11175 SW 93RD AVENUE-1 ADDRESS:
11175Svil � Av l
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP _
Date Requested "- �' �' AM tJ ! PM _ BUP
BLD
Location ;< �/ ���� AL.0 Suite MEC
Contact Person Ph (PLM)—
1
Contractor Ph SWR 11
BUILDING- Tenant/Owner ELC (/
Retaining Wall ELR X'
Footing F NOT REQUESTEDUESTED
FPSFoundation FOUND DURING RESEARCH Drain
Crawl Drain NO INSPECTION(s) IN FILE _ SGN
Slab �� �� V'-e--�� SIT
Post& Beam
Ext Sheath/Shear _
Int Sheatr'Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler __--_-
Fire Affirm
Susp'd Ceiling
Roof
Final _
PASS PART FAIL - ---------- ___ --._.
FUMBING7
Post& Beam
Under
�, — -». --- ---- - -- --
Under Slab
Tap Out
Water Service �� _
Sanitary Sewp� �1 --- --- -__-- - ---
Rain Drains v
u
ASS PART FAIL
ANICAL _
Post e. `seam --- -- - —� -
Rough In
Gas Line - ----- - ---
Smoke Dampers
Final -- ------.. --- - ----
PASS PART FAIL
ELECTRICAL i - -- - ---- -------- i -—
Service
Rough In ---
UG/Slab —
Low Voltage
Fire Alarm
Final
C�l PASS PARI _ FAIL ___-— �-
LL SITE
Backfill/Grading - -
Sanitary'Sewer
Storm Drain ( ) Reinspection fee of$� � required before next inspection. Fay at City Hall, 13125 SW Hall Blvd
Catch Basin i I Please call for reimpection RE' _ _�— [ ]Unable to Inspect no access
Fire Supply Line
, n r
ADA --I-
Approach/Sidewalk ( I;J U Inspector p �1 V EXt, I
Date Other ---�— --
Final ++
PASS PART FAIL _I DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . .. PLM98-0077
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED! 03/23/98
,--.,ARCEL: IS135DB-09500
SITE ADDRESS. . . : 111*75 SW 93RD AVE
SUBDIVISION. . . . : REEL ACRES ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :001 JURISDICTION: TIG
------------------------------------------------
CLAS3 OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :9F WASHING MACH. . . . . . : 0 BACKFLOW PREVNrRS. . : 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . 1-1 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . . 0 CATCH BASINS. . . . . .. . : 0
FIXTURES- -- ---------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE 'TRAP'S. . . . . . . : 0
LAVATORIES. . . . : 1 OTHER FIXTURES. . . . . 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : I WATER LINE (ft ) . . . : 0
DISHWASHEERS. . . . 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Converting former bathroom back to original use As bathroom.
Owner: ----------------------------------------------------- FEES
DONNA CHAVEZ type aMOIAnt by date reept
11175 SW 93RD AVE PRMT $ 25. 00 DEB 03/23/98 98-304317
' TIPAPI) OR 97223 5P(-,T $ 1. 25 DEB 03/23/98 98-304317
Phone #:
Contractor----------------------------------
, R D PLUMBING INC
13900 NW SPR JNGV ILLE RD
r-ORTLAND OR 97229 ---------------------------------------
Phone #: FAX 297-7344 $ 26. 25 TOTAL
Reg #. . : 000739 REQUIRED INSPECTICNS
This permit is issued subject to :he regulations contained in the PLM/Underfloor
Tigard Municipal Code, State of Ore. Specialty Codes and all other Top--out Inco
applicable laws. Ali wirk will be dune in accordance with Misc. Inspection
approved plans. This permit will expire if work is not started Final Inspection
within 180 days of issuance, or if work is suspended for more
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 9521-800I-0010 through OAR 952-Mi-M. You may
obtain copies of these rules or direct questions to Off by calling
(903)246-1987.
4- or-
Issued �,p Permittee Signature -
...........................................4....4.............4..........
Call 639--4175 by 7:00 p. m. f'or an inspection needed the next bi-,siness day
..................A.......4.....................+...4-4.......................4-++
CITY OF TIGARD Plumbing Application FZec'd B
13125 SW HALL BLVD. Commercial and Res:dentia) Date Recd
TIGARD, OR 97223 Date to P.E.Date to osT,.
