9567 SW JUBILEE COURT m
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CITY O F T I G A R D MASTER PERMIT
DEVELOPMENT SERVICES DATE SSUIED: 5/620044-001sU
RV
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171
!TE ADDRESS: 09567 SW JUBIL EE CT PARCEL: 2S111BA-07600
SUBDIVISION: JUBILEE PLACE ZONING: R-4.'I
BLOCK: LG T: 004 JURISDICTION: TIG
REMARKS: 108sf, addition.
_ BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SEI BACKS REQUITED
CLASS OF WORK: AC^ HEIGHT: FIRST: 108 sf BAbcMENT: of LEFT: S SMOKE DETECTORS. Y
TYPE OF USE: SF FLOOR LOAD: 411 SECOND: sf GARAGE.: sf FRONT: 20 PARKING SPAr ES:
rYPF.OF CONST: 5N DWELLING UNITS: I THRD aI RIGHT: 5
OCCUPANCY GRP: PJ BOF..+
,' BATHTOTAL: '06 of VALUS: 10,680 00 REAR: LII
PLUMMAG
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS RAIN DRAIN: rRAPS.
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAN DRAINS: CATCH BASINS.
TUBI.HOWERS: GARBAGE DISP WATER HEATERS: WATER LINES: SCKFLW PREVNTR: GREASE TRAPS:
MECHANICAL
OTHER FIXTURES:
°UEL"TYPES FURN<100K: BOIL%'MP<3HC: VENT FANS: CLOTHES DRYER
FURN>=100K: UNIT HEATERS: HOODS: OTHER UNITS
AAX INP: btu FLOOR FURNANCES VENTS: WOODSTOVES: GAS OUTLETS.
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUb ADD'L INSPEC1101,5
1000 SF OR LESS: 0 - 20n amp: 0 - 200amP: WISVC OR FDR: PUMPARRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 400 amp. 201 -400 amp: 1st VWO SVOFCR: IN, SINN/OUT LIN LT: PER HOUR.
LIMITED ENERGY: 401 800 ami. 401 600 amp: EA ADDL OR CIR: I'III SIGNAL/PANEL: IN PLANT:
MANL'HM/SVC/FDR: 601 • 1000 amp: 801+amps-1000% MINOR LABEL:
1000+smplvolt:
PLAN REVIEW SECT'JN
Reconnect only: -
>•4 RES UNITS: SVCIFDR>=225 A.: 600 V NOMINAL: CLS AREA/SPC OCC
ELECTRICAL-RESTRICTED 0NERGY _
A.SF RESIDENTIAL 8 COMMERCIAL
AUDIO L:,rEREC: VACUUM SYSTEM AUDIO 6 STEREO: FIRE ALARM: INTERCOWPAOING, OUTDOOR LNDSC LT:
BURGLARALARN: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTEC'rIVESIGNL:
GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
MVAC DAIAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: 70TAL FEES: $ 355.38
PASERO,MARK G+SHARON M OWNER This permit is subject to the regulations contained in the
9567 SW JUBILEE CT Tigard Murbcipal Code,State of OR Specialty Codes
TIGAR D,OR 97224 and all other applicable laws All work will be done in
accordance with approved plans This permit will expire
if work is not started within 180 days of issuance,or H the
work is suspended for more than 180 days
Phone: Phone: ATTENTION Oregon law requires you to follow rules
adopted by the Otegon Utility Notification Center 1 hose
Rea At: rules are set 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
Slab Irsp
Electrical Rnal
Final Inspection
Issued gv : ► Permittee Signature
Call (503) 639-4175 by 7:00 p.m.for an Inspection needed the next business day
i
Permit 4':
Is ied by mats: !1 D --
Statement: Information Notice to Property Owners
About Construction Responsibiloties
Note: Oregon Law, ORS 701.055(4). :• quires residential construction per init appli-
cants who are not registered N-ith the Construction Contractors Board to sign the
follotrring statei?iertt belbre a braiding pc,rmit can he issued This statc-ntent i.s i-equired
fire residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.0111(7),
need not sub..nil this statement. This statement will he filed 101h the permit.
