13130 SW GRANT AVENUE N
1 � o '
v
I
PAC) L1 w c
1 i
I 1
.y/s'7"in.j G.
IC AGe ?
if
�xiST I NG
HOME I ��
�x �s'Ti vel G 4L r2 A I N tJ►2 N sT-`E
-- - - __
I
L N DIZ. I I VE
37 '
v�N e 11 C�r-t ,
I �
c7- I
_ 3
�
/1 ,
__._-.._..ALL
L-N AL (� iTi - om t r-O
D J<y-) t E G E L
I �"72 G �I T
c -f-1)
NOTICE: IF THE PRINT OR TYPE ON ANY I I I I ! i I ! f 1 1 T I !
r � � fl � l � � � � � � � l � � � 1111I- TrTr � rr-r r � � i � rllrrlltrfllll
I I I I I l i l I I I { III { I I � I � r Tr �111r�rrlrr{ I IIr1111 III III 1 1 1 1 1 1 1
IMAGE IS NOT AS CLEAR AS THIS NOTICE � Z 3 4 � � 2
IT IS DUE TO THE QUALITY OF THE _ _ N zg
ORIGINAL DOCUMENT E 6Z 8Z LZ 8Z 5Z � Z EZ Z TZ OZ 6i ST
9
L � 9T 5T � i ET ZT iT i F 8 L 9
lilllllll!hulllilllllllllllllllllllllll111 I { I. 111. 11 lllllll. 11U_ I11111{IIIlillll IIlillll Ilillllllllllllllllllllilllillllllllllll !illllllllllllll � 111llill l-IIIL(ll�llll. l111 � _ �� 11J1111���11 �
w
w
a
w
E
I
XS n Tc T
CITY O F T I G A R D MLCHANIGAL
DEVELOPMENT SERVICES PFRMIT
1312;,"SW Hall Blvd., Tigard,OR 97223 (503)6394171 PERMIT #. . . . . . . : MEC960407
DATE ISSUED: 11/25/96
PARCEL-: ES102CP01000
SITE ADDRESS. . . : 1.3,130 SW GRANT AVE
SUBDIVISION. . . . : NORTHTIGARDVIL-LE ADDITION ZONING: P-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :34
I----------------------------------------------------------------------
(',')-ASS OF WORK. . ,Al-T FLOOR FURN. . . . : 0 EVAP C001-ERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS... : 0 VENT FANS. . . : 0
OCCUPANCY (-,Rl:,. . :R3 VENTS W/O APPt: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL. TYPES-----------..-- 0-3 HP. . . . : Ib DOMES. INCIN: 0
: /GAS/ 3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTIJ 15-30 HP. . . . : 0 REPAIR UNITS: o
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . - 0
GAS PRESSURE. . . : 504 HP. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : I
FURN f 100K BTU: 0 <= 10000 cfm : III GAS OUTLETS. .- I
TURN ) =100K BTU: 0 > 10000 cfm : 0
Remarks -. Adding gas fireplace.
Owner: FEES
CONRAD SCHUBKEGE1_ type amount by date reept
13130 SW GRANT AVE PRMT $ 25. 00 ARA 11/25/96 96-286892
5PCI $ 1. 25 DRO 11/25/96 96-28689c-'
'TIGARD OR 97223
Phone #: 598-.1025
Contractor,: -
OWNS R
-------------------------
Phone #: $ 26. 25 TOTAL..
Reg 1 13125
REQUIRED INSPECTIONS
This permit is issued subject to the regulat inns contained in the Gas Line Insp
Tigara Municipal Cede, State of Ore. Specialty Codes and all other Post/Beam Insp
applicable izus. All work will be done in accordance with Mechanical Insp
approved plans. This permit will expire i' work is not started Misc. Inspection
within 180 days of issuance, or if work is suspended for more Final Inspection
than 18@ days.
inn
Call for inspection 639-4175
Plan Check 0
CITY 0M TIGARD Mechanical F irmit Application Reid By -
13125 SW HALL BLVD. Commercial and Residential Jate Recd _
TIGARD, OR 97223 Date to P E.
(503) 639-4171, x304 Date to DST
Permit 0 /l Uldw2 7
Print or Type called _
Incomplete or illegible applications will not be accepted
-- Name at o.r.wp;,%WPropa Description
c•I• !*1: I t 1 C^F '� Table 1A Mechanical Code - OTY PRICE AMT
Job so-.«Adai.ea styes A) Pemut Fee •0- 4. 10.00
Address
soda cairsi.ie Lp B) Supplemental Permit3 0.'
