11539 SW TALLWOOD DRIVE ADDRESS:
11,21-6X L J LaLu pr,
i:\records\microflm\targets\building,doc
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 5W Hall Blvd.,Tigard,OR 97223 (503)639.4171
CERTIFICATE OF
OCCUPANCY
PERMIT 0. . . . . . . i MST96, 0420
DATE ISSUED: 06/13/97
PARCEL.: IS133CD-15400
,ITE ADDRESS. . . . 11539 SW TAt-LI400D DR
SUBDIVISION. . . . : PEBBL.ECRFEK #3 ZONINGsR---25
BI-OCK. . . . . . . . . . : LOT. . . . . . . . . . . . . 44 JURIGI)ICTIONs
CLASS OF WORK, :NEW
TYPE OF USE. . . 4SF'
TYPE OF CONGTRs5N
OCCUPANCY GRP. iR.5
OCCUPANCY L_OAD:c�
Remar,k% i Path I
Owner-:
COST(-) PACIFIC 1-40MES
8625 SW CASCADE
STE 61,16
BEAVERTON OR 97005
646-8888
COSTA-PACIFIC HUMES
(DBA R A K DEVELOPMENT )
1625 SW CASCADE AVE STE 606
8EAVFRTON OR 97005
Phone #1 503-646-6888
Pr�q 0. . : @0065t
It-,Is Certificate [4tants occupancy of the above referenced building oi- poy•tlon
thet-eaf and confirms that the building has beet) inspected for complianre wit!.
f:he State of- tv
t�eqoSpecgroup,ialty Codes fat the goup, occdr
-upancy, and use -ineg,
the r*ft'encod per-mit was issued.
iWIL-DING INSPECTOR Of F EC- L
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION S�-
24-Hour Inspection Line: 6394175 Business Phone: 6394171 �
Date Requested: 0113 -7 _ ' A.M. P.M., MST:G/�l7 ^G
Location:��� �;� 1 �.• (L-07 BUR _
Tenant:_ y _ Suite: _.Bldg: 2 NEC:
Contractor: 1�//_ - Phone _9 73- J PLM: _
/r,�
Owner: �-t _ , Phone: -. —�- -- ELC:
ELR:
SIT:
BUILDING BLDG n't) PLUMBING CHANtCAL ELECTRICAL SITE R
Site cam Post/Bewn eam Cover/Service Sewer/Stonn
Footing Roof UndFI/Slab Rough-In Ceiling Water Line .--'
Slab Framing Top Out Gas Line Rough-in L'G Sprinkler
Foundation Insulation Sewer IfooNmct Reconnect /atilt
Bsmt Damp INywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab _ 11
Shear/Sheath Fire�S"k1r Crawl/Found Dr Heat Pump Low Volt EROS 10 N
pprovc Approved pprov Approved Approved
Lppr/Sdvv1k rd Not Approved o A proved Not Approved Not Approved
FINAL FINAL FINAL FINAL
CY Call for reinspection C7 Reinspeclion fee of S_—_—,required before next impaction I7 I Inahle to inslx•ct
10�Inspector: _ _- I�te. — Page—of—,-
I
CITY OF TIGARD BUILDING INSPECTION DIVISION X 3�
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
Date Requested: � v cx-� A.M. ^ _ P.M. MST:
Location: l _ IIUP:
A
Tenant: 'iuite: Bldg: NEC:
Contractor: _Phone: _ _ PLM:
Owner; r, (-��si• �� C"/'— Phone: ..3 7 ELC:
ELR:
SIT: _
BUILDING G(cot'h PLUMBING MECHANICAL ELECTRICAL SITE
Site earn Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm CrawlNound Dr Heat Pump Low Volt
Approved Approved Approved Appmved
Appr/Sdwlk vcd Not Approved Not Approved Not Approved Not An roved
AL FINAL FINAL FINAL FINAL
l
OL
1
/
t
O Call for reinspection 7 O Reinspection fee of S required before next inspection O Unable to inspect
Inspector: ��. ' ---� Date:_ ,\ Page 2---of- -4—
Page No. i CASE HISTORY FOR CASE NO.: MST96-0420
COSTA PACIFIC HOMES
11519 .SW TALLWOOD DR
09/21/97
Action Description Rey/ Schd/ End/ Action Notes Diop By Update Upd
Code Sent Done Done Date By
MSTA005 Application received / / / / 09/03/96 RECD B 09/03/96 BON
MSTA00B Permit Created / / / / 09/03/96 PEM) B 09/03/96 BON
MSTA010 Check for prrl. restrict. / / / / 09/27/96 09/03/96 BON
MSTA012 Plain routed to Plans Examiner / / / / 09/03/96 PEND B 09/07/96 BON
MDTA026 Plans approved by Plans Exmr / / / / 09/12/96 PASS RT 09/12/96 BT2
MSTA030 Reviewed plans routed to DSTS / / / / 09/12/96 PASS RT 09/12/96 BT2
MSTA050 Hold for / / " / 03/2.5/97 PER RICK BOLEN: HOLD until reineper_tion HOLD JMH 06/06/97 J•H
fee of $15.00
is paid anti shear wall in irproved.