I ill in 1h� -,11i1iropriate blanks and initial boxes I and 2,and either box 3A or 38:
T I I own, reside in,or will reside in the completed structure
1141 2. i understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
I I ",A. 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
311. i will be my own general contractor.
If i hire subcontractors, I will hire only subcontractors registered x%ith the Construction Contractors
Board. If 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 cf the
name of the contractor.
hercht certifc 111:11 Ilre abo%-e informaiiim ix correct:►nd that I leapt,read and dei nnderstclnd the Information
Notice to Prclperr� 01sners about ('4111str110io11 Resil"llsibilities cin the reNerse side of this form.
Lle
r4permit applicant) (Date)
4ign�atu'
While copy to Issuing agengy permit file,
pink cop►-to applicant)
Information Notice to Property Owners
About Construction Responsibilities
I'll is ht/nrrrrrltion ;%ofIf t• I,i i'rol?t rrl OII'I w I-.% uhout( 'mistructim? RI sl)(oilsihilities
,Wls deI:(,Ieq `d hlthe l on,kimclion t.'unlroctor� Rniu•d ill crt rordunr(• It ifh !.H. `01.05.)-(Sl.
II'\(,it ale its actin: Now t+\\II ctnitr;lttor to om,,truct a rle\\ home or make a substantial intpro\ement to an e\istink stru+.ture,
Null can prc\-,'lit many prob!cnr,by bcin;t ass arc of the ll llu\\Trig rr;pl-nsihilities and areas ofcorrcem.
EMPLOYER RESPONSIBILITIES:
If\ou hire Persons not registered \\ith the t'onstrtic Iion Con tractor,, Boar-.I to du labor I11 constructing., or ass is(Itit,, in the
Low4ruction or improvement of a residential structure.you\\•ill. in most Instances,he ruled to he an employer and the people
WI hire\\ill he cmployee! As the employer.you mtr;t comply Loth the following:
Ure�on'sa'ithhohlin�taxl:rw: Asancin ploycr,y(it lIli ustwith hold inconIetit xesfrom ernployecwagcsIII lie tiIneCot ployees
?ire paid. You\\ill be liable for the tax paynnvnts even if yotr don't actually \\ithhold the tax from your employees. Fur more
inl'urmaliitn,call the(tr.•t�nn L)cpt.crf(tcvenue,tr 't•3:�-SI►u I.
Unemployment insurance tax: As atl cmplr,y er. y•nl arc rlcquirc\I to Pr:, A LIN fur uncal -ill\oleo( in.ln ancc purlur cs on the
wagesel all employees. Fill-more infornlatitnt.4all the t trcg;un l:mPlo}Inenl Uepartmer t at 371+-.iS-1•1.
Workers'corrrpensation insuranc-: ,1 an emplt,y er,y 1u me,ul,Icct lu t:2c Urcg;t,n Vb'urkcr 'r',,,ng,rrtsation l_.a\s,and nntst
obtain\\crfkcrs'culnpcens;.ttinrl insuraner fur\,+ur cmpinyrc;. If\ru fltil to obtain\+rrker�':onlPcntiation insurahcc.\ulr rn<ty
he subjectit,penalties and"ill he liable forallcl,111.1Lt"Is ifunel,fyul'rernployec-<i,iniutctlnnlhclot), I ormorcinfortrletiun.
call the l\i\isit.rl :;,thr 0011.,1111,1 ril of C'on;ttrtter and ftusines tier\iic�ai<�,a5-7MgR.
U.S.Internal Rr\'enue tier ice: .\,;ill cn,ply`wl-, „1:nttl;l r,Ithhold 1,12 leral inctmnc ttl\ Ir++nl crf,plo ec~,'s\ag;cs. )"Ill a ill he
liahlcli,rthrt;lxpa}mento+ rnif-\t,+Illitln'r;Ictuallsssithln,ldtheL;l\ IolitI ,rclnitrogation,calltlie lnternalRcvellue1�ct•\lce
al 1-8004Z9-10,101
U•ll).