Narns for Marne of ousew"1 1.) Furnace to 100,000 BTU 6.00
Ownerind.ducts 3 vents
`� �ih!s --
Me"Adanss 2.) Fumace 100.000 BTU 7.50
incl.ducts a vents__
ch+srw.- Lp Pnoie - 3.) Fldor Furnace 6.00
incl.vent
Nam.,u name,Aa,sr»ss1 4.) Suspendel heater,wap heater 5.00
or floor mounted heater
Occupant Mary ACIMI S 5.) Vern not ind.i. 3.00
S >P 1 appliance peat
CAWState Zip Pnona 6.) Boder or comp.heat pump.ar cond. 6.00
to 3 HP;absorp and to 100K BTU
Name 7.) Boder or comp,heat pump.am,coed. 11.00
3-15 HP;absorp and to 500N'.BTU
Contractor Me"A"011a 8.) Boder or comp.heat pump.ar cond. 15.00
15.70 HP.absorp un',.5.1 rrd BTU
Ani copy of crt(,ua ria Phan 9.) Boper or oomp.heat lvr,p.*pond. 2250
Current Licenses 30.50 HP;absorp urd 1-1.715 mol BTU _
Orepa:Const_Ca*Boar!Lr-e E■p Darr, 10-) Boller or comp,heat pump,air cond. 37.50
>50 HP;absorp unit 1 75 mil BTU
COT&-si eu Tax or Meso t Exp Dad 11.) Air handling and to 450
10,000 CFM
ArchitectNae^' 12.) Au handling and 7.50
10.000 CTM+
Or Me"Ad"U 13.) Non portable ---- 450
evaporate cooler
Engineer ctyrstate zip I Priors 14) Vent fan connected-~ -� 3.00
to a ie Jud _
Desa*e wort New O AftmtjonX Repair O 15.) Venblabon system+not 450
to be done Residential O Non-msdentul O inchded in appliaanrx permit
Additional Descr-iption of wort 16) Hood served by
mechanic al exharni 4 50
17) Domestic mcverauxs _ 75C
E,cisprg use of - 18.) Convnerwt or ndusmW 30 00
building or Property.- ��f ---- --� - type incinerator _
19) Clothes dryers,etc 450
Proposed use of 20) Other units v 410 U
building or property
C Type of fuel-od O natural gas LPG O electric O 21) Gas pipaig one to four outlets 2 00 D
` I hemoy actnowiedae that I have read this appucztion,that the 22) More than 4-per outlet (each) 50
inforniatiot given is correct that I am roe owner or authorized agent of
the owner,that plans subrrutted are in compliance with Oregon Sate QTY.SUBTOTAL
laws. _ _ ---
Signature of Owne lAgent ` Date 'SUBTOTAL
5
/v 5`h SURCHARGEJ4 4
/(..-. ,��` . Imo/ _ / f ; t •;i �.ra,t . - -
Cortact Person Name Phone PLAN REVIt W 25%OF SUBTOTAL-
'tI -•r ./ ` --� C�J'; --- ---TOTAL �/f
J
tdstMechpmCdoc r. r 'Minimum permit fee is S25•54,;surtrtiarge
Rey 71%
CITY OF TIGARD
DEVELOPMENT SERVICES MASTER PERMIT
PERMIT #. . . . . . . . MST96-0126
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 11 /25/96
PARCEL : 2S 102CB--O I OVIO
S I 1 F* ADDRESS. . . : 13130 SW GRANT AVF=..
SL.IBIDIVISION. . . . : NORTHTIGARDVILLE ADDITION ZONING: R-4. 5
BLOCK. . . . . . .. . . . . LOT. . . . . . . . . . . . . ..34
Remarks: ADDITION 845 SO FT PATH I
_�- ------------------ ----------------- BUILDING ------- ---------------
REISSUE: STORIES... ...: 1 FLOOR AREAS-- ------- BASEMENT...: 0 sf REGUIRED SETBACKS---- REGJIRED------------
CLASS OF WORN.:ADD HEIGHT .......: 12 FIRST.... : 245 sf GARAGE.,..-: 0 sf LEFT..........: 28 SMOKE DETECTRS: Y
TYPE OF USF...:SF FLOOR LOAD....; 40 SECOND...: v, -f FRONT.........: 20 PARKING SPACES: 0
TYPE OF CONST.:5N DI4LLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 11
OCCUGANCY GRP.03 BDRM: 1 BATH: 0 TOTAL-----: 845 sf VALUE_1: 54638 REAR..........; 90
---------------------------------------------------------------- PLUMBING -----------------------------.------------------------------------
S1NKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 1 _AUNDPY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATrH BASINS..; 0
TUB/SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES:
--------------------------------------------------_ MECHANICAL --------------------------------------- -------------------
FUEL TYPES----------- FURN 1189K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 1 CLOTHES DRYERS: 0
/GAS/ / / FURN =I 00Y, ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAIL INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 2 WOODSTOVES....: 0 GAS OUTLETS...: 0
----------------------------- ------------------------------------ ELECTRICAL ------------------- ----•-------------------------------------
--RESIDENTIAL UNIT--- ---SEFVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- -- MISCELi_ANEOUS---- --ADD'L INSPECTIONS--