MSTAU90 (F) Ready to issue / / / / 09/13/96 PASS CJS 09/13/96 CJS
MSTA092 (F) Lseue combination permit / / / / 01/14/97 RASE TMH 01/14/97 DST
M93'A095 Inoue plumbing signature form / / / / 01/27/97 RECD JMT 01/27/97 JT
MSTA097 Issue electric signature form / / / / 01/27/97 RECD JMf 01/27/97 JT
META-/05 Footing Insp / / / / 01/22/97 pending- usa 11-19; rebar detail for PASS RB 01/27/97 RB
bearing pais; seismic restraint; dig out
(muck) footing; d. ,n water from bearing
pads; low point drain.
MSTA706 Foundation Insp / / / / 01/27/97 pending- add hd's at rear wall; change PASS RB 01/27/97 RB
HP'e for 4D-2A
MSTA710 Poet/Beam Structural / / / 02/04/97 #-1- provide hangers or post to pier at A/N KS 02/04/97 F.PS
interior bearing beams
MSTP711 Poet/Beam Mechanical / / / / 02/04/97 APP KS 02/04/97 FSS
MSTA713 Crawl Drain / / / / 02/03/9'7 APR OR 02/Ul/9'7 GES
MSTA'717 PLM/Underfloor / / / / 01/31/97 not ready FALL, MS 02/06/97 MRS
MSTA717 PLM/Underfloor / / / / 02/04/97 APP GS 04/15/97 RB
MSTA720 Mechanical Insp / / / / 04/15/97 see framing this date FAIL RB 04/15/97 RB
MBTA720 Mechanical Insp / / / / 04/17/97 see framing this date FAIT. PS 04/19/97 RB
MSTA720 Mechanical Insp / / / / 04/22/97 oee building final this date PEND RB 04/22/9'7 RB
MSTA'722 Plumb Top Out / / / / 03/24/97 NO TEST PAIL MS 03/26/97 RB
MSTA722 Plumb Top Out / / / / 03/26/97 TEST WASTE THPG ROOF; STRAP UPPER LAV DIS GB 03/71/97 GES
VRr AT MID HEIGHT
MSTA722 Plumb Tnp Out / / / / 04/01/97 PArg MA 04/01/97 MRS
MSTA722 Plumb 'fop Out / / / / 05/27/97 PASS JMH 05/27/97 JT
M.STA723 Electrical Service / / / / 03/31/97 APP GS 03/31/97 GEA
MSTA724 Electrical Routh In / / / / 03/31/97 LITE NEEDED AT REAR PATIO DOOR APR GS 03/31/97 GES
Page No. 2 CASE HISTORY FOR CASE NO.: MST96-0420
COSTA PACIFIC HOMES
11,,39 5w 'rALLWOOD DR
09/21/97
Action Description Reg/ Schd/ End/ Action Notes Diop By Update Upd
Code Sent Done Done Date By
MSTA72!i Framing Insp / / / / 04/09/97 #-1- see inspection notes to numerous DIS KS 04/10/97 KBS
MSTA725 Framing Insp / / / / 04/15/97 notched floor joist greatstnan d/6; FAIL, RB 04/23/97 RB
notched beam at rear of g .rrge- greater
than d/4; soffit ductwork in garage;
insulate behind shower upstairs-viewed
from garage; add stud at interior side
wall of garage; block/enclose return air
plenum; hanger floor joisto at base of
stairs; ventilate vaulted rafters;