OTHER RE'JPONSIBILITIES AND AREAS OF CONCERN:
('odecompliant.e: !tIch,11 . ,{\ins; n\ Imlilt eIomrcicodcreyuirlrntents
thllI ntrt\ he hrtmigIlt!.' your attention Irl,ugzll nlspec 1,.•1.s
ialrilits and pruperl\ danra};c iny;rranrc: 1 1`.ltact\ton ulsuraltcl,j1pent u,;rc ifyI'll Ila\c;It1\•yu:tte Insarancc co\cragc for
;1�t Iden'`;and tarli�,`ilm•, ,Ik 11;11 lalling! Lt nl;,I'nirlt t,\ rTla\ \\ales larliagc from pipe ptml;Iures. fire. ,+r\sorl,that must tic
IC-d141c
Time tll tiuper vise e.rttpfoyee%- %like sure\ou't.l\; Srlt7iclr nt tirne t ;aper\iso.\ow-employees.
tl'•.1,11;'r-f 1;C! kl;tkL: Ilr '\ull h;t\t'1 R'e\glertlK'In acl Hs\t llf l `.\n LL'ltefill '(+I1IraCll+f-ll,t (,l,rdlllatt:thl'1':n,k t,f I I+LIkh Ill lllld l l::loll
undl•� and tl.ht,tifv building r,ffic•ia!`:at thr apprc,Ptiate times srrthev Iran perf�rrnl tote retplircrl in;p.tlion5.
II \t+ll h>1`.0;I,IdltionaI 1111 ,lll� 11.
`r,; , ' Ilt,'.I }. l'}if; lit?ar'11•, It,�.;11C�1 .It 'r1+1 `�III,IIIIt'I til N1 `Illtc 11111
I '�I
Building Permit Application FOR OFFIC.6,USE ONLY
('it%' ,►f T igjrd DateBe� PertnitN
13125 3W Hall t3hvd.,'Tigard,OR 97223 Plan Revie � bl Other Pcmut \�
Phone: 503 639.4171 Fax 503.598.1960 Dete1B �"
Inspection Line: 503.639.4175 Date Ready/by tori+ ® See Attached Cherklla for
Internet: www.ci.tigard onus Notified/Method. supplemental Informatlar.J\\
�y
YPE OF WORK REQL'IRF,D DATA:t-AND 2-FAMILY DWELLING
-- -- Permit fees*are based on the value of the work performed.
C3 New construction --_ -- ❑Demolition —_ _ Indicate the value(rounded to the nearest dollar)of all
9A Iditiocti'alteration/replaccmcnt Cl Other equipment,materials,labor,overhec,l, d the profit for the .0
work indicated on this application.
CATEGORY OF CONSTRUCTION . -
--- Valuation: $ d 6 Q
91-and 2-family cmellitigCommercial/industrial —
Number of bedrooms:
E3Accessory build•ng Multi-family
I ❑ Y
❑ Master builder ❑Other Number of bathrooms:
JAB 51TE 1NFORMATiON AND LOCATION — Total number of floors:
Job site address: _riv JR New dwelling area: /p8 square feet
City/State/ZIP
Garage/carport area: square feet
� �� 91>L� _ _ �+
Suite/bldg./apt.no.: Project name: Covered porch area: square feet l
Cross street/directions to job site: C �'/�/�N,t�[i/ Deck area: _quare feet �.
Other structure area: square feet
_ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: J/�6,��. ,�,�.� Lot no.: y' Permit fees*are based on the value of the work performed. �.
Indicate the value(rounded to the nearest dollar'of all
Tax map'parcel no.. 17 1rlllz ' -071<M _ equipment,materials,labor,overhead,and the profit for the
t)ESCRIPTION OF WORK work indicated on this application.
