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InitiallyGood 0 cD w 0 z D rn z c rn 10793 SW 106" ' AVENUE CITY OF T' w(V=A R® � MASTER PERMIT PERMIT#: MST2003-00197 DEVELOPMENT SERVICES DATE ISSUED: 5/30/03 13125 SW Hall Blvd.,Tigard, OR 9722.3 (503) 639.4171 SITE ADDRESS: 10193 SW 106TH AVE PARCEL: 1S134AD-09100 SUBDIVISION: WINDSOR PLACE ZONING: R-7 BLOCK: LOT: 028 JURISDICTION: TIG REMARKS: Addition of 110 square feet to second story, no change to footprint of building. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS R' -� CLASS OF WORK: ADD HEIGHT: FIRST: 0 of BASEMENT: at LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 110 of GARAGE: of FRONT: 15 PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: TIal1D of RIGHT: 5 VALUE: 20000 00 OCCUPANCY GRP: R3 BORM. BATH: TOTAL I to . sf REAR: 75 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAN DRAINS: CATCH BASINS: TUBISHOWERS: GARBAGE DISP: WATER HEATERS: WAi ER LINES BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN t 100K: SOILICMP<3HP: VENT FANS: CLOTHES nRYER: FURN>=100K. UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL LNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS AVU'L Ilk SPECTIONS 1000 SF OR LESS: 0 -200 amp: 0 •200 amp WISVC OR FDR: PUMP/IRRIGATION: PER INSPECTION. EA ADD'L 50OBF: 201 400 amp. 201 400 wnp tet WIO SVC*DR: = SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EAADDL BR CIW SIGNALIPANEL: IN PLANT: MANUHMISVCIFUR: Sol 1009amp: 601+alnpe•l000v: MINOR LABEL: 1000•amolvoll: PLAN REVIEW SECTION Reconnect only: >600 V NOMINAL: CLS AREAtSPC OCC: >=4 RES�INITS: SVCIFDR>•225 A.: ELECTRICAL-RESTRICTED ENERGY — A.SF RESIDENTIAL B,COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH BOILER: HVAC LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL: OTHR HVAC: DATAITELE COMM: NURSE CALLS: TOTAL N SYSTEMS: TOTAL FEES: $ 535.97 Owner: Contractor: This pe mil is subject to the regulations contained In thle VITALI,JOHN& MICHELE OWNER Tigard I lunicipal Code,State of OR Specialty Codes and 10793 SW 106TH AVE all othe applicable laws. All work will be done In TIGARD,OR 97223 accordance with approved plans. This permit will expired work is not started within 180 days of issuance,or If the work is suspended for more than 180 days. ATTENTION: Oregon I N requires you to followrules adopted by the Phone: Phone Oregon Utility Notification Center. Those rules art set 503-620-5046 forth in OAR 952-001.0010 through 952-001-0080. You Ren r: may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Electrical Rough In Final inspection LE raming Insp nsulation Insp Electrical Final Mechanical Final Issued By : 0. Permittee Signature Call (503)639-4175 by 7:00 p.m.for art Inspection needed the next business day ra ' 4 Build ing.'Permit ADplieation Received 9 C Pe Wing Date/B o.Nyr , ,w Planning Approval Other City of Tigard Date/B : Permit No.: Plan Review Other 13125 SW Hall Blvd. ' Permit No.: Date/B : Av5r-A-03Land Use Tigard,Oregon 97223 Post-Review Phone: 503-6394171 Fax: 503-598-1960 Date/B : Case No. duns.; See Page 2 for Internet: www.ci.tigard.or.us r_ ('ontact Name/Method: 5u Icmentallnformation 24-hour Inspection Request: 503-639-4175 — D t7� n�t� �N�A)�'E T "aTP,e,�T e) .r �r/1u0"/A t"T t?/#d je ICrl�(1 Q�7� REQUIRED DATA: TYPE OF WORK --- - Demolition 1 &2 FAMILY DWELLING New constructiull Addition/alteration/re lacement Other: _ -- Note: Permit fees'are based on the total value of the wor:performed, Indicate CATEGORY OF CONSTRUCTION the value(rounded to the nearest dollar)of all equipment,materials,labor, 1 &2-Family dwellin r Commercial/Industrial overhead and profit for the work indicated on this application Accesso Buildin Multi_ amil __—_- $�O�( � Valuation...................................................... Master Builder _Other: _-- No.of bedrooms:_.— No.of baths:__ _------- JOB SITE INFORMATION and LOCATION _._ Tutal number of floors •••••• - ,lob site address:107". Tf6TM Me• New dwelling area(sq.ft.).........................'.... X - Suite#: Bldg/Apt#: Garage/carport area(sq.ft.).... ---- Covered porch area(sq.ft)..........••................. Pro cet Name: —.— Deck area(sq.ft.)............... ........................... - Cross street/Directions to job site: Other structure area(sq.ft.)......... ........ ....... -- K)0j^'pt k o,_,ro REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: Lot#: Note: Permit rec arc based on the total value of thew performed. Indicate TAX ma / areel #: ��_._ t}11 value(rounried t e nearest dollar)of all equi nt,materials,lalxx, UE$CRI!'TION OF WORK. overhead and profit fix work indicated on t application L.. �-oaft—Y --__ Valuation... 