12845 SW KATHERINE STREET-2 i
N
Ul
I
i
i
J�8d2i�tS 3NlM3HIVM MS 5687,7
CITY O F TI
CARD
DEVELOPMENT SERVICES
13125 SW Hell Blvd.,7798rd,OR 97223 (503)994171 1,4,T
1,15 T) 0:3 1 7
j
P T$14 Ki
qrl T 177 T r,
--------------------------------------------
r".00p ----------- WEMEN", t 0 sr RMORED sETsX';s--- Rr
P
HEIGHT...,.,.. 0 rlRST.,. �A P7... I if ,1'w
El r
n4p,
UNIT9, FINBSOW- 0 Or M4T.........
.7r 7' po"' l 0 TUT41.• 100 of UkUr_ lINI 9SP4... ...... . 0
------—----- -------- ---------
f< Al'rK C1_0"TTS,- 0 WAVING WK 0 L�Wpy � RAIN "RPIN ;t!
0 DIWUPSHERS- 0 FLMV 11RATNe. 0 smp !-INE 0 SF WN l'qakllv;! 0
7 c-Mor-F PIED. 0 WATERPSOTtr" 9 W474 !_'W rlT ?f'vT'
PAN I ,Up 0 Pr,!L TMO ',4P: 6 urr CAK..
NON lM 0
Jr.,- ......... .
AM INP. 0 ET!! CLMO cUPN4Cf.F-. 0 Z,,Nj'r"
0 STOVES..,,
17, 0 WISK IR FM P %W/TFRlr:4T19N: q
7'01 4
V ai6. 4" 0 1 W/o SVCS`PR. 1 IS!GNMY, i-IN 01 PES w0;I,
qN, �p a �',Rk'POWL, a
kpw TIEW 5FMON
P7 /sor
7 ' 'IRE PALA!�*'
WP/T.r COMM, r,
wr
REDUREP I lPFrTljYS ------
..........
Plan Chec M 0 3_&o` '
' ('Y OF TIGARD Residential Building Permit Application Recd By —
2S SW HALL BLVD. New Construction additions or Alterations Data Recd
,ARb, OR 9'7223 Single Family Detac-ted or Attached (Duplex) Date to P E.
j03-639-4171 � Date to DST,____!
"93-6847297 rj(oPermit$ M'., '
V- Prirn or Type Called c s
Incomplete or illegible applications will not t c, accepted
~� Nome of Protect r Name
Job v6-R7 bl vA)l,(/C.R/y /.v'c /3cDAPcr�
Address Site Address Architect Mailing Address
/m' SuJ X�tMt Ciy(- s r i rc.t0�'y
N:me C ty/StateZip Phond
L/i,�/A O• S/�y,�
Owner Mailing Andress Name
city/estate Zip Phone Engineer Mailing Address
Name —— city/state Lip Phone
general G' �vA,F,,c, Descnbe work New n Addrion O '`.iierahon O Repair O
intractor Mailing Addrou to be done:
Additional Descrioticn of Work:
City/State Zip Phone !
Oregon Const.Cont. Board L c.0 Exp. Date
,act* Copy of
Current cdr Buseiess Tax or Metro N Exp. Dat, PROJECT
Licenses Naris EVALUATION $
schanical NEW CONSTRUCTION 6704LY:
Sub- Mailing Address Sri. Ft. House: Sq. FL Garage
Detractor NO —FlagYES NO
City State Comer Lot YES Lit Lip Phone �'
(check one) _ check one)
uonch Copy of OregConst Cont- Board Uc Exp. Date Restricted I Audio/Stereo Burglar
Energy System _ Alarm
Current I CUT Bus rices Tax or Metro a Exp Date Installation ___ Garage Door HVAC
'.icensea
Name Opener Systems
lumbin (check all that Other.
g aprry, _ 1
Sub- Mo.,!-ng Ar+^-re." V'All the Iectnc:?i subr,ontractor wire for all YES NO
rin!ractor restr.cted e.,prgy inc�callabons7 I
C•tyiState Lip I Phone - Has the Subdivision Plat recorded —NTA— YES 740
I
_h Cop of Oregon CJnsi. CJnt. BOaro�_i a ~Exp Uc,e Relssut of MST#: Solar Compliance
Copy
_ (Calculation Attached) _
unent Plumoin, Lic 4 Ex;) Date _
_icenses I hearby acknowledge that ; have read this application, that the
COT Business Tax ,r Metro x Exti Qa'e
— information given is rorrert that I am the owner or authorized
agent of the owner, and that plans submitted are in compliance
Name ----� -- with C',r. yin State laws.
er trical I (''A"A"Y /4 Signature of Owner/Agent Date
Sub- Mauing Addres.R r:ontact Pers9n Name Phone!!
ontractor ! -- �` c,�=a`, u�� 5,79-
C;ty,State Zip phi ne- FOR OFFICE USE ONLY: —
Plat d _— — I Mali/t L#.
