo flux 11140,Salmi,014 9-7 "1 ) 51!-. .
,o ;;''w- lrl'I I 'Clle N(1attl IN located at 700 Summer St. NI Suite 31101, In Salem.
I,;--q, thin')111.1
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CITY OF TIGARD BUILDING INSPECTION DIVISION �sT
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
—Date Requested O'2 / —AM PM _— BLD
Location_ _ (_�C- C)rfvl IOWA Suite — _ MEC
Contact Person � Ph y !!? PLM
Contractor —� Ph SWR
BUILDING Tenant/Owner _ —�- -~_�- ELC
Retaining Wall Y R— ELR
Footing —--
Foundation ACCeSS.
FPS
Ftg Drain _
Crawl Drain Inspection Notes SGN _—
Slab ------ -- -- - — - SIT
Post& Beam
Ext Sheath/Shear
Int Gheath/Sheaf "—
Framing _ -._.__�CC[L/L ✓i�ic:�,/c _�z' � JC'� � Zt �.�_� 1 [Lr
Insulation
Drywall Nailing --
Firewall
Fire Sprinkler t s e�YAIm i else .
Fire Alarm —
Susp'd Ceftin
Root
Mme, - --------- - — - ------
in
PART FAIL _ ---
PLUMBING
Post&Beam —
Under Slab
Too Out
Wan.r Service
Sanitary Sewer - -
Rain Drains
Final
PASS PART FAIL.
MECHANICAL
Post&Beam - - -- . - -
Rough In _
Gas Line
smoke Dampers
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 fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ j Please call for reinspection RE. V j j Unable to Inspect-no access
ADA
Approach/Sidewalk
Other Date S" � ' Inspector Y Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
5
APPROVED FOR CONSTRUCTION
CITY OF TIG_ARD e
PCf2PAIT l 0.h7SfS1.0305*SITE ADDRESS l/Gud Sw �j'�it•G,,,.�, �•
.s BY --- '_.. DATEI;y��
Z LIABI 17Y: The City of Tire rd, Oregon,or
its employees, shall not be esponsble for
M i d1screpancies which may aear hereon.
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R A F-,M F N T
JUL-21-97 MON 23 :26 MILES DOWNING 9683799 II P, 01
MILES DOWNING 684-1334
P.O. BOX 230972 968-5798 fax
TIGARD OR 97281-0972
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CITY OF TMASTERTPERMIT
III . . ' : MST97-02 87
DEVELOPMENT SERVICES DATE ISSUED: 07/18/97
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171
PARCEL: 15135DC-06700
SITE ADDRESS. . . : 116 :0 SW GREF_NBURG RD
SUBDIVISION. . . . : ZONING: R--4. 5
BLOCK. . . . . . . . .. . LOT. . . . . . . . . . . . . JURISDICTION: TIG
Remarks: Repairing staircase using alternate building design approved by Jim Fu4.
--------------------------------------------------------------- BUILDING ------- -------------------------------------------------- ...
REISSUE: STORIES.......: 0 FLOOR AREAS---------- BASEMENT...: 0 sf REGUIRED SETBACKS---- RF.OUIRED-- -- -
CLASS OF WORK.:RF..P HEIGHT........: 0 FIRST....: 0 sf GARAGE.....: 0 sf LEFT..........: 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD....: 0 SECOND...: 0 sf FRONT......... . 0 PARKING SPACES;
TYPE OF CONST. :5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 9DRM: 8 BATH: 0 TOTAL------: 0 sf VALUE..$: 600 REAR.......... : 0
--------------------------------------------------------------- PLUMBING --------------------------------------- ------ -- ---
SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LA'JATORIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS.. ; 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 2
TUB/SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS. : 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
------------------------------I------------------------------- MECHANICAL -..------------------------------------------------__ ----_--
FUEL TYPES-------- FURN ( IOOK ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: 0
FURN >=100K ..: 0 UNIT HEATERS..: 0 HOODS......... : 0 OTHER UNITS...: 0
MAX 14P.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....; 0 GAS JUTLETS...: 0
------ ---------------------------------------------------------- ELECTRICAL -----------------------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCE LANEOUS---- --ADD'L INSPECTIONF-
1000 SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp..: 0 WISVC OR FDR..: 0 PUMP/IRRIGi"ION: 8 PER INSPECTION; c
EA ADD'L 500SF.: 0 291 - 400 amp..: 0 201 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR...... ; E
LIMITED ENERGY.: a 401 - 600 amp..: 0 401 600 amp..: 0 EA ADDL BP CIR: 0 SIGNAL 11PNF-L...: 0 1N PLANT......:
MAW HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0
1000+ amp/volt.: 0 ------------------------------------ PLAN REVIEW SECTION ------,--------------------------
Reconnect only.: 0 1=4 RES UNITS..: SVC/FDR)=2c5 A.i ) 600 V NOMINAL. CLS AREA/SPC OCC:
----------------------------------------- --------- ELECTRICAL - RESTRICTEJ ENERGY -------------------------------------------------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL-------------------------------------------------------------------------
MID d STEREO.: VACUUM SYSTEM..: AUDIO t STEREO.: FIRE ALARM.....: IN1FRCOM/PAGI4G: OUTDOOR LNDSC LT:
BURGLAR ALARM.. : 0TH: :: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER.,: CLDCR.......... : INSTRJMENTATION: MEDICAL........: OTHR:
HVAC........ ..: i)ATA/TELE. COMM.: NURSE CALLS....: TOTAL N SYSTEMS: 0
Owner: ----------------------------------Contractor: ----------------------------- TOTAL FEESO 42.50
MILES DOWNING OWNER This permit is subject to the regulations contained in the
11600 SW GREENBURG RD Tigard Municipal Code, State of Ore. Specialty Codes and all
TIGARD OR 97223 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone t: 684-1334 Phone 11: 639-4171 X370 not started within 180 days of issuance, or if the work is
Reg 1..: 0N131 suspended for tore than 180 days. ATTENTION: Oregon law
_. -----------------.—- _ requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-M10 through OAR 952-291-0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503)246-1987.