(503) 639-4171 Permit* 1t(e
Print or Type Related SWR#_ -
Incomplete or illegible applications will not be accepted Called _
Name of DeveloprrentlProject On back Indicate Work Performed by fixture.
-lob FIXTURES (Individual) QTY PRICE piMT
Address street Address Suite Sink 9.00
11175 SW 93rd Aven Lavatory 1 9.00 q p0
Bldg# City/State Zip
Tigard, OR 97223 Tub or Tub/Shower Comb. 9,00
- _
Name Shower Only 9.00
Donna Chavez Water Closet 1 9.00 9.00
Owner Mailing Address Suite Dishwasher 9.00
same Garbage Disposal 9.00
City/Slate Zip Phone -
Washing Machine 9.00
Name Floor Drain 2." 9.00
_ 3" 9.00
Occupant Mailing Address Suite 4" 9.00
City/State Zip Phone
Water Heater O conversion O tike kind 9.00
Laundry Rooin Tray 9.00
Name Urinal 9.00
R. D. Plumbing, Inc. Other Fixtures(Specify) - 9,00
Contractor Mailing Address Suite - 9.00
13900 NW S rin ville Rd
Prior to permit City/State Zip Phone 9.00
issuance,a copy Portland, OR 97229 297-7422 9.00 -
of all licenses are Oregon Const.Cont.Board LIc# Exp.Date 9.00
required if 73913 Co/98
-Sewer-1st 100" 3000
expired in COT Plumbing Llc.# Exp.Dat I Sewer-each additional 100' 0 25.0
database 26-31' 06/98 l_ _
Name Water Service- 1st 100' 30.00
Architect Water Service-each additional 200' 25.00
Or Mailing Address Suite Storm&Rain Drain-1st 100' 30.00
Storm 8 Rain Drain-each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New O Addition O Alteration}p Repair O PoAullon Device
to be done: Residential O Non-residential O Residential Backflow Prevention Device' 15.00
Additional description of work:
convert former Bathroom Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
back to original use as Bathroom _--
Insp.of Existing Plumbing 40.00
_ eft_ --
Existing use of Specially Requested Inspections 40.00
building_ orprcperty_ single family residential _ per/hr
r.c Rain Drair,,single family dwelling 30.00
Un Proposed use of Grease Traps 9.00
huilding or property_
�- -
I hereby acknowledge that I have read this application,that the information QUANTITY TOTAL
Isometric or riser dingrrm is required it ouandy Total is "9 2 25.00
given is correct,that I am the owner or authorized agent of the owner,and 'SUBTOTAL
cc that plans submitted are in compliance with Oregon State Laws.
LO Signature of Owner/Agent Date
1a0 5%SURCHARGE 1 .25
01/21.1/98
PLAN REVIEW 25%OF SUBTOTAL
Contact Person Na ne � Phone Required or ly A fixture qty total is>9 _
Chris 297-1422 TOTAL
-- 26.2
'Minimum permit fee is$25+5%surcharge,except Residential Backflow
Prevention Device.which is$15*5%surcharge
I�dHslplmepp dot-S/ar
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
Capped f Removed Moved Replaced
Sink - — — --
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet _
Dishwasher
GarbagE Disposal
Washing Machine
Floor Drain 2" --
3"
411
Water Heater -
Laundry Boom Tray — _—
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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1587
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
r,
Date Requested• � ���� ��- M.��__ PP.M._ MST: _
L7ocation: Z / 5 _ h �(/�� -- _ BUR
Tenant: Suite: —7 Bldg: MEC: /�i�/ /� 'j
Contractor: 1 Z < / — _ �i1t21 %'_" Phone ., /9 - -7 �- �— PLM: iL—f0)1 /
Own:r: O\ `)l — / Phone: q ELC:— -
ELR:
_ SIT:
BUILDING BLDG(ron'tl - PLUMBIN , MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFl/SlabRough-In Ceiling Water Line
Slab Frarniug AP Y ,as Line Rough-In UG Sprinkler
Foundation Insulation Sewer I10CAMuct Reconnect Vari,
Bsmt Dfluip Drywall Storni Furnace TLMP Service MISC.