Oregon CJrs,t Cont Board Lr,0 E=p Date -` ij�/ c,>)
-ach Co l
Py °t __ __ SatbackSf Zone: ��
"urrent E:eancai Lc w Exp Date I i �, , 50l pr 1 f,
A� Engineering Approval ( P!an fi jTIF
Approval:
COT 9usinass lax or Metro 0Exp Oeste -
- rWapp.doc(dst) 1/97
Permit ;$ Account Qescriction Amourit Amt. Pd. Bal. Due
tiIST. Permit (BUILD) C
Plumy. Permit (PLUMB)
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT)
State Tax (TAX) 0-b
Bldg: %
Plumb:
Mech:
ELC/ELR:
Plan Check
MST: (BUPPLN) 'lL' C + lw >
Plumb: (PLMPLN) _
Mech: (MECPLN) _
CDC Review '(LANOUS) _ _ Vy--
Sewer Connection (SWUSA)
P,eimbursemer�c District
sewer Inr,pection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT'
Erosion Control Permit (ERPPM-F)
Erosion Planck/USA (ERPI_ AN)
Erosion Planrk,ICOT (F'ROSN)
Fire Life Safety (FLS) ►�/-,—, —tom, ,
TO'IA.L S:
r.,sfapp doc (dst) V..47
Permit #:
LL, �
kSued by: J t.— Date:
lgg9 --
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 buildi tg permit cc,t be issued. This statement is required
for residential building, electrical, mechanical, and plus +hing permits. 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.
Fill in the appropriate blanks and initial boxes I and 2, and either box AA or 313:
I own, reside in, or wili reside in the completed structure:.
5 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
V before or upon completion.
❑ 3A. My general contractor is __—
(Name) Contractor repis. #
I will instruct my general contractor that ail subcontractors who work on the structure must he
registered with the Construction Contractors Board.
OR
�.S 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, 1 will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit nf the
name of the contractor.
I hereby certify that the above information is correct and that 1 have read and do understand the Information
Notice to Property Owners Hbout Construction Responsibilities on the reverse side of this form.
T (Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
I
f
W
Information Notice to Property Owners
Abcut �,Construc.ticlrt Responsibilities
B r,/,i*t� lk'/ftl (!� .�,� ,'lll 05
)�I7llt'C)tL'll ttlIIIrIt I t 1 4, 11116: •I IP"d. ;inllli"t11 Id"I'll,r,. ',I :I j;r.I.iiI III 11-1 111 'th('III Ir ,{11 i•11••I!IV'' cI1-�� -f11�'
Ii A iII't 111a itl;, '�� I :'.C: .!W".! [,i t1� II'li ,it lli�, - ,} ,tll lL) iIi,,i iiflll +.lm 1 s+i♦ G ,.ti
EMPLOYER t=iESPONGIBILMES;
'.II. , i� 'Ill .J
�'! il�-�i �t>I,rc!'1'I Il�IY1 �7'�I•g I. !! .I', Y,i , _� ��i, iti I..�.., i. I;,.,_I;ti. i � tl"�i�,�Ire��( ,:li 7'I 1'r�,.,.
� I, :I' I., + It1111t1"y'i,f°4 1,. ,' ���i�.. •f .,,a. I4 i1�-( , ..lul(l'v' 44'(:11 illt� I� pl,,.� ;Ii
R)F'l i,Ia1�. ,�}t1r�1(111}f[t�!�;1Y11tV4; '.al.'n �1rr`. .,fl �rlrla i��i l fa•iil !:. I
11a l 41II ht IiAhi:' i I I I 1 lr,l 11 WIf I I f V II,I v I :}.;I ! ! IiIIIII 4( III" III
1 11E`t11111<1y!'11t't81 111"�111'FIIi!C"��Na: i'Iilllfl.i I'�� l'I' :r I::'. I ,u.C:114 �, '. I;l ;r
III, I.01;�'.rirr,� %Ili.'1 )II' 't_,{11 /11�'i��'. 1'('IPi {.'lkr'tolliv1!1,,1)t'i1i1E�f3+�I1lU� jj4illlillf��l"rtJlll'4U"�
1'1'r►t'hrt'ti'cnr►tl►t ,. � .� . ! �� l;' l '�."' i' I
lF�'itlt�itlStll'illit'I'' II''� 1 i; •illl+� i. "���;Il,� It,.11�� l i�' Ii — I.';I'a
.�,� ,,;It11�•!,F ,�„ II Ih. � � �� ,u,.�
JIhIct 11l>I'1('Ila 1176�11111�NO 11 Ear ll.'(ilc li;! .Ill� ;I"I .:p' ;i ,it G'lii t,tail,r�1 11i r,. -1•;illlill'C".�� i°( I li���+, t1.';tl'i llfll!",17.