Valuation:
1---- / - y -a-✓—� J l----' S
Existing building area. ;quare feet
- — --— New building area: square feet
—PROPERTY OWNER ❑ TENANT —_ Number of stones: — ,—
Name: / /;, - �,-�.., j��Yj ' ----- Type of construction: --
Address: �S'D-7 !�. J�/moi/rr ll _— Occupancy groups:
City/State/ZM :r q,•i / Existing
--- -
Phone �),�� ��/ t; Fix:( ) Ncw: ---
f APPLICANT CONTACT PFRISON NoTiCE
Business name: _ - All contractors and subcontractors are required to be
1 licensed with the Oregon Construction Contractors Board
Contact name: /A�ftunder ORS 701 and may be required to be licensed in:he
Address: 9.:cfl fkr ��`j�(�/ ['1 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZII': r/./ �-�n1J >!J a ply: _--
Pbane:l e ) !'- i Fax:: —
E-mail:
CONTRACTOR -- -- -
Business name: 2 „ G , �F•A%r' BUILD:N(; PERMIT FEES*
Address: Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone:(J��) -r �/ Amount received
CCB lic.: �j% - _ __ - - Date received:
Authorized signature: 1pe�r:-,�Gy' This permit application expires If a permit Is not obtained
within 180 days after It has been accepted as complete.
Pant name: — _ i�Date: " Fee methodology sel by Tri-County Building Industry
Service Board
i\Bmlding'Penniu%BUP-PemiuAppdoc 12/03 4404613T(II/000MM90)
One- and 'Fivo-Family Dwelling
BuildinLy Permit Application Checklist 1
City of Tigard 7A. ,d
Permit No
13125 SW Hall Blvd.,Tigard,OR 9727.3
Phone: 503.639.4171 Fax: 503.598.1960 rmits:
24-Hour inspectionLine: 503.639.4175 G Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us L❑ Other
I Land use act Ions completed. See jurisdiction criteria for conc•un ent reviews. ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc, ❑
3 Verification of approved plat/lot. ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity _
6 Sewer permit. _ ❑ ❑
7 Water district approval. _ _
8 Soils report. Must carry original applicable stamp and signa ,.e on file or with application. ❑
9 Erosion control ❑plan ❑permit required. include d-•:,cage-way prote.tion,silt fence design and location f"catch- �] ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing col ,.-mance to applicable local and state
building codes. Lateral design details and connections must be incorporr.:d r.;:o the plans or on a separate full-size
sheat attached to the plans with cross references between plan location and details. Plc r review cannot be completed if
copyright vtolations exist.
I i Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway; footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
and location. _
13 Floor plans. Show all dimensions,room identificat, ri,window size,location of smoke detectors,water heater, ❑ ❑
furnace ventilation fans,plumbing fi>Aures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
constniction. Show details of all wall and roof sheathing,routing,roof slope,ceiling height,siding material, footings
and foundation,stairs,fireplace construction,thermal insulation,etc. _
15 Elevation views. Pr,-ide elevations for new construction;minimum of two elevations for additions and remu,:,ls.
Exterior elevations must reflect the actual grade if'he change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- �]
prescriptivc_path analyt is provide specifications and calculations to er incerin�standards.
17 Floor/roof framing. P-ovide plans for all floors/roof assemblies,indicating member siring,spacing,and bearing
locations. Show attic ventilation.
I8 Basement and retaining;walls. Provide cross sections and details showing placement of rebar. For engineered L ❑
s -terns,see itenm 22,"Engineer's calculations." _
19 Bes n calculations. Provide two sets of calculations usiag currew code design values for all beams and multiple joists
over 10 feet long and/or any heam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑
21 Energy Code compliance. Identify the piescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e,shrar wall,roof truss)shall be stamped by an engineer or ❑ Li
architect licensed in Oregon and shall be shown to be aliplicable to the project under review.
23 Five(5)site plans are required for Item I I above. Snc plans must be 8-1/2"x 11"or l I"x I?". #TT#:]
24Two(2 sets each.re required for Items IG, 19 20 and l2 above. ❑
25 Building laps shall not contain red lines or tape-ons. "Mirroted"building plans will not be accepted.
26 "Reversed"buildplans must meet criteria outlined in the Permit&System Development Fees document.
27 "Drawn to scale"indicates standard architect or engineer scale.
28 Site plan to include tree size,type and location pet approved project street tree plan(if applicable),and City of Tigard �]
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. �
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions,
including decks,patio covers(over nun-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior tL September 9, 1995.