1000 SF OR LESS: 0 0 - 2N0 amp,.: 0 0 - 200 alp..: 0 W/SVC OR FDR..: 1 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L WSF.: 0 201 - 400 amp..: 0 201 - 100 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIM?TEP ENLRGY.: 0 401 F-00 amp.. : 0 401 - 601 0 EA ASDL BR CIR: 0 SIGNAI-/PANEL.. ,: 0 IN PLANT......; 0
MANF HM/SVC/FDR: 0 601 - 1.000 amp.: 0 601*amps-1000 .: 0 MINOR LABEL -10: 0
1000+ amp/volt.: 9 ---------------------------- -- --- PLAN REVIEW SECTION ---------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDA)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
--------- -----.--.---------------------------------- ELECTRICAL - RESTRICTED ENERGY ---------------------- -------------------------------
A. SF RESIDENTIAL-------------------------- B. COMMERCIAL-------- ---____------------- ------------------------------------------
PUD10 I STEREO.: VACLNIM SYSTEM..: AUDIO b STEREO.: FIRE ALARM_— INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM_: 0TH: ;: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER.. : CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC............ DATA/TELE COMM.: NURSE CALLS...,: TOTAL N SYSTEMS: 0
Owner: -------- - - -- ------------ -- Contractor: --------------- . . - - TOTAL FEES:$ 641.1'
CONRAP SCRIBKEGEL OWNER
13130 SW GRANT AVE
TI6ARD OR 97223
Dhone #: 598-1025 Phone I1:
Reg A..: JILL
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 Mill be done in accordance with approved plans. This permit will expire if work is not started w:th;n 1;80
days of issuance, or if work is suspended for sure than 180 days.
--------------------------------------------------------- REQUIRED INSPECTIONS -----------------------------------------..
Footing Insp Post/Beam Meehan Electrical Servi Electrical Final
Footing Insp Post/Beam Meehan Framing Insp Mechanical Final
Foundation Insp Underfloor insul Insulation Insp Buildir', Final
Post/Beat Struct Crawl Drain Gyp Board Insp Eresic^ Control
Post/Seam Struct Mechanical Insp Rain drain Insp
Pcr-mittep 5ignat r.rr-e : �2 ?Fi� 'IYyC Tssr.rer'
Call for- inspection - G39•-4175
CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT -
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 RESTRICTED ENERGY
PERMIT #: EL.R97--01C,2
DATE ISSUED: 06/09/97
PARCEL: 2S1O2CB-01000
SITE ADDRESS. . . : 1C130 SW GRANT AVE
SUBDIVISION. . . . :NORTHTIGARDVIL_.LE ADDITION ZONING: R--4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :34 .JURTSDICTN: TIG
F'ro.j ect De ser i pt i on : install burglar alarm
A. IRESIDENT IAL--- _.________-_ B. COMMERCIAL-_.__----.__-._-----_-___-.___-.----------------.
AUDIO R STEREO. . . : AUDIO R STEREO. . : INTERCOM R PAGING. . :
BURGLAR ALARM. . . . : X BOILER. . . . . . . . . . : I__ANDSCAPE/IRRIGAT. . :
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . . DATA/TELE COMM. . , NURSE CALLS. . . . . . . . .
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSU LITE!
OTHER: : : HVAC. . . . . . . . . . . . : PROTEC'TIOE SIGNAL. . :
INSTRUMENTATION. : OTHER. . : . .
TOTAL # OF SYSTEMS: 0
Owner-: --- - -- -- --- --... __- -----------------.._._ __..__._...... -- FEES
CONRAD SCHUBKEGEL_ type amount by date recpt
13130 SW GRANT AVE PRMT $ 40. 00 TAT 06/09/97 97-295655
TIGARD OR 97223 SPCT $ 2. O0 TAT 06/O9/97 97-29565
1_
I"ICYTIe #:
Contractor: --------------------------------------------------------------
BR I NKS HOME SECURITY $ 42. 00 TOTAL_.
8059 SW CIRRUS DR
------- REOUIRED INSPECTIONS - -
BEAVERTON OR 97008 Ceiling Cover Elect' l Service
Phone #: 641-0574 Wall Coven Elect' l Final
Reg #. . : 000444
This per0 ., issued subject to the regulations contained in the C � --
Tigard Municipal Code, State :f Ore. Specialty Codes and all o'her Permitee Signature
applicable laws. All work will be done in accordance with I
approved plans. This permit will expire if work is not started ; /J
within 188 days of issuanL;. or if work is suspended for more _
than IN days. I s S1.ied By
------------------ - ------ --OWNER INSTALLATION ONLY------ -------------__ _.._.._____
The installation is being made on property I own which is not intended for
sale, lease, or- 1"ent.