M�, onry Ceiling Rain Thain AIC IK;Slab
Shcar/Sheath I-irc Spklr/Ahn Crawl/Found Ir I lent Pump l,ow Volt
Approved A prove Approved Approved Approved
Appr/Sdwlk Not Approved _< Not Approved Not Anproved Not Approved
FINAL FINAL FINAL FINAL
i
Y
I7
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ti
CI Coll for reinspection L7 Reinspection fee of S_ required helitte next inspection O l Inahle to inspee
Inspecto .��• f -- ---- Date:_ Page of
F
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drair Cover/Service FINAL:
Foundation Water Line Gelling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mech.
PIbg.Und/Flr/Slab Plbg. Top Out Insulation' Elec!,
Post/Beam Struct. Mech. Rough-In yp. Bd.
Sar. Sewer Gas Line Appr/Sdwlk Reins,
Other: C,_�
Date: � -f A.M. �P.M�j. ' Entry:_
Address:
Tenant: _ Ste: MST:
— BUP:��-016
�T
Con/0: __ MEC:_
PLM:
ELC: ,
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
F--
PN�.j
�I -- - _
Imo!
Inspector: _ Date:
APPROVED _ DISAPPROVED/CALL FOR REINSP. CF CO
BUILDING PERMIT
CITY CSF T I GARD IMERMIT It. . . . . . . : UPOE, 0'0`410
COMMUNITY DEVELOPMENT DEPARTMENT DATC ISSUED: 03'/03/96
13125 SW Hall Blvd.71gard,Gregor 97223e8199 (503)639-4171
1`'(111cr—L-. I S 17 300-01)500
'I I T E P D 10 0 C 1117 : SW I' i"-!V C
LUBD 1 V 1—0 ION. RZEL O—t—RES ZONINr:R-4. 5
. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1
rLC:.".P AREAS-- EX—ERIOR WALL C.ONSTRUCTION
^L(* i^ or WOr,.I,',. .nl,-T F I RST. . . . 0 5f N. S: E:
TYPE '2r- USE. . . : nFN,1'"' t?) F PRCTr�.CT
TYI-jL' OF CONST. :5N . . . 0 5f N S: E. W;
"-1NCT: rIPE ';CT" :C:_"UPANIC'( GPr-". -R3 I"OTnL , 0 5f POOr CO
SCCUPANCY LLAD: .7 BASEMENT. : 0 S ARCA SEP. RATED:
,Toto'. : 0 HT: 41 ft cnr%,(ICF 0 5f 0 C C'J, Scr. rATr_J;
ME Z 2,71. Rr(2.0
,JL- , REQUIRED—-
'`LOOR LOAD. . . . 0 p s f LE-F7: C ft- KPIT: 4"1 -Ft r!R ISPI-L . 13MOK DE7. . .
"WEILLINIS, UNITS: 0 FRNT; 0 Ft REAR: 0 ft F-IR ALRM: HNDICP (ICI-";
1r:Dr1M'_: o ZnT) IS: 0 imr, z',,jpr,-zr-z 0 r-,po cunp; !"'AR!-'.I mri 0
)(,),—UE. $. 520
lviniwk,;: REf',I_ACIN0 GARnOr- DOOR WITH A 13TONDARD 3C,"' Door
FEEZ
1.)DI'ANA CHAVE-.1 t y pf? z�mount by d ai;F,
" 117:- SW 01311C (IVE PRMT $ Z5. 'ZZ Bor4 0._1,/00 r)1") D
1C,. , 5 JD 02/i 2 6 C, 9C
JoAr
%J) or 1)-7,- rcv z. 15 roN 03/00/DG 'fir,
-ne #: Lo t 6 93
w 11141 C R
PECUIREJ INCPECTIOW,
'
"ric, per a" i� Awed s;1"ject to the i'llg-Jitiors contained in the rvaminu In F,p
-igard Municipal Code, State of Ort, Speci;'&Iy Codes and all other
Ipplicable laps. All w:A will be done i-i acni-dirce with
pprc,,,d plars. This will fXpi,le if WQ�A is nut started
it;'.r "? days of issunce, v if is ;uspondid for more
`lan 'uX
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Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(5031) 639-4171
.Jobsite Address: _ Z//75 's 1 3 C_- __
Office Use Only
Subdivision: — ���t,ee5 Lot #
Cortact Date / / Initials
Valuation: ��G' Result
New Construction Only: (Square Footage) �'�
Planck/P,ec # � C /C) �! �
Permit #_&111 >G - 0/0 U
House. _ Garage: — Reissue of
Map & Tl,#
Corner Lot? 6z N Flag Lot? Y N Zone V)- ,~
Owner: lq60t=lyL (poi 1v C- Plat #_
�;,'-lress: �Qrovals_i�e uG lied t rr 1 Ip �
Planning Setbacks F Solar r
-- Engineering
Phone: L 5�3�(o .� '� // _ Other
Contractor: p c,a r e Items Required
Subcontractors
Address: Trus,- Details _
Other
Phone: ( ) Notes
Contractor's Licen!e #
(attach copy of current Oregon license)
Contact Name:
Contact Phone.