1:\Building\Permits\One-Two-FamilyChecklist.doc 12/03
Electricai Permit Application FOR OFFICE USE ONLY
City of Tigard
Date 13,
Date Fi
131 111'Halt Blvd.,"regard,OF 9- flan H:,Ic•, I)tberl'vrnnl
Phone 510 614 4171 Fax 503?'I� •, - I)aI)atc�H_,_.�
Ins ectlnnIate 503.6394115 -- ® tint1age.lar --~
p i Ua'c I�aJ, t4. lues j • +
intamcl sv',vsv cl tigard or us `\o111ica Mvth„dufl''li�n) nod(n(nrmaimit
TYPE OF WORK � PLAN REVIEW —�
❑ NC%kr constructio �'n Addlhomalterauon v.,rlaccnient ( Please check:II that:,ppl%
❑viers Ice over 225 amp
Demolition ��_Otl,er
s,cumm'I []II lazurduua h,cunon
❑ _ _
❑tier\Ice,,,er 320 amps rating ❑B ,.uildn;over I uU sy It.
CAT6GOR`ti CONSTRUCTION „I I-.Ind_ lumpy dsvellntgs 4 or more tics\ residenilul
I-air
d 2-family dwelling [I Commercial Industrial ❑ Accessory building ❑S%steni over 000 volts nominul units In one structure
❑Building over three stories Feeders,400 unps ur more
ElMulti-family C3 Master builder ❑Other ❑1)ccupanl load over 99 persons ❑�IJlt ll tal'lUl'ed alt lll'h fees ill'
JOB SITE INFORMATION AND LOCATION ❑1.gress,lighting piun RV pu'k
❑Ilculth-care tacility ❑Other
JrI no. Job site address: ?��' sd�� �u�i�jt �' 1 -` - --
I---- _
Submit�srt�ufpluns\nth u,y utthc uhtrvl:
City/StatclZIP: �� /,/ �T j J ']'he uhuvc ue not apph\able to tenipulun runsnuruun sets Ice
FEE" SC'HEKLE
Suite/bldg./apt.no.: Project name: -- DesrriprLu, Ql, ler Inlnl_
Cross street/directions to job site: Nexv residentiul tingle-or nutlti-fantih dwelling unit.
93 ee /h-'r Includes attached ilar•age.
i,1)O0 ay It nr Icss 145 1 - '4
Subdivision: rlf Lot no. �,/A Iva udd'I 500 sq Il or portion 3340 1
Limited energy,residential 75.00 2
Tax map/parcel no.' g -4,,J�CD —
.t�l�i,_fL Limited enr•gy,nor,-resldcntui 75.011 2
DES( RIPTION OF WORK Each manufactured or modular
tkellln'.sen ice and/or feeder 9(l 90 2
Mrlikes or I'ce_ders Installation,allerallou•and/or r0ooe-utio�u
200 amps or less 90 30 2
X111 ,unps h)41111 utttps ""`j �-
PROPERTY OWNER — � ❑ 100 N5TENANT —
— 401 unips t( al-1 unips 10000 2
Nam S�flr� ,/ ^o�f �� �'D 001 an)ps n) ,.19)0 unlps 24u bu 2
Address. I)vcr L0u0 amps or volts 454.05 2
fF7' fit./ *til// r/ 2
-- — Reconnect oniv 06 85
CityiStatc,21P: l!✓�� ��l 1�� Temporary cervices or feeders lnstallation,alteration,and/or
relocation _
Phone:VV) 4�e '�/ 1� Far.1 1 2191 amps or less 1 6 A I
Owner lnstallation. This installation is being made on property that I o\vn which is not 201 amps to 400 amps lou 30 2
intended for sale,Icase,rent•or exchange,according to ORS 447,449,670,and 7u l 401 amps b)bleu amps 133 75 2 1
Owner signature: _ Data_ _ Branch circuits-new,alteration,or•extension.per panel
APPLICANT CONTACT PERSON A i rc for hrunch circuits oink --�--
scrvlce or(ceder fen,each 005
Business name: branch circuit r —II
II Pec for hrunch cocuits I
Contact name: �/ �/ 1�fll•e, �/ I. — —. „intone service or Feeder Fee,
.�!i O�✓<r�. f 4095 2
/- each brunch circuit
Address: pylf/ ' �N6/K/ �I Each add'I branch circuit O.GS 2