insulate / flame spread uncer tub at
master; clone off attic ofan space at
fireplace venting; add railing to
scab-on of gable truna at to,. of stairs;
add vent baffles at flat adjac,utt to
vault; support dryer vent w/in attic-
gas dryer vent limitations; firestop
floor level of duct chase between fwd
and rear bedrme; metal plate protection;
vent baffles minoed,
MSTA725 Framing Insp / / / / 04/17/97 sediment trap for gas line to FAIL RB 04/21/97 RB
furnace/hot water heater
vent baffleo
close off attic space at fireplace flue
b-vent sleeve in attic
dryer vent
MSTA725 Framing Insp / / / / 04/22/97 # 1- AM inspecti,ta corrections DIS KS 04/7.2/97 KBS
incomplete.
PM innpection was approved by ItB,
prior tO my arrival
MSTA725 Framing Insp / / / / 04/22/97 see building final notes this date PRND RB 04/22/97 RB
Page No. 3 CP.SR HISTORY FOR CP-:, NO.: MST96-0420
"OSTA PACIFIC HOMES
11539 SW TALLWOOD DR
06/21/97
Action Description Reg/ Schd/ End/ Action Noten Disp By Update UFd
Code Sent Done Done Date By
MSTA726 Shear wall In"p / / / / 03/19/97 nail top edge of wings of garage; rear FAII, RB 01/21/97 J+H
wall of garage- HPAND strap miseed-
retro-fit strap; sheathing at rear wall
needs to be attached to mud sill- nail
plate; exterior sheathing (entire
perimeter) needs to be secured to mud
sill- nail perimeter plate; sheathing at
kitchen needs to be nailed 3/12; ND-6A's
reed to be secured; CB-16 straps missing
27' in length w/blocking; $15.00
REINSPECTION FEE DUE CAR RICK 032597
USE
"BUILD" CODE.
M3TA726 Shear Wall Inep / / / % 03/24/97 HP utrap missing at rear wall of garage; FAIL RB 03/28/9.1 PFS,
tighten HD's; nail sheathing as marked.
MOTA726 Shear Wall Inep / / / / 03/25/97 report dtd 3/24 incomplete $19 RB 06/12/97 J•H
MOTA726 Shear Wall Inep / / / / 04/15/97 PArn RA 04/15/97 RB
NOTA721 Low Voltnge / / / / / / 09/03/96 BON
MSTA735 Gas Line Inep / / / / C•', '15/9 176120 PASS RB 04/23/97 RB
MSTA740 Insulation Inep / / / / 04/21/97 #-1- framing or mechanical not approved DIS KS 04/22/97 KBS
MSTA740 Innulation Inap / / / / 04/22/97 pending- insulation of header. Add PASS RS 04/22/97 RE
nailer for gyp bd. Maintain clearanre
from insulation at location of B vent.
Firestop thry penetrations. Mech issue
to be disclosed at sell.
MSTA-745 Gyp Board Insp i / / / 04/24/97 pending- check record for water line PASS RB 04/25/97 RB
inspection approval; b-vent
clearance/collar.