Subcontractors: Architect/Engineer:
Plumbing: ._ Address:
Un
Mechanical:
'- (attach copy of current OR Contractor's License)
J
Phone:LD
m
JOB DESCRIPTION: ( cAALC l.1 3G S• lc
,(ICric> ►7yUv' t7Yi L=X,StrrVTC�n,S7c�/✓ lcn� �LZ0J ) 6,-- L( / ULr�
Applicant Signature Applicant Phone number
Received by: _ r,Lw _ Date Received:
N uoTa.nv«.,ro
y
Permit Account Description Amount Amt. Pd. SaL Duo
86 jP— l Ud Bldg. Permit
Plumb. Permit (PLUMB)
Mech. Permit (NECH)
Stats Tax (TAX) /•z , ! 'Z,_'
Bldg:
Plumb:
Mach:
Plan Check (PLANCK)
Bldg: L
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSOC)
Residential nF (TIF-R)
Mass Transit TIF (TIF-�11CT)
Commercial TIF (TIF-C)
Industrial TIF MF-I)
Instituticnal 71F (T1F-IS)
Office TIF (TIF-0)
Lvater Cua!ity (WCUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion PlancklUSA (ERPLAN)
Erosion Planck;COT (EROSN)
OTALS:
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F�c/�'Y►�c n C� l n/ fu lMt�c-G� L,r;S f%N f ,� K �/ C�v�T'S �.u c:�`�crn.
✓c ry /6 '/ Se Hi-ly Or l'���_ �e vAe
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Permit#: bU `l(0` U L)
Address: _ Lt l 1 SLj 6V
IX
1N j issued by: >0 Mit _ Date: 3 — �
t
Statement: Information Notice to Properti- Owners
About Construction Responsibilitiew
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 be issued. This statement is rquired
for residential building, electrical, mechanical, and plumbing pe,als. Licensed
architect and engineer applicants, exempt fi-om registration ;wader ORS 701.010(7),
need not submit this statement. This statement will ► tiled with the permit.
-.-L.-
ill In the appropriate blanks and initial L,,xes 1 and 2, and either box 3A or 3B:
W1. i own. i, side in, or will reside in the completed structure.
MSI 2. 1 Understand that 1 must register as a construction contractor if the structure is sold Or offered for s ale
before er upon completion.
F1 .iA. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
(l OR
I 4f
3B. 1 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 CCB and will immediately notify the office issuing this building permit of the
~ name of the contractor.
J
Ci
I hereby certify that the above information is correct and that I have read and do understand the Information
LL; Notice to Proper Y Owners about Construction Responr4hilities on the reverse side of this form.
(Signature of permi�plicant) (Date)
(whitc copy to issuing agency permit file,
pink copy to applicant)
5 3 S D l3 '- D`jSS OD
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00
I k I J P 1 t11 1 111 1,11 I'l P1 I 1 .11 1 1 1,111. t
11 J, 1 11 111111 :.I
1, 1.1 111
0 it 11 f '1 11 1 1 H I I Wit it I: I I
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K 0 10 1"
II 11.11 A JA I lipll 11 1111 1/11;1
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SW 93,H
its
CITY OF TIGARD BUILDING INSP►_CTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough in FINALS
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underllr. Insul. Shear Wall Gyp. Bd. , t.