OWNER' S SIGNATURE: DATE
CONTRACTOR I NISTALLAT I ON ONLY-----
-- - - ----- -
' 1
16NATURE OF q_UPR. EI-EC' N: DATE:
LICENSE NO:
i Call for inspection - 639-4175
Community Development RE=STRICTED ENERGY EtF�'-TRICAL APPLICATION
13125 5W Ball Blvd. f ERMIT # c —
Tigard,OR 97223
Phone(503)639-4171
PAX(503)684-7297 DATE ISSUED_____ _
=Y TD,-) No. (503)684-2772
CITY OF TIGARD Inspection (503)639-4175 ISSUED BY
PLEASE COMPLETE ALL SECTIONS
1. LOCATIONOF INST. %LLATI N 4. TYPE OF WORK
( ��� S . w ��D_tL
ABdrm RESIDENTIAL—Restricted Enerrggyy Fee . . . . . . . . . 540.00
L,J oil
'1) (FOR ALL SYSTCMS)
City Stale "Zip Check Typ of Work Involved:
PERMITS ARE NON T RANSFt RAIR L ANI)NUN-REFUNDABLE AND EXPIRE IF WORK ElAudio and Stereo Systems
IS NOT STARTED WITI IIN 11M DAYS OF ISSUANCE ORIF WORK IS SUSPENDED FOR
180 DAYS. > Burglar Alarm
❑ Garage Door Opener'
2. CONTRACTOR APPLICATION ❑ Heating,Ventilation and Air Conditioning System'
ContractorRINKS HOME SECUR 'Y ALARM J� I ype ❑ vacuum Systems*
Address 8059 S.W.
CIRRUS DRIVE, BEAVERTON 97008 ❑
Date_ I __ COMMERCIAL—Fee for each system . . . . . . . . . Q,S1S1
(SEC OAR 91.8-260-260)
Property Owner_ Q Check Type of Work Involyg�;
Contractor's Board Reg. No. 044421 ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone # (503) 641--0574 _ _ ❑ Clock Systems
❑ Data Telecommunication Installations
3. OWNER APPLICATION ❑ Eire Alarm Installation
❑ HVAC
Print Owner's Name Phone No ❑ Instrumentation
Address ------ ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control'
City State Zip ❑ Medical
Thh Permit Is issued under OAR 918.320-370.This applicant agrees to make only El Nurse Calls
restricted energy Installations(100 volt amps or less)under this permit and to do the ❑ Outdoor Landscape Lighting'
following:
1. Only use electrical licensed persons to do installations where required.(Certain EJ Prote live Signaling
rrtidential and other transactions are exempt from licensing.These have ❑ Other
asterisks(•).All others need licensing).
2. Call for an inspection%lien all of the installations under this permit are ready
for inspection at 503-6394175. ❑ Numlxr of Systems
3. Purchase separate permits for all Installations that are not ready for inspection
when the inspector is out to Inspect under this permit. •No licenses are required. Licenses are required for all other Installations
4 Assume responsibility for assuring that all corrections required by the inspector -- —are done,and
5. Assume responsibility for calling for a final inspection when all of the S. FEES
corrections are completed.
The person signing for this permit must be the applicant ora person
a. Enter Fees $
authorised to bind the applicant.
b. 5% Surcharge(.05 x total above) $_
Signature
TOTAL $----�--
Authority if-other than applicant
ENERGAP.CHP
r
i
RECEIVFU
JUN o J 1997
COMMUNITY DEVELOPMENT
CITY OF TIGARD BUILDING INSPECTION DIVISION MS)T —
Date
BUP
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
Requested �� ,L( AM PM �_ BLDi
Locaticn /3Suite MEC
Col's V- S111� �<< 6-8/ _ L
Contact Person h Ph (P'7 q- U 4 PLM
Contractor _ Ph SWR _
C ..
UILRLW Tenant/Owner ELC _
Retaining Wall ELR
Footing Access:
Foundation FPS —__--
Ftg Drain SGN
Crawl gain Inspection Notes: -----^---
Slab cr SIT
Post& Beame77U�/
Ext Sheath/Shear '"
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -------_-----------
Roof
---Roof
Misc
in
SS PART FAIL ------- - - ---- -
L ING
Post& Beam ---- ---
Under Slab
Top Out - -
Water Service
Sanitary Sewer —i
Rain Drains
Final - - -
PASS PART FAIL _.
MECHANICAL
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 ( J Reinspection fee of —_required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( )Please call for reinspection RE: ( ]Unable to inspect-no access
ADA
Approach/Sidewalkf�
V �./
Other Date Inspector Ext
_
Final
PASS PART FAIL DO NO REMOVE this inspection record from the job site.