MSTA759 Raiu. drain Inep / / / / 02/03/97 APP GS 02/03/97 ONS
MSTA760 Watir Line Inep / / / / / / 09/u3/96 B01H
M9TA761 Water Service Inep / / / / 02/03/97 PAtJS MS 06/13/97 MRS
MSTA765 Appr/Sdwlk Insp / / / / 05/01/9'1 1. FINISH FORMS PASS PI 05/01/97 RAS
-, PIPS TO NREPHOr.ES (BOTH SIDES)
MSTA771 «RRINSP$CTIOF» 1 / 1 / 03/25/97 no further inspections until paid $ 15 RB 06/13/97 J•H
M8TA771 c REINSPECTION» 04/04/97 / / 04/04/9'1 RAID, PLUMBING REINSPECT PER MIKE PAID JT 06/11/97 J•H
SHEEHAN
■
Page No. 4 CASR HISTORY FOR CASF NO.: MST96-0420
(OST) PACIFIC HOMRS
1.1519 SW TALLVK)OI) DR
09/21/97
Action Description >Req/ Schd/ End/ Action Notes Dinp / 'lpdate Upd
Code sept Done DaneBy
Data
s
MSTA760 «REINSPECTION» 06/11/97 / / 06/10/97 plumbing reinspection fee paid 06/13/97 RAID RAB 06/11/97 J•H
MSTA790 Electrical Final / / / / 06/0:/97 Final electrical approved - AC PASS BRP 06/03/97 J•H
compressor not installed. Panel
nchedule could be ;neater and specific
an to circuit and devices served (SEC'.
110-12).
1 MSTA790 Slertrical Final 06/06/97 / / 06/06/97 Cl-'w 4LlTAACF. PREVIOUSLY APPROVED. PASS BRP 06/06/97 J•H
MBTA795 Mechanical Final / / / / X6/06/97 UNAh.., PERFORM INSPECTION, NOT READY FAIL RB 06/07/97 J'H
/ MSTA795 Mechanical Final / / / / 06/13/97 PASS RB 06/13/97 J•H
MSTA795 Mechanical Final / / / / 06/13/97 PASS RD 06/13/97 J*H
MSTA797 Plumb Final / / / / 06/06/97 NO 4OT NATEP FAIL MB 06/12/97 J•H
MSTA797 Plumb Final 06/11/97 / / 06/10/97 I. IrPRv cn water heater drain needs to PA 11, RAS 06/12/97 J•11
br strapped.
7.. flat 6 cold water reversed an tub.
3. 'frim ring on ice •iaksr missing.
4. 'frim ring on ACV box missing.
Pay reinspection fee of $25.00 before
reinspect icer.
MSTA797 P1•tmb Final / / / / 06/1.3/97 APV RAM 06/13/9'1 J*H
MSTA799 Building Final / / / / 04/22/97 dincl.ose to buyer- that dryer venting PEND RB 04/23/97 RB
wao changed out for 5" and exceeds
25'w/elbow reduction- dryer venting
shall be in accordance with manuf.
instal, standards for qas dryeru and may
ke required for booster venting.
Nxceeding vent size was called by Ken S.
MSTA799 Building Final. / / / / 06/06/97 NOT READY, DNAALR TO PERFORM INSPECTION. FAIL RB 06/07/97 J•H
MSTA799 Building Final / / / / 06/09/97 1. Pre-wored for AC unit-not to be PAIL RB 06/09/97 JOH
installed by contractor.
2. Permanent house numbers.
1. Repair vent. rcreen at refrigerator
line.
4. Confirm tempered glazing at shower in
master bath.
S. Plumbing final required.
MSTA799 13uilding Final / / / / 06/10/97 reinspection fees not paid ($40.00) FAIL RB 06/12./97 J-H
Plumbing final required first
Page No. 5 CASE HISTORY FOR CASE NO.r MST96-0420
COSTA PACIFIC HOMES
I 1"19 SW 7A.r,1JWOOD DR
00/21/97
Action Description R-11 Schd/ End/ Action Notes Diap By Update Upd
Cade Sent Done Done Date By
MSTA799 Building Final / / / / 06/11/97 Dau Goodrich sent letter to verify PARS RB 06/13/97 J+H
plumbing reverse (hot/cold) corrected.