5— -----—— _ Existing building arca lsq.ft. _ New building arca isq.ft ....................'... ... Number of stones..... 1•ype of construct' - _-- TENANT Existing:... PROPERTY OWNE[t Occupancy gr (s): Existing: -- NanTe. CTyir + - -- -- New: Address:30713 - -- (y/State/Z_ `_ _.=1-f- ----- - NOTICE: All contractors end subeontr tctors arc required to be P110ne03� _ rax: licensed with the Oregon Construction Contractors Board under _.. CONTACT PERSON provisions of ORS 701 and may be requited to be licensed in the APPLIGIr.T - jurisdiction where work is being performed. If the appiicant is exempt r Business Name: --- -- frorn licensing,the following reason applies: Contact Name: --- Address: City/State/Zi : - Phone: _ ,__ _Fax: — BUILDING PERMIT FEES'' E-mai I: rn ✓' - _ Please refer to fee schedule. CON RACTOR -___---__-- Business Name: r / - - Fees due upon application.... ........................ 5--��-- Address: _ _ Amount received.. ........ ..... . ...... ...... .. __ $ _ Cit 'State/zip:- _- __- _ rax — _-- Date received:_ Phone r CCB_ Lic. #: — __ --_---- --- Authorized . yll� 03 Notice: This permit application expire.If a perrr::r h obtained oalned wlihin Signature: Ju _.- Date: f 180 days after it has been accepted as complete. *Fee methodol18y set by Trt-('ounty ttulldla8 ludustry Service Board (Please print name) 7♦ 5 , %'i ,,,I)sts\Pcnnit form%\Illdgi'crrn tApp.doc 01103 One-and Two-Fainily Dwelling Building Permit Application Checklist_ Reference no.: 2, k Associated permits: Ciryo(Tigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other: Phone: (503) 639-4171 Fax: (503) 598-1960 i 1 1R A oil OLIA' 1 Land use actions completed.lice jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 7-Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. __--- 8 Soils 1 eport.Must carry original applicable stamp and signatur:on file or with application. 9 Erosion control U pima t,permit required.Include drainage-way protection,silt fence design and location til' catch-basin protection,etc. 10 _L Complete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size sheet attached j2jjUlans with cross references between plan location and details. Plan review cannot be completed violations exist. e/Plot plan dra o scale.The plan must show lot and building setback dimensions:property comer elevations(if Uere is more a 44t.elevation differential,plan must show contour lou•,at 2 11.intervals);location of easements and (� Fi�eway'fc otprint of structure(preluding decks);location of wclls/scpuc s�qcmti;utility locations;direction indicator;lot area;building coverage area:percentage ofcoverage;impervious area;ext,ting structures on site;and surface drainage. l2 Foundatlon plan.Show dimensions,anchor bolts,tiny hold-downs and reinforcing pads,connection details,vent — size and location. _ 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater. furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member siic�and spacing such as floor hcams,headers,joists,sub-floor, wall construction,rool'construction• More than ane cross tenon may he required to clearly portray ron,uuction.Show details ol'all wall and roof sheathing,rool'ing,root slope,ceiln)g height,siding material,Rx)ting.s and foundation,stairs, fireplace construction, thermal insulation,etc, _ 15 Elevation views.Provide elevations I-or new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grad's if the change in grade is greater than four toot at building envelope. full-size sheet addendums showing foundation elevations with cross references are acceptable. --- -7 16 WAIT bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non rescriptivc path analysis provide specifications and calculations to engineering standards. 17 Floorlroof framing.Provide plans for all floors/root' i,sentblies,indicating member sizin•t,spacing,and hearing locations.Show attic ventilation. _ _ 18 Basement and retaining walls. Provide cro- ��.cl n, nd It showing placement of rchnr• For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculations.Provide two sets of calculations using current code design values for, beams and multiple,joists over 10 feet long and/or any leam/joist carrying it non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more n(l liap noes• __ _ 22 Engineer's ealculations,When required or pad,ides.