� . lwlli_{1iW,1lvilife.Sen ice: :A wIciIlpl1.f':t:l.ti0iih?ili"ithilt :,_1 : i':i.,, ill, Ll,tlIr1111(.tl!l,ll�iiii'4� l Lp{'ti Ytl,i
11;11111 Is11'111 'P,I Iv"le111 f'Vi'h IU liill'111It'Ii!Illl', l4 it 1lVl,tll11he:1', -iI
OTHEH NES^ONSIBILI iIES ANIS AREAS OF CONCERN:
t, IIY11'i,1111t11h:+1t f'A". !'a�,ill<'pl'1'IIIli l ll1jdc4 illi 1111•1�IlY�,''l.! •W;lit,I''.:4iit�!I'lit�� !"`I "i'. !!� iill t:!111 ;I.' I'.,f"�'I �� �u1, (t t',Ii(( !il, flI
11411 !it;!';' lir hq,11L9I11 !+` 4f'Stll' ❑lit'llhltll (11!'':1714'! P'1�,111"� 1;�rI�,
i�IJ11111�
mm 17fopt 1-1;1 d1.11►iil�l'111.511►':►tll't'.: l .1lli+l1 `y�'Li' III'�UI"Jl1G:aryl' �ll lir ;t' '1 j�.11.!I141�'L' ikti4l�lhti.i Illmil:llll:'' 1
�_. Id.. I11. _110 'alkit l', l 111mg 11,( 1',. PAW .�'�CI'1;(il1 14'itI `1 I_},litlitl?t.` If.'til l`!�)•„' I)Ilt,t(1111"•, 111i:. lil 111111 !1111.1 k-
IY`
Vi1111° tat rl itis,1'1111114i'vi
;'yi►t`rike' 'k'1-ii l` `I mW 4'1 X1111:14"i 11!l�r°�11 L1j�,.. ❑ }! rn�.'h!?i"t1!"1',i t, (' 1 1 �.I� l 1 17 1 t 1111 Yf1I '11
1 r:'f(„'l+lr' I � rt:'11C1 !11('1111' � lY lti rll e , ,_I !'
,101 1 ifs lwii y 1 1 i1.1111t, of lii'i(04 lit 1111 i!11'l°if111(I"11(`11look t;o th'''V f':ill pl-r1l I"i`7111f" lilts W' .
c oddill"11:II 1:.111(".s,{In11 ._ �.t,l lit' it ;41� 111. 1 I7.I (1i1�_1"tlri( t1111t.Ei',,IWl') I3ll+
t; ti. ' i I 1 he Boilr11 I, I" II1.11 II ;r111 tiu.Ilr,u f ! ^:I tiuilcr IIH), In 'ialc n1.
„I
Qb
� )
it
10
I -
o �x
0 Z
r0 n
CA
pp�� Cj r1 r_1 l
T
rii
w
1 h
3 �
N
N
� � i
� �
� �
0
�-
��
.,
,�' ��
r �'b �
,���
��
��
��
C'`,
f!
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone 639-4171
Footing Rain Drain Cover/Service �ttQ
Foundation Water Line Ceiling -Plumb �
Post/Beam Mach. Shear/Sheath Framiny -Meeh.
Plbg.Und/Fir/Slab Plbg.Top Out Insulation
Post/Beam Struct. Mach. Rough-in Gyp. Bd Bidd
San, Sewer Gas Line Appr/Sdw.k Reins.
Other. _..---- __--- - -
Date: A.M. P.M. try:
j�'Address: _ _� •2
Tanant:.-___,__. _.-._._..__ Ste MST:
qq DUP:
Con/ _ .�-[- old I -- - MEC:e
PLM: � _
E LC: ._
THE FOLLOWING CORRECTIONS ARE REQUIRED: CIA
r
i
C -
Inspector: _.
Jt0'VE_D DISAPPROVED/CALL FOR REINSP. CF CO