City State:Z.IP e/�ii 91 � Miscellaneous(cercice or feeder tot Included)
_CG_ Pump or Inlgauon circle 53 40 _ 2
Phone:r�I 1 i
Fax: :l 1
Sign or outline lighnng _53 4l1
E-mail _ Slgnul sitcoms)or hooted_
CONTRACTOR v---- energy punel.alteration,of
extension 1)cscrlhe I Page 2 ,
Business name:
Address _ ^ Each additional Impection over ollowahle in am it
of the uhny
I'er tuspcclu,n 02 511
City'State ZIP: Imestiption pet hourl i hr titin) 02 511
Phone:( 1 — x'( 1
Industrial plant per hour 73'5
_— ELECTRICAL PERM IT FEES"
CCB Lic.: Flectrical Lica u� Su r% Lic.:
_ p Suhtuml
Suprv. Electrician signature,required Plan re\less 125 otperntu feel
State surcharge is",,,I pernul feet
Print names �_— --i
-- -------- -- --� TOTA1. PERMIT FF.F'
Authortied denature ,moi/ - �, l — —�-- --J
-_ /�r� ,�..rl� / ?O jr [ /— ThA pernd(applirar after
t ha%liven
Ira carne ix i c nbilt tv uUhin Ixu
- /��— -- --`---'�- Ja!x arra It ha.burn acceprrJ:n roll, tr
hi'Int nlU11C: I DJtC' fee nlrth•,J„b,v, .c;b, In.t,nnu. 11�.uIJmg Indu•u, •cr l.r li„arJ
••\unlhrr„I nt•pe,n,at.per pc:nnl,di„arJ
Ituldwv Permnr HA,Prrrnn 1pl,4", I:
vAectrical Permit Application - City of Tigard
Pale 2 - Supplemental Inf wmation
L11>! TED ENERGY PERMIT FEES:
RESIDENTIAL NVORK ONLY:
Fee for all residential s-cstems combined........ y75.00
Check Type of Work I ivolyed:
❑ Audio and Stereo Systems*
Burglar Alaim
❑ 6arage Door Opener*
1❑ Heating. Ventilation and Air Corditioning
Sysf;m*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for -ach commercial system....................... 575.00
(SEE 01.K 918-260-260)
Chec'<Type of Work Involved:
r] Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
❑ Data Teleconimunication Installation
❑ I-ire Alarm Installation
❑ II\'A(
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other
Total numher(if commercial items:
*\,) licenses are required. Licenses are required
for all other installations
Ih. tmg Petrone VIA'Permit Art,be 4
w � � _�Q•l•C, fw�flr � A�r',��d�
eeL
10.0' .- -- -— - - - ----- — - -- ----. _.
.... ..... ..... ........... ... .................. ......... ......
7 0' Concrete peuo
r
30,
3.0' 3.0' 14.0'
7.0'
- — Nook
/,Ldp
Kitchen
Family
Room
_. 34.5' 21.0'
-----------
u��� .5
Beth Laundry
Living
Room
6.0'
Entry
2.0' 7.0'
3.0' +,p1'_Q Q 3.0'i r.'oitc. ��
Garage 21.0'
Por. L --
U)
'0.0'
i
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•
�GAKtI - 00---
�Y RMIT Np.:
13U11,[JY� �•1 �'S Not Appr,wed
ING UI G
PI�ANN ks: � Approved
1`'-----
Regttired Setba': Strcet Side: Rear' . 151
c'de: a`�' Garage' ate'" t Approved
Fri►nt. -�' A A proved
V mal Clearance:U) it, O feet No
Wlnximum Kui�ding He K uired: Q Rcceivc :cl
Letter Req
CWS Service Provide; �-at -04
Date'
B•: EN T' (] Not Approved
p,Ivti1NApproved.dvl-s 1 U6PA ed ,roved
% of P{rl
Actual Slope:�-� -Approved z 0
Sitc Mali {Iy/
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APR-1ia'� - 5. 2004'8 4:01PMMRRKCLEAN WATER SERVICES 503 6814439To:5e268iN0--'`'4 . IF.