MSTA96D (F) Inoue Cert. of Occupancy / / / / 06/13/97 mailed 0/21/97 JT 08/21/97 S•W
MSTB'108 Erouion Control / / / / / / 09/03/96 BON
'` CITY OF TIGARD
DEVELOPMENT SERVICES VASTER FIERMIT
13125 SW Hall Blvd., T!9ard,OR 97223 (503)639-4171 P,EPt1IT #. . . . . . . : M 9 1 7L,- 01 &.L'.0
DATE ISSUED: 01/1.4/97
PIARCL-L: 15133CD- I'-)'400
Sll'E ADDRESS. . . . 11539 SW TALLWOOD DR
3lJBD I Q IS I ON. . . . - PEBB1..FC'RC--.E1J. #3 70114"LNG* 925
131..0CV.. . . . . . . . . . LOT. . . . .. . . . . . .. . .
Remarks: Oath I
--------------------------------------------------------------- BUILDING ---------------- ------------------
REISSUE:
----------------REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: @ sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WOR.:NEW HEIGHT........: 24 FIRST....: 949 sf GARAGE_ . 520 sf LEFT...,......: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD...,: 40 SECOND...: 883 sf FRONT.......... 20 PARKIwl SPACES: I
TYPE
OF CONST.:5N DWELLING UNITS: I FINBSMENT: sf RIGHT.........: 5
OCCUPANCY GRP.:R3 BD%I: 3 OATH: 31 TOTAL------: 18,:2 sf VPLIJE.At 131755 REAR...,......; 15
----------------------------------- ——------—------- PLUMPING —--——---------—-------—------------------------
SNKS......... I WAT'_R CLOSETS.. 3 WASHING MACH.,: 1 LAUNDRY TRAYS.. 0 PAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 5 DISHWAbHERS...i I FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS..: 0
TUB/SHOWERS...- GPPgPGE DISP..: I WATER HEATERS.: I WATER LINE ft: 100 BrKLW PREVNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
---------------------------------------- ----------------------- MECHANICAL ---------------------------------------—----------------------
U- L. TYPES---------- FURN ( 16W, I BOIL/CW ( 3HP: 0 VENT FP.NS....... 4 CLOTHES DRYERS, I
/GAS/ I I FURN )=100V 0 UNIT HEATERS-: 0 HOODS...,.....: I OTHER UNITS...; I
MAX INP.: 0 BTU FLOOR FURNACES- 0 VENTS.........: 0 WOODSTOVES...... 0 GAS OUTLETS,..: I
-------------------------------------------------------------------- ELECTRICAL --------------------------------------------------------—------
—RESIDENTIAL UNIT-- ---SERVICE/FEEDER---- --TEMP FRYE/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANER)S---- --ADDIL INSPECTIONS-
1000 SF OR LESS: 1 0 - 200 amp..: @ 0 - 20h ?on,,: 0 W/SVI OR FDR., : 0 PUMP,!IPRIGATION: 0 PER INSPECTION: 0
EA ADD'L 5005F.: 3 281 - 400 alp.,: 0 201 - 400 asp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY,: 0 401 - 600 arp.,: 0 401 - W asp..: 0 EA ADDL PR CIR: 0 SIGNAL/PANEL...; 0 IN PLANT..,...: 0
KW HM/SYC/FDR-. 0 601 - to@@ alp.; 0 601+aops-I000 v: 0 MINOR LABEL -10: 0
IN@+ alp/volt.: 0 __•-----------------. .._.------ PLAN REVIEW SECTION ---------------------------------
Reconnect only.: 0 )=4 RES UNITS-- SVCIFDR)z225 A.: ) 600 P NOMINAL: CLS AREA/SPC OCC:
------------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ---------------------------------------------------
Q, 7 B. COMMERCIAL-----------------------—------------------—----------------------------
AUDIO a STEREO.: (JACLKJM SYSTEM..: AUDIO I STEREO.- FIRE ALARM--: INTERCOMIPAGING: OUTDOOR LNDSC 1.f:
BURGLAR ALARM-- 0TH: X BOILER.........s HVAC...........i LWAPE/IRRIS: PROTECTIVE SIGINL:
rARAGF OPENER-: CLOCK..........: 'INSTRUMENTATION: MEDICAL.....,. . OTHR:
INK...........I DATA/TELE COMM.: NORSE CALLS....: TOTAL # SYSTEMS: 0
Owner: -----------------------------------Contractor-. ---------------------------- TOTAL FEESO 4103.31
7DSTA PACIFIC HM COSTA-PACIFIC HOMES
9625 SW EAKADE 86c5 SW CASCADE AVE STE.606
7,TE 606
REAVERTON OR 97005 BEAVERTON OR 97005
phone 0: 646-BBAB Phone #: W, 3-646-8T9
Peg 0..: 65157
This permit is issr!Pd sut,1!._,t to the regulations ^ontainrJ in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws, A), wclrl( will be done in accordance with approved plans, This permit will expire if work is not started within IN
Jays of issuance, 01 if Work is suspended for more than IN days,
------------ REouign INSPECTIONS _ ---__._------------------.----------------------
rooting
-----------------------------------rooting Insp PLM,/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
-oundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk !nip Erosion Control
Post/Deas Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
Post/Bees Meehan Flectrical Servi Fireplarp Insp Pain e n Insp Mechanical Final
Cram) Drain Electrical Rough Gas Linej Water Line Insp Plumb Final
Till
''Iet'm itt ef! Sj.gT1a0.WPTTT�� I S 5 I-lerl Ily
f 01- n siject j.Liti --- 639-.4175
CITY OF T s;FwE R CONNECT T ON
DEVELOPMENT SERVICES PF RMI f
13125 SW Hall Elvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : F-;WR96-04?,l
DATE ISSUED: 01/14/97
PARCEL : IS133CD-15400
5ITF_ PDORES S. . . : 1 .539 SW TAL_LWOOD DEQ
SUP:r I V I S I ON. . . . : P'EBBLECREEK #3 ZONING: R-r--'5
P.;-OCK.. . . . . . . . . . . LOT. . . . . . . . . . . . . :44
-------------------------------------------------------------------------
TENANT NAME- - :
USA NO. . . . . . . . . . . FIXTURE. UNITS. . . . 0
CLASS OF WORK. . . :NEW DWELLINh UNITS. . - 1
TYPE OF USE. . . . . :SF NO. OF RU I LD I NGS: 1
INSTAI..L_ TYPF. . . . :BUSWR IMF'F_RV SURFACE: 0 f
RNmar^k�; : Path 1
Owner: --- -- ___...__.____._..._._______.__________w.__._____..______..__._. FEES
COSTA PACIFIC HOMES type amaLrnt by data r-e pt
8625 SW CASCADE PRMT $ 2200. 00 DRN 01/14/97 97-2138864
GTE 606 INSP i ?.`;. 00 DRn 01 /14/97 97 2138864
BEAVE<RTON OR '37005
(,46--8888
:0Tit Tact or: ______________---------------
COSTA—PACIFI.F. HOMES
nF,25 SW CASCADE AVE STE. 606
13EAVERTON OR 97005
I'1- one #: 5503-646-88B8 $ 223n. 00 TOTAL
Seg
-- - - REQUIRED INSPECTTONS --- _-
`his Applicant agrees to cosply with all the rules and regulations S p w er, I n F p e c t i o n
�f the Unified Sewage Agency. The perait expires 14 days froe
'he date I ued. The total aeount paid will be forfeited if the
perait expires. The Agency does not guarantee the accuracy of the
Ade sewer laterals. If the sewer is not located at the eeasureeent
given, the installer shall prospect 3 feet in all directions froe
-he distance given. If not so loca�ed, the installer shall pur-*ase =
a "Tap and Side Sewer" Pervit and the Agency will install a lateral.