MASTER PERMIT
CITY OF TIGARD DATEIISSUED:•04/17/966-P112r~
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.9199 503 639-4171 PARCEL: 2S 102CP-01 tiaOQ
S ..x
1TE ADDRESS. . . : 1130 SW GRANT AVE
SUBDIVISION. . . . : NORTHTIGARDVILLE ADDITION ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :34
Remarks: ADDITION 845 SQ FT PATH I
_--_----------------- BUILDING ------------------•---------------------_— -.---- --
RU SSLE: STORIES.......: 1 FLOOR AREAS--------- BASEMENT...: 0 sf REQUIRED SEI8ACKS---- --
CLASS OF WORK.:ADD HEIGHT........: 12 FIRST....: 845 sf GARAGE.....: @ sf LEFT..........: 28 SMOKE. DETECiRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 21 PARKING SPACES: 0
TYPE OF CONST.:511 DWELLING UNITS: I FINBSRENT: 0 sf RIGHT.........: 11
OCCUPANCY GK,.:R3 BORN: 1 BATH: 0 TOTAL------: 845 sf VALUE..1: 54636 REAR..........: 98
--------�_�_� ------- ---------- ----- ------------ PLUMBING
SINKS.........: 0 WATER CLOSETS, : 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: @ CATCH BASINS..: N
TUB/bHMRS...: 1 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNIR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: @
--------------- - - - --- --- ---------- -- MECHANICAL -----------------•-------------------------..-_� ---- ---------
FUEL TYPES---------- FURN ! I00K ..: 0 BOIL/CMP ( 3HP: 3 VENT FANS.....: I CLOTHES DRYERS: 0
/AAS/ / / FURN :=100K ..: 0 UNIT HEATERS-: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 01U FLOOk FURNACES: 0 VENT 5.......... 2 WOODSTOVES....: 0 GAS OUTLETS...: 0
----- --- - - -- - - - - -- - - - - ------- ------ ELECTRICAL ----- -- --- ----------- ------- ------ - -- --
-RESIDENTIAL UNIT--- ---SERVICU FEEDER---- --TEMP SRUC/FEEDERS-- .---BRANCH CIRWIIS--- --- M1SCtLLANEOUs -- -ADD'L INSPECIIONS--
1000 SF OR LESS: 0 @ C% alp..: 0 0 - 200 amp.. : 0 W/SVL UR FDR..: 1 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 40@ alp..: @ 201 - 400 amp..: 0 1st W/O SVC/FDR: @ SIGN/OUT LIN LT: @ PER HOUR......: 0
LIMITED ENERGY.: 0 4@1 600 amp..: 0 4@1 -- 6@0 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PAWL...: 0 IN PLANT......: 0
MANE M1/SVC/FDR: 0 41 - 1@@@ amp.: 0 601+amps-1@00 v: 0 MINOR LABEL
I@W4 amp/volt.. @ - ---------- --------- --- PLAN REVIEW SECIIUN ----------- ---
Reconnect only.: @ )=4 AES UNITS..: SVC/FDR =225 A.: ) 60@ V NOMINAL: CLS AREA/SPC OCC:
__-_----------------------------— —__- ELECTRICAL - RESTRICTED ENERGY ------------ --
A. SF RESIDENTIAL-------------------- -- B. COMMERCIAL---------------------------------------------------------------------._ ..
AUDIO I1 STEREO.: VACUUM SYSTEM..: AUDIO l STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: OTH: :: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: I NSTRUMENTAI ION: MEDICAL........: OTHR:
"VAC...........I DATA/TELE COMM.: NURSE CALLS....: TOTAL N SYSTEMS: @
Owner: ------ --- ------ ----- -----Contractor: ------- - ------ -- -- TOTAL. FEES:1 615.50
CONRAP SCHUBKEGEL OWNER
13131 SW GRANT AVE
TIGARD OR 97223
PhG:ie 1: 598-1025 Phone LL:
Reg C.: JILL
This permit is issued subject to the regulations contained in the Tigard Municipal Lode, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. M is permit will expire if work is not started within 180
days of issuance, or if work is suspended for more than 180 days.