Date Requested: �G Gl j r _Time:—M--.-�_PM
Address: l -S "2 { ---,
a
L( — ( r! O Permit #: <J 2oCp
r
THE FOLLOWING CORRECTIONS ARE REQUIRED:
xz
_ �LCCr7L ,4 7- "U"-) F-Ar��
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Inspector: Date:
APPROVED DISAPPROVED `IMPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD
OREGON
June 1, 1995
RE: BUILDING PERMIT #
Inspections) have been conducted on this project. However, we
have no record of any subsequent or final inspections within the
past 180 days.
Please note that permits become void if there has not been an
inspection performed for over 180 days. In that case, the Building
Division may require a new application and fees to continue work.
A notice of non-compliance against the property may also be
recorded by the City.
Please advise the Building Division, IN WRITING, within 1.5 days of
this letter, the status of this project . You may request
additional -lime to complete the project.
Respond IN WF"TING to: Building Division, 13125 SW Hall Blvd. ,
Tigard OZ 9 :2.s . Be sure to include the following information:
1 . Building Permit #.
2 . Address of property.
3 . Your name.
'Y
4 . Your phone number 8 :00 a.m. - 4 :00 p.m.
If you are ready to schedule your next inspection, please call our
24-hour Inspection Recorder at 639-4175 .
J
ingtn\add_inapectiona
13125 SW Holl Blvd., Tlo ard, OR 97223 (503) 639-4171 TDD (503) 684-2772
C17 OF TIGA RD
WYOFTWARD BUILDING PERM11-
COMMUNITY DEVELOPMENT DEPARTMENTs
1:�l 25 SW HWI Blvd. P.O.Elax 2M97,TigaM,On 97223(603)910.4175 ERMIT DUP92-01-0E,
DATE ISSUED: 07/21/92
,=ITTE ADDRESS. , . : 11. 175 SW 93RD CT PARCI:1.: 113135DB-095-00
.-)..JBDIVISION. . . . : REEL ACRES ZONING. R-4. 5
k3i.-OCK. . . i-OT. . . . . . . . . . . . . . 1,
REISSUE: FLOOR EXTERIOR WALL CONSTRUCT ION
L,LASS OF WORK. :ADD FIRST. . . . :644 Sf N: S: E: 1HR W:
TYPE OF USE. . . . CoF TiECONE). . . .-644 S i. PROTECT OPEN INGS?
TYPE: OF CONST. :5N THIRD. . . . : 1288 s N: S: Eo W2
OCCUPANCY GRP. -R3 TOTAL Ff ROOF CONSTt FIRE PET?
L
iC CUPANCY LOAD: BASEMENT. : s f AREA SEP. RATED:
,.:-)I OR. :2 HT. ;'23 ft 1-77 A P A V3E. . . : S F OCCU SEP. RATED:
93MT,).- MEZZ'1 - READ SETBACKS____--_— REQUIRED----------------------
V:ILOOR LOAD.. . . . :40 psf LEFT t 10 Ft ft FIR SPKI-_- SMOK DET. . :
DWELLING UNITS: FRNT: ft REAR- 15 ft FIR ALRM: HNDICP AC;Ci
:3EDRMS: BATHS,- IMP EJRFACE- PRO CORR: PARKING:
,)ALUE. $ 10000
Remarks : D/W MUST BE HARD SURFACED—NEED TO OBTAIN S. O. P. PRIOR TO OCCUPANCY
AF.W GARAGE 01_D D!W APRON MUST BE ELIMINATED OR NARROWED
Owner. ------------- FEES
')I Or
N AND DONNA CHAVEZ type amol.int by date r e C p I;
i175 SW 93RD AVE PRMI $ (30. 50 JH 0i/f_1/92
3 JI-11 4-11 0 1/9 L,
!A.4_APD OP 97224 5PCT 4. 03 JH 07/21/92
—
.,hone #: 620-6598
(intractor:
ALUEN T & DONNA J CHAVEZ
111'/5 SW 93RD AVE
) I(3(4RD OR 97224
'hone 6,20- 6598
i�eq
REULIIRLL) INE3PELTlUNS
This pet-sit is iisupe subject to the regulations contained in the Foot/fc-),.ind Ins13
Tigard M,inicipal Code, State of Ore. Specialty Codes and 311 other Framing Insp
applicable laws. P11 work wi:1 be done in accordance with (,iyp Board Insp ------
approved plans. ibis persit will expire ff work is not started Rain drain Insp
within IN days of issuance, or if work is suscended for tore Appr/Sdw1k Insp
than IN days. Final Inspection
F.'ermittee
tii Tssved Py :
Lal I f or in-,i_,ec:t i on 639-4175
13115 SW Hall Md. PLNI.i #
CITY OF TI GARD PO[lox 23397 PERMIT # l ."p>Z - -)-4rc, _—–_
COMMUNITY DEVELOPMENT DEPARTMENT Tigard,Orcgon972LA
(S03)63"171 DATE ISSUED
JOB ADDRESS: Z,// JS S LJ ?I"j- /It, TAX MAP/LOT /s i 35 Vv— d ct;(%)
SUB: act-,5 _ LOT: _� LAND USE: C-- `(.