d B y :
Call. for, inspect i.on - 639--4175
01"
Plan Cheek
C!TY OF TIGARD Residential Building Permit Application Rec'dBy 1 .Ik1�C'l,.aaur�
13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd S- j-7 `1!<
TIGARD, OR 97223 Single Family Detached or Attached Date,to P E 5 'lh
(503) 639-4171 Date to DST 2 C
Print or Type Peri`# 01�j`�6,
Called
Incomplete or i;legible applications will not be accepted
Name of Suadwision Lot# Nme
1 Job e'vele-' '.:46� -- W y
Architect g dr
9s1s�I
Add
res$ $t�Address all G I Ivrtti� pr' /(/ J
jJ�1L�U �j1r I,UDD �✓ /��ty� tat Z`+DI D Pho.ie�
Name �I,roc.- ' l Il.c� j'r` �I�u 7 1" ✓ /
Owner Mailing Address
Engineer t al�g Address
rstate Zi
PW 4� 9 ^
1p�`7�G ityiSta!e
Name '' 1v� n Y IV
General .,(,( r✓l , a:;, d�u-JYI.�' 1 Cescnbe work ne addition O alteration O repair 0
Contractor Mailing Address tode done
Additional Description of Work:
ratyiState Zip Phone
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of r' t, 1 f I Project r
j Current COT Business Tax or Metro# EP, Date Valuation $ `�
/
Licenses I i L--- —�--
v me — NEW COINOTRUCTION ONLY: _
Mechanical (t�
Sq.F . H s Sq Ft Ga ge:
Sub- Mailing Address __ _
Contractor
; c St _ Corner Lc�t Yes No Flag Lot I Yes
ty/s� t l�- h n! y (check one) (check one)
�
CtL 4'W-.'_ _p h?C) C7 J/_quu Restricted Audio/Stereo burglar —'
Ore n Co i.Cont. Board Lic# jJ/a Energy System Alarm
attach Copy of
Current COT nes Tax or Metro# p i Installation Garage Door HVAC
Licenses � U I V Opener Systems
N�a�`�e (check all that tither:
Plumbing "�'o �� 11)01li apply)
Sub- Mailing Address Will the electrcal subcontractor vire for allI Yes No
s
restricted energy installation
Contractor fir �i� � ��' Has th Subdivision Plat recordedi? N/A Y No !
G tState
su of MST# Solar compliance
Oregcr; 'ons o t. Board Lic# E .„ �J if/
`�.
Attach Copy of /1/111'r/7 t� �" 1111_'�(),G- /G (Calculation Attached)
Current P)y" ing�L�c�A t i I hereby acknowiedge that I have r-ad this apolication, that the
G
Licenses 'Lo! E 1 (/ ,�J� information given is correct that I a•n the owner or authorized agent of
CO� sines Oa M r x t P the owner, and that plans submit+da are in comcl ante with Oregon
l- State ws
___--_--
NaW gig � `' 1 t r I
Electrical f� �� t� r, t P n Name ) e y
Sub_ Mailing Address r��
Contractor ���j �CCt�� ►`UI��E'..('�(�l�Gf FOR OFFICE-USE ONLY:
Aty";; j tate hPlat# _ Map/TL#
v , -
Oregp�r„�n;t, int Bnarn Lac# Qate�
Attach Copy of lijJ 2WI Lid Setbacks Zone Solar.
Current Eiee� Lit �^ � a
Licenses 6 (7�(� ��
COT siness Tax or Metro u i D e Engineering Approval. Planning Approval TIF
sts rr;:app doc
rBal. Que,
Pe.�mit # Acog, aLDu ii.�ttn Amount Ami._?�.
910 -V `/ MST. Permit (BUILD) :1 S/� —
Plumb. Permit (PLUMB)
Mech. Permit (MECH) �3 S v _ _ 5
ELClELR Permit (ELPRMT) a2--,2,
State Tax (TAX)
Bldg: 4�
Plumb:
Mech:
ELC/ELR:
Plan Check
MST: (BUPPLN) S c_>>
Plumb: (PLMPLN)
Mech: (MECPL.N)
CDC Review (LANDUS) C)
Sewer Connection (SWUSA) �,
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) Z)
Residential TIF (TIF-R) 7L) �S 7tJ
Mass Transit TIF (TIF--MT) _ /2U_ _ �2'G
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/LJSA (ERPLAN)
Erosion Planck/COT (EROSN) PV, YT
Fire Life Safety (FLS) _ _ X
TOTALS: 5-1 S U Vc� 'rJI
`dstslmstarp doc
P.ev 7/96