-- _ --- ------ -------- --------- REQUIRED INSPECTIONS --- -- -----
Footing Insp Mechanical Insp Rain drain Insp __-
Foundation Insp Electrical Servi Electrical Final
Post/Beam Struct Framing Insp Mechanical Final
Post/Beam Mechan Insulation Insp Building Final
Crawl Drain gyp Board Insp ��Errros�ilnCoontrol
I'ermiittee Signature s� �f � �JJ_C!X.��-�-� Issued BY
Call for inspection - 639-4175
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171 N
Jobsite Address: l3/3 o S w �'►-e,. �
Subdivision: _ Lot # Office lase Only
Contact Date / / Initials
Valuation: Result —
New Construction Only: (Square Footage) Planck/Rec # _
c���r P,�rmit # 41,2
House Garage: _ Reissue of
Map & TL # '-A
Corner Lot? Y N Flag Lot? Y N Zone
Owner:
,�� 15* Plat #
� u 6��_— — -
Approvals Required
Address. T_ _
Planning Setbacks _ Solar
---C- -----/—-- Engineering ——. -----
Phone � L_`� I 0 -1-1Z�1 Other
Items Pequired
Contractor:
/1�
� Subcontractors
Address Ott.) Truss Details
Other
Notes - -- ------
Phone: ( 1
Contractor's License
(attach copy of currant Oregon license)
Contact Name:
Contact Phone:
Subcontractors: Architect/Engineer:
Plumbing: -- _ Address
Mechanical:
(attach copy of current OR Contractor's License)
Phone. 1
JOB DESCRIPTION ill s9 _
Applicant Signature Applicant Phone number
Received by _- _ _ ___ _ Date Received.
H`bplidlh`I!!!Op
Permit ;$ Account Oescriptlon Amount Amt. Pd. Bal. Due
�5ff 12 Bldg. Permit (BUILD) a E8 023 D, w
Plumb. Permit (PLUMB) —`
Mech. Permit (MECH) -Z .2 3
G
SlInNX (TAX)
Bldg: / yy 1740 U
-i
Plumb:
Mech:
Plan Check (PLANCK) ;70
Bldg: /9U, u
Plumb:
Mech:
Sewer Connection (SVVUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-0
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water duality ;WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) a26
Erosion Planck/USA (ERPLAN) yet/�� V
Erosion Planck,/COT (EROSN)
6t2 . ;a
TOTALS: � .S/U• SU f lU-Z ,
Permit #: IL,j q(e 0/c_`'
- OF
X Address: �_
P
Issued by: L e: / 7 6:�''
'a03 --
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 he issued. This statement is required
for residential building, elerfrical, 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.
Bill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 38:
1. I own, reside in, or will reside in the completed structure.
2. I 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
(Name) Con' 7tor regis. #
I will instruct my general contractor that all subcontractors who work on the structui, must be
registered 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 I change my mind and hire a general contractor. I will contract with a contractor who is
registered with the rCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is Torre': and that I has e read and do understand the Information
Notice to Property Owners about Construction Resimirtihilit ies on the reverse side of this form.
�,,Y&21X &1W_k&qJ 17-
(Signature of perm(if applicant) (Date)
(White copy to issuing agency permitfile,
pink copy to applicant)
1
information Notice to Property Owners
About Co-istruction Responsibilities
Notr: This Information Noticf to Property Owners about Construction Responsibilities
was developed l»,the Construction Contractors Board in accordance with ORS 701.055(5).
if you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibtliurs and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons riot rcgisterl-d with the Construction Contractors Board to do labor ui constructing or assisting in the
construction or improvement of a residential structure,you will,in most instances,be ruled to be an employer and the people
you hire will be employees. As the employer,you Must comply with the following:
Oregon's withholding tax law: As an employer,you must withhold income taxes from employee wages at the time employee
are paid. Y( a will he liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the Oregon Dept.of Revenue at 945-9091.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information,call the Oregon>t?mployment Division at the Department of Human Resout-)e5
at 378-3524.
Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compensation Law,and MUM
obtain workers'compe.nsa.tion insurance for your employees. It you fail to obtain workers'compensation insurance,you may
be subject to penalties and will be liable for all claici costs if one of your employees is injured on the job. For more information,
call the.Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. internal Revenue Service: As an employer,you roust withhold federal income tax from employees'wages. You will be
liable for the tax payment even it'you didn't actually withholrt the tax. For more information,call the Internal Revenue Service
at 1.8110-k29-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder frn this project,you are responsible for resolving any failure.to meet code requirements i
that may tx brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures,fire,or work that must he
re-clone.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have they expertise to act as your own general contra.'.or,to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have adAi iondl queti'tions, write or cull the Construction Contractors Board&0 Box 141409 Salem,UR 97309-5c,.2,
-,03/378-4621). 'Che Board is located at 7(N)Summer St. NE Suite 31X1, in Salem.
pror-own.pm4
1 IN
i
r. ',(., IT . . .
. . . / 1CITY OF TIGARD DA7L IaDUED: 43/2
79G
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171 PARCEL;
;11a"IIVT^IOtJ. . . . s
1110'7[4T I GARD V I LLE F' DDITIOt4 ZDhdihlG: R- '+. r
?CI!.. . . . . „ . . , . . LOT. . . . . . . . . . . . . ..34
:aavks; ADDITION 615 SO FT PATH I ___----__-___.