------------------------------------------------- ------- REQUIRED INSPECTIONS -------------------------------------------------------
Framing Insp ---
Building Final -
Issued By : Permittee Signat ure:�
r-+++++++++++++++++-++ + +1, +++++++++++.4F+++++++++++++++++++++++++++1 +++++4 ++ 4
Call 639-4175 by 6:0 p. m. for an inspection needed the next: siness day
Plan Chock _ 7 � �-
r OW IGARD Residential Buclding Permit Application Redd ay
3125 SW HALL BLVD. New Construction Additions or Alterationso..te Recd - r
1GARD. OR 97223 Single Family Detached or Attached (Duplex , j,. Date to P E. 1-(1
503-639-4171 I '! Date to DST -7- I ir
503-684-7297 /1 ( ' Permit M
Print or Type ,i" called
Incomplete or illegible applications will not be accepted
Name of Protea Name
Job IL ,(�)
Address Site Address Architect Mailing Address
(, ")(;.' i .li:'t INISi4,ib d 1)
City/State Zip
Name
Phone
1 � \ i L l 5 O i,")%y'lV(n
Name
Owner Mailing Address
i1h. 8Ox
CityrState Zip Phone Engineer Mailing Address
T I C 1 7.21 (--it-',I i ' City/StateZip Phone
Name
General '., �_ Describe work New O Addition O Alteration O Repair
Sontraetor Mailing Address to be done.
Additional Description of Work:
c.ty/State Zip Phone f j'X , ' i l,n' 4 c
Oregon Const.Cont. Board Lac.• Exp. Date
attach Copy of
Current COT Business Tax or Metro+/ Exp. Date PROJECT
Licenses VALUATION
Name
Mechanical
NEW CONSTRUCTION ONLY:
Sub- Mailing Address Sq, FL House: Sq. Ft. Garage
Contractor Comer Lot YES NO Flag Lot YES NO
c•ryrstate Zip Phone (check one) (check one)
Oregon Const.Cont. Board Lic.M Exp.Date Restricted Audio/Stereo Burglar
Artach Copy of Energy System Alarm
:urrent COT Business Tax or Metro 0 Exp. Date Installation Garage Door HVAC
_,tenses Opener Systems
Name (check all that
Other.
Plumbing apply)
Sub- Mailing Adnress Will the electrical subcontractor wire for all YES NO
contractor restricted energy installations?
�^ryBtate t.o Phone Has the Subdivision Plat recorded? NIA YES NO v
Cregon Const.Cant. Board L.c.MI Exo. Date Reissue of MST* Solar Compliance
.;tach copy of I (Calculation Attached)
Current P!umcirg Lac. >r Date I hearty acknowledge that I have read this application, that the
L tenseExp.s information given is corTect.that I am the owner or authorized
cor Business Tax or Metros I Exo. Date agent of the owner, and that plans submitted are in compliance
-- -- with Oregon State laws.
Name Signagire,of Qw Agent Date
Electrical ,'/7 y' y
Sub- Mailing Aaaress Contact Person N Phone#
Cor tractor (
C•ty State Z:p I Phone — FOR OFFICE USE ONLY:
Plat>x MayplTUi
Cregon Const Cont Board L c.# Exo Date
+tlach Copy of ` Setbacks: I Zone: Sol
--urrent i E eancai L.c s Exo Date !�'
_,tenses � Frig!Iee�nr�g Aporoval: P! g �pproval: I TIF
iCOT 3us�ness�ax or Retro s I =xp Date
"::�FMCL DCC ZSTI i#97
Permit 0 Acct. Descrntpion COT WACO Amount AmL Pd. Bal. Due
MST. Permit (BUILD) (UBUILD� `
Plumb. Permit (PLUMB) (UPLUMB)
Mech. Permit (MECH) (UMECH)
ELC/ELR Permit (ELPRMT) (UELPMT)
State Tax (TAX) (UT.kX)
BLDG:
PLUMB.