VALUATION: _ /0, coo
OWNER SPECIAL NOTES
NAME: C'_fid Uc z REISSUE OF: Sff CcYn/nf/LJ __
ADDRESS: // / 7S s `7 3"r HvP LAST REISSUE:
FLOOD PLAIN/
PHONE: 610 6,S- `7f _ _ SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: C� c� - PLANNING: _
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER: 110 -rlr
CONTR. BOARD #: FXP DATE:
ITEMS REQUIRED
SUBCONTRACTOR: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: ��,�_ a � ywc TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE: �rnr_;G --
COMMENTS: - Gt ST ►3F _12PLF l) , Alfeh_ 7L, 1-'KC OK' 76 OCCGff=iq/t C'
F Ne k/ C 'A/F U D �/4,j rl eC(Y ?1 c( c= Z in I &1A7f b Oa A7AR,Cmr
APPL CANT SIGNATURE
Received By: Dote Received: 77 I
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
,Fuffl 02c'lo 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees —
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) o 3 U3
Building . 3
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building _51,33
Plumbing
Mechanical
10-230 06 Fire ——
30-202 00 Sewer Connection --
30-444 00 Sewer Inspection —
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
2.5-448-03 Office TIF Fees — -
25-448-01 Residential Traffic Fees —
25-448-05 Mass Transit TIF Fees —
52-449 00 Parks System Dev Charge (PDC) ----
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) — — —
24-445-01 Water Quality (Fee in lieu of) --
24-445-02 Water Quantity (Fee in lieu of) —---
TOTAL l3�8G � 3
nm/358711.W11
/$F Permit No:
Address: —
' Issued b Date:
\ .' '•/ FOR OFFICE USE ONLY_
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction perniit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment 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 be
filed with the permit.
Fill in the applicable blanks, and iniVal boxes 1 and 2, and either box 3A or 313:
1 . � I own, reside in, or will reside in the completed st ucture.
2. 11 i understand that I mus( register as a constructio;i contractor if the structure is sold
or offered for sale before or upon completion.
3. A. 1 My general contractor is
Contractor registration number_
will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B. 1 I will be my own genera contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mird and do hire a general contractor, I will
contract with a contractor who is (tnistcied with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side f this form.
Signature of Permit ppIIcant Date
4-
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO. :92--4P9744
CHECK AMOUNT 84. 53
CHAVEZ, DONNA CASH AMOUNT 0. 00
ADDRF-c5E s 11175 SW 93RD CT PAYMEN'T I)A'(*E 07121192
SUBV I V I f--p ION
,rIUARD, OR 9'720.,.3—
PURE 0517 OF f-InYMENT AMOUNT 1701D PURPOSE OF PAYMENT AMOUNT PAID
BUILDING PERM 80. 50 ST. BUILD PER 4. 913
TOTAL AMOUNT PAIJ) 84. 53
•
r,lTY nF TXGPR13 RECEIPT OF PAYMENT RECEIPT NO. 298
CHP-.'CK AMOUNT
NAME CHAVEZ, At DEN & DONNA CASIA AMOUNT 0. (be
AIJURES15 e 11175 SW 93PD COURT PIWYNE�
sa, �'q I
TIGARD, OP 97223-,
Fl1tlFyflt E= OF PnYMENT AMD1.IN"r r',n I D PURPOSE OF -PAYMENT AMOUNT PO(D
rLPIN CHECK FE 6/66R 5E. .:1..
t 1175 S. W. 93RD Cl . ATTACWD WRAGC
TMAL AMOUNT PAID 52. 33