---------------------------------- ------- BUILDING ----------------------------------_ ---------
E1GGl STORIES.......: 1 FLOOR AREAS-_-------- BASEMENT...; 0 sf REQUIRED SETBACKS---- REQUIRED..-----------
ISS OF WORt(.:ADD HEIGHT.......... 12 FIRST..... 615 sf GARAGE....... 0 sf LEFT..........: 5 SMOKE DETECTRS: Y
"E OF ME....SF FLOOR LOAD..... 40 SECOND...: 0 if FRONT......,..: 20 PARKING
7' CONST.:SN DWELLING UNITS: 1 FIr1AXNTs 0 sf RIGHT......... : 5
'iNCY GRP. :R" SDRM: 1 BATH: 0
TOTAL -s 615 sf VALUE.,t: 39766 REAP..........: 15
------------- - --- PLUMEING -----------------------------—---------------------------
---- --------------•----------------------------------- --
Q WATER CLOSE'S.: 0 WASHING MACH,.1 0 LAUNDRY TRAYS.: 0 RAIN DRAY ft: 0 TpAP5.........: 0
,:RIES....: 0 DISHWASf• E...: 0 FLOOR DR,AINS..s 0 EWER LINE ft: 0 SF RAIN DRAINSI 0 CATC4 BASINS..: 0
11OWERS...: Q GARBAGE DISP..: 0 WATEF HEATERS.: 0 ►,ATE? LIr)E ft: @ OCKFLW PREVNTRs 0 OTHEREFIXTURES, 0
MCCIM. I_AL ---------------------------..____..-___________..._..------_........__
.=L TYPES-- ------ FURN ( IMF ..I @ BOIL/CIS' ( 3HP: 0 VENT FANS....... I CLOT)IES DRYERS: 0
:A;/ / ! FURN '=100K ..: 0 UNIT HEATERS..: 0 HOODS.........1 0 M-H UNITS..... 0
,�Iy INP,; 0 BTU FLOOR FURNACES: 0 'VENTS.........: 2 WOODSTOVES....I 0 GAS OUTLETS...I 0
------------ ELECTRICAL ------------------------------------------------ --
__.__...
,C. IDENTIAL UNIT-_- ---SERVICE/FEEDER---- ---TEMP SRVC/FLEDERS BRANCH CIRCUITS- ----MISCELLANEfxIS - - AiiD'L iNSpE:TIDNS
^, OR :ESS: A @ �@@ amp..: 0 @ - 2@@ amp.. ; 0 W/SVC 0(, FDA..: 1 PUMP/IRRIGATION: 0 FSR INSPECTION:
TOTE 50®SF.: 0 201 400 amp..: 0 201 - 400 alp..: 0 1st W/0 SVC/FDR: SIGN/OTU' LIN LT: C PER HOUR......: @
NERGY,: 0 401 600 amp..: 0 40: 6@@ amp..: 0 EA ADDL BR CIR: 0 ;IGNAL�fANEL...: Q IN PLANT......: 0
0!/SV ' 601 - 100@ alp.: C 501+amps-1000 v: 0 W SEC LABEL -i@: 0 --
`,'; ,,.,��C:FDA: 0 P
1@@@+ amp/v;,lt.: 6 ----. .___.....__._. ____.._.___-_---.__-- pLAN REVIEW SECTION -----------------------..______
Reconnect :-ly.: @ >=4 RES UNITS... SVC/FDR)--22'W A. ) 600 V NOMINAL.. CLS AREAISPC flCCs
- ELECTRICAL - RESTRICTED ENERGY
_ ....._. . -.._-------
B. cert;'ERCIAL-. -____--------__-__---------- - �,
STEREO.: VACUUM SYSTEM ... AUDIO I STEREO.: 71RE ALARM.....: INTERCOM/PAGING:RIG: PROTEC?I';E IG: OUTDOOR LE SIh�ILe
LT:
'J.,.GLAR ALARM..: 0TH: .. BCI!ER.........: HVAC.......,... . LiRVDECARE/IR
"?RAGE OPENER..: CLOCK... INSTRLnNTATION: MEDICAL........: MR:
,",'AC ... ......s DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTDSI 0
TOTAL FEES: SI0.5F
JNRAP SCHUBKEGEL OWNER
::,Q JW GRANT fly,
:3ARD OR 97223
-`ire Ii: 598-1:425 Phone A:
Reg I.. : fe"
s ;emit is issued subject to the re;ulations uitained in the Tigt,., Municipal Cade, State of Ore, Specialty Codes and all other
Cr:icable laws. All work will he done in a_cordance with approved plans. This pereit will expire if 40r4 is not started within 194
..a,s of issuance, or if worN is suspended for more than 180 days.