MECH:
ELC/ELR:
Plan Check
MST: (BUPPLN) (UBUPLN)
Plumb: (PLUMB) (UPLUMB)
Mech:
(MECPLN) (UMEPLN)
CDC Review(BUILD) (CDCBLD) (UCDC)
CDC Review(PLN) (CDCPLN, N/A
Sewer Connon (SWUSA) (USWUSA)
Reimbur. District ( 1 ( )
Sewer Inspection (SWINSP) (USWINS)
Parks Dk�v Charge (PKSDC) N/A
Residenbal TIF (TIF-R) (UTIF-R)
Mass Transit TIF (TIF-MT) (UTIF-M)
Water Quality (WQUAL) (UWQUAL)
Water Quantity (WQUANT) (UWQANT)
Erosion Control Prmt (ERPRMT) (UERPMT)
Erosion Planck/USA (ERPLN) (UERPLN)
Erosion Planck/COT (EROSN) (UEROSN)
Fere Life Safety (FLS) (UFLS)
TOTALS:
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd,Tigard,Oregon 97223@8199 (503)639-4171 PLUMBING PERMIT
PE R lyl I T #. . . . . . . : PLM94-00L:''--1
4 DAIE ISSUED: 02/09/94
SITE ADDRESS. . .. : 11600 SW GRE ENBURG RD PARCEL. 15135DC-.06700
SUBDIVISION. . . . : ZONING: R-4. 5
13LOCK. . . . . . . . . . : LOT. . . . . . . . . . . . .
—------------------------------------------------------ -------------
(',LASS OF WORK. . !ALT GARBAGE DISPOSALS. . - MOBILE HOME Sr-,A(.,'ES. :
TYPE OF USE. . . . :SF WASHING MAC:H. . . . . . . : BACKFLOW P,REVNTRS. . -.
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . ..
t.( WATER HEATERS. . . . . . . CATCH BASINS. . . . . . . .
, IXTURES--------------- LAUNDRY TRAYS. . . . . . . SF RAIN DRAINS. . . . .
�a I NKS. . . . . . . . . . .. URINALS. . . . . . . . . . . . GREASE TRAE'S. . . . . . . .
LAVATORIES— — : OTHER FIXTURES, . . . .
IUP/SHOWERS....: SEWER LINE (ft ) . . . . : 11210
WATER CLOSETS. . : WATER L I NI-E ( ft ) . . . . -
1.)1 SHWA SHE R S. . . . : RAIN DRAIN (ft ) . . . . :
Remarks : New sewer line & tap to replace failed Bile
� jv)nere FEFS
LLOYD SHAW type amol-trit by date re(-1)1
11600 SW GREENBURG RD PRMT $ 30. 00 JH 02'/09/94
TIGARD OR 97223 5PLT $ 1. 50 JH 02/09/94
Phone #:
Contractors ---_----_.-------------_.--_-.-_-_
OWNER
Phone #: It 31. 50 TOTAL
Reg #. . :
REDUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if worst is not started
within 188 days of issuance, or if worilo is suspended for mote
than 180 days.
e r,m i t t a e S i g n a t 1.t r e
ssi-ted By :
- .
fori -
Call nnpection - -639-4175
City of Tigard PLUMBING PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit #
Tigard, OR 972.23
(503) 639-4171
Desaiption
I l tom a 51.E t"sGZFFlyaL%(LCr- ORS 814-21.610CITY PRICE AMT
Job - ��rata L� c1^1 z 13 FIXTURES
Address m --
7.50
vatory
I ub or I u ower Uomb.
aY-C) Shower Only
Xff— Water Closet
Owner 11 re as 5" G-rz �►3t�RG Rte, i wa ,er lT,F '
ge isposal— 7.50
-
_ (;-I Washing MaMne
Floor Drain 7,50
Water Heater - 7.50
-Laundry ry Hoorn ray 7.50
Urinal
erfixtures peG
.»
J
9 w
Contractor
MISCELLANEOUS
- �—
Sewer I st
Sewer-ea.Addit. 100 15.00
afar Service I st 100, 20.00 '-"
hereby acknowledge MTTFave read is app ca cion,that the Water Service ea. Addit. 200' 15.00
information given is correct,that I am the owner or authorized agent of
the owner, tftat plans submitted are in compliance with State laws,that I Storm h Rain Drain 1st 100' 30.00
am registered with the Construction Contractor's Board,that the number Storm 8 Rain Drain Addit. 100' 15.00
given is correct. (If exempt from State registration, please give reason
below) Mobile H,:.,ie Space 25.00
c ow Prevention
Device or Anti-Pollution Device 7.50
Any I rap or as o
Connected to a Fixture 7.50
Describe work new0--a33-it-ion-'U- alteration U repairCy— Calcfi Basin 7.50
to be done residential Q non-residential Q 40.00
Insp.of Exist. Plumbing per hr
40.00
roSpecialty Requested Inspections per hr
Existing use o �� `�� K c� in rain, singe amr
building or property dwelling 15.00
Residential ac w prevention
Proposed use of devices 15.00
building or property t� t�f^�c r
'(Except residentsai backriow
prevention devices)
NOTICE 'Minimum Fee*25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5%SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25%OF SUBTOTAL
COMMENCED. `-
TOTAL
Special Conditions -- -
Rate issued by,
hn'PLlMB7M7
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