JR
� X tele Number
CieanW'ht;,l� ServieeS Sensitive Area Pre-Screening Site Assessment
VIM Vnw - ,11noD) 15 Civet.
Jurisdiction _ _ _ Dated
Map&Tax Lot � / �- Qi'!op �— Owner
`site Address
1' Pees A41110t Contact
Proposed Activity `_,.�� G !��r xQ, Address � r_!2 y'
---- — Phone
oAt w use only below this line
Y N NA Y N NA
Sensit,'vc Area Compos' a Mep Stnrmwater Infrasirocturs maps
Map# - -.3 f W . -- -- QS#
Locally adopted studies or mapE> Other
C.� Sper.iN D �� Specify ..it V o&0"�>1Av�'
Based on a review of the abr,ve Infnrmatlnn and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order NomfiRw 4r.r 0q 40
Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT
P11UST PERFORM A SITE CERTIPICATION PRIOR 1-0 ISSUANCE OF A SERVICE
PROVIDER LETTER OR 1` URMWATFR CONNECTION PERMIT. If Sensitive Areas
oxist on the cite or within 200 fret on adjacent properties,a Natural Resources
Assessment Report may also be required.
Saitsitiv,e areas do not appear to exist on site 7r within 200' of the t to.This pre-
screoning site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently 6.movered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REOUIRED. THIS FORMA WILL SERVE AS AUTHORIZA i iON TO ISSUE A
STORMWATER CONNECTION PERMIT.
j� The proposed activity does not meet the definition of development. NU SI'i
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
;0P;M___—
Reviewed9y: Date:
Returned to Applicant
Poet-It"Fax Note 7671 oa' ,f T- Mail Fax A Counter
i�� !"f T L:agnFl l ,ry
I)dl
kc.
Co DSL _ Co. J"
1
Phune N Phnnt
CITY OF TIGARD 24-Hour
BJILDING Inspention Line: (503)639-1175 10ST
INSPECTION DIVISION Business Line: (503)634-4171
BLIP
Received _rLc 5 Date Requested._ " - AM-_-____ PM _-_ BLIP
Location qf5 7 11 IriC _.Suite-_ _______. MEC
Contact Person _ �GL2 �. Ph "�_ PLM
_
Contractor Ph( ) _ SWR —
BUILDING T9nanVOwner _ _ ELC __—
Footing ELC
Foundation Access:
Ftg Drain ELP. -
Crawl Drain
Slab <;z- co'tZ'- `' Inspection Notes: ' D -ST-
Post&Beam
Shear Anchors _ 1 -
Ext Sheath/Shear
Int Sheath/Shear ✓S�" rPSL-1- QE�SG(Z VA (�fu
Framing �- �T�Z) -----_----
Insulation
Drywall Nailing ---
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ��--
Root
PART FAIL -
ING
Post&Beam
Under Slab
Rough-In
VVater Service
itary Sewer
Rain Drains
C _-- -- -
Catcch Basin/Manhole
Storm Drain ---- ---------- ------ -- ---
Sho:Yer Pan
Other: - -- -- -- ---- -
PASS PART _FAIL - -- -- - - --- --_ -- -._
MECHANIC_A_L _
Post&Beam - _-------------__.._.—.�-- ------ ---- —
Rough-In --- ------- --- -------- --------- -------- ----
Gas Line
Smoke Dampers - ---- ----- - ------ -- --
Final
PASS PART FAIL --- - - - ----- - -- ---- -
ELECTRICAL _
Service
Rough-In - - ----- --- -- ---
UG/Slab
Low Voltage
Fire Alarm
Final F-1 Reinspection fee of$ required before next inspection. Parity Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Pleese call for reinspection RE:_-_ -- E,Uaable to inspect-no access
Fire Supply Line
ADA
Approarr,,Sidewalk Dili_ iris�ectOr �..
Other.
Final DO NOT REMOVE this Ins-action record from the job site.
PASS PART FAIL