REQUIRED IN"SMTIONS
.Jtir g insp - Mechanical Insp Rain drain Insp �.. -•------
,lation Insp Electrical Se+•vi Electrical Final --
st.'Beam Struct Framing Insp M,chanical Final ---
'r=_'.!Bean Mechu Insulation Insp Building Final - — —-
awl Drair Gyp Board Insp
m i t:i e D i rt.a t 1-t r-p : L.� ._ .._ _._._ _.__-_ _
� 1 : fret' n - 639 4175
Residential Building Permit Application
City of Tigard
1312.5 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: J 3 i'.3� `711
� Office Use Only
�` i' Q, I Lot # ��_
Subdivision• '� � -
3 7� V Contact Date / / Initials
Valuation: ' � / -- Result
New Construction Only: (Square Footage) Planck/Rec #
Permit #
House �' f _ Garage. _ Reissue of
Map & T Z—
FN
SI Z - n _
Corner Lot? Y Flag Lot? Y (N) Zone Plat # MOwner: � Coif I�l'�I7 't J --
1 r, ! fth , VI Approvals Re uq ired
Address: —
Planning Setbacks Solar
i Engineering _—
Other
Phone. ---
Items Required
Contractor:
Subcontractors
Address: — _ -- Truss Details
Other
No►es
Phone: _T—
Contractor's License # -
(attach copy of current Oregon licensa)
Contact Name
Contact Phone --
Subcontractors: ArchitecVEngineer:
Plumbing. ----- Address ---
Mechanical: -
(attach cop; of current OR Coritractor'.s License)
Phone:
JOB DESCRIPTION / - ---- --
Applicant Signature Applicant Phone number
11
Received by _ ( _ ' Date Received
Permit Account Description Amount Amt. pd.
Bal. Due
Bldg. Permrt (BUILD) _
Plumb. Permit (PLUMB)
Mech. Permit (MECH) ^7 1
Stab-Tax (TAS ,
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg: �
Plumb:
Mech:
Sewer Connection (S USA)
Sewer Inspection SP)
Parks Dev Charge (pKS&C)
Residential TIF MF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF MF-C;)
Industrial TIF (TIF-I)
Institutional 71F (TIF-IS)
Office TIF (TIF-0)
Water Quality ('NQUAL)
'Nater Quantity (WQUA.-4 T)
Fire Life Safety (FL c)
Erosion Carl Permit (ERPRIA T)
=rasion Planc!c'USA (ER?LAN) — '
Erosicn Planc!c'COT (ERCSN)
c I
TOTALS:
Permit#: MIZ51 61 !ak -
Address: -�3
Issued by: -1.`�101�l= 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 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 38:
1. 1 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 completion.
F-1
3A. My general contractor is (Name) Contractor regis. #
1 will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
S 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subco„tractors 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.
hereby certily 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 re%erse side of this form.
if
(Signature cif permit applicant) (Date)
(Whit(, copy to issuing agenc v pernit file.
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note: This lr{lortnation Nutii r to Property Owners about Construction Responsibilities
was developed by dre Construction Contractors Boar in accordance with ORS 701.055(5),
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contract( Board to do tabor in constructing ur assisting in the
construction or improvement of a residential structure,you will, in trust instances,he uled to be an employer and the people
you hire will be employees. As the employer,you must comply with the following:
Oregon's withholding tax law: A,;an employer,you roust withhold income taxes from employee wages at the time employees
are paid. You will he liahle for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the t lregon Dept, of Revenue at 945-8091,
Unemployment insurance tax: As an employer, you are required to pay it tax for twornployment insurance purposes on the
wages of all employecs. for more information,call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compensation Law,and utust
obtain workers compensation insurance for your employees, if you fail to obtain workers'compensation insurance,you may
In subject to penalties and will be 1;able for all claim costs if one of your employees is injured on the job. For more information,
call the Workers'Compensation Division a the Department of Consumer and Business 4ervicex at 945-7888.
U.S.Internal Revenue Service: As an employer,you mint withhold federal income tax from employees'wages. You will be
liable forthe tax payment even if you didn't actually withhold the tax. For more information,call the Internal Revenue Service
at. 1-8(x)-829-11)40.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for th i,project,you are responsible for resolving any failure to meet code requirements
that may he brought to your attention through inspections.
i.iability and property damage insurance: Crxttact your insurance agent to-,ee if you have adequate insurance coverage for
accidents and omissions such as falling tools,paint overspray, water damage from pipe punctures, fire,or work that must be
re-done.
Time to supervise employees: Make seine you have sufficient time to super iwe your employees.
Expertise: Make sure you have the expet•.ice to act as your own general contractor,to coordinate the work of rough-in and finish
trades, and to notify building officials it the appropriate times so they can perform the required inspections.
if you have additional questions, write or call the Construction Contractors Board(PO Box 14140,Salem,OR 97305-5052.
5031378-4621). The Board is located at 7(x)Summer St. NE Suite 3(X),in Salem.
prep-own.p M
1194
SEE 35MM
ROLL# 23
FOR
LnRGE
DOCUMENT