(i c shear wall,ru„ ) •hall hC ,tamped by an engineer ur7�j architect licensed in(aregon and shall he shown to he nl,r1111 t'ho the W I ' , � "- 1 23 Five(5)site plans are required for Item I I above, site plans Must he h-1/2" x I I"or I I" x 17". _ 24 Two(2)sets each are required for Hems 16, Irr,20&22 ahooe. 25 Bailding plaits shall not contain red lines or tape•om "Mirrored" huiidang plan,will he not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit& system I)evelopntent Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tee site.type&location per approved project ,freer true plan lit'afr.tirahlcl.and CU1'Street Tr, List. _ Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink. Iced ink is reserved for department use only. ata 4614 n VO( OM) Mechanical Permit Application Received Mechanical Date/By: `7 / 0:' Permit No: ' City of Tigard Date/o:Approval Building Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land Use Date/By Case No.: Internet: www.ci.tigard.or.us Contact luris.: 29 See Page 2 for 24-hour Inspection Request: 503-639-4175 Nan.::blethod: Supplemental Information. r TYPO OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST i; New construction Demolition Mechanical permit fees'are based on the total value of the work ❑ Other: performed. Indicate the value(rounded to the nearest dollar)of all Addition/altcrationireplaceii��t _ mechanical materials,equipment,labor,overhead and profit. CATEGORY OF CONSTRUCTION _ value: S See Page 2 for Fee Schedule 1 &2-Family dwelling Commercial/Industrial ACCeS50 Buildin Multi-Family RESiDENTIA[.F. UIPMENT/SYSTEMS FEE*SCHEDULE — Description Qty Fee(ea.) Total Master Builder Other: Hcating/Coonn JOB SiTE INFORMATION and LOCATION Furnace-add-on air conditioning_ _ _14.0(1 _ Job site address: O? 'ice Q,t�• Gas heat pump _ 14.(i0 I31d /A t.#: Duct work — 14.00 — Suite#: _- . g. _ .r- H drunic hot water systcrn 14.00 Project Name_ _ Residential boiler Cross street/Directions to job site: for radiator or hydronic ast❖m 14.00 l Jo(TV,.0aX__61D-,T(3 TL- Unit heaters(fuel,not electric) (in wall,in-duct,suspended,etc.)_ 14.00 Flue/vent for an of above 10.00 Rc air units 12.15 Subdivision: — 1 r Ot# — Other Fuel Ap Ilances Tax map/parcel#: Watcr heater 10.00 DESCRIPTION OF WORK Gas fireplace _ 10.00 Tkdr00��_P T �, Flue vent(water heater/gas fireplace) 10.00 J T Log lighter(gas) 10.00 ( `( Wood/pellet stove —_ 10.00 U _ Wood fireplace/insert 10.10( Chtmne liner/flue/vent 10.001-- -Tp--T 10.00 TENANT Other: 10.00 PROPERTY OWNER EnvironmentalEzhru &Ventilation Nanle: Mine Range hood/other kitchen equipment —. 10.00 Address: T Clothes dryer exhaust 10.00 Cit /State/Zi : _ Single duct exhaust —` Phone: =� Pax: (bathrooms,toilet compartments, APDL CA CON'T'ACT PERSON utilitys room _ 6 g0 _ Name: Attic/crawl space fans 10.00 Other- I(I Address: P/_t Fuel Piping _ City/State/Zip: _ _ _ _ **($5.40 for first 4.$1.0 erch addtltond Furnace,etc. Phone: — Fax: __— Gas heat pump E-mail: 1,Mt L °�n� __ Wall/sus ended/unit heater CONTR CTOR Water heater _ J -- ---- c lace Business Name: r r Fir — - *. Address: _ 13BQ Cit /State/Zi Clothes dryer(gas) i " _ —. Phone Fax: Other. i'otal: CCB Lic. } : _ —. _Mechanical Permit Fees* Authorized Subtotal: S Signature: Dole:VIVO__ ----- _ -- R - --- --- Minimum Permit Fee$72.50 S —_Plan Review Fee(25%of Permit FecL..S li1L 1f` (Please print name? State Surchargems*of Permit Fee)_.$ TOTAL PERMIT FEF. $ Notice: This permit rppiication rzpires Ira permit is not obtained olthin *Fee methodoluRv set b)Tri-0' unty Building Industry Service Hoard. 190 days oner It haii been accepted as complete. i\nsts\Permil FormsWecPemiitApp doc 01103 Mechanical Permit Application-City of Tigard Page 2 -Supplemental Information ' Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof,to and including$10,000.00. $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$100.00 or fraction thereof,to and including $25,000.00. $25,001.00 to$50,000.00 $379.50 for(lie first$25,000,00 and $1.45 for each additional$100.00 or fraction thereof,to and rrciuding $50,000.00. $50,001.00 and up $742.00 for the first$5J,000.00 and $1.20 for each additional$100.00 or fraction thereof'. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 B'ru,including 955 ducts&vents Furnace>100.010 BTU including ducts 1,170 &vents Floor furnace including vent 955 _ Suspended heater,wall heater or floor 955 mounted heater Vent no!inclu,';d in appliance permit 445 Repair units 805 <3 hp;absorb.unit, 955 to 100k BTIJ 3.15 hp;absorb.unit, 1,700 101 k to 500k BTU 15-30 hp;absorb.unit,501k to I mil. 2,310 BTU _ 30-50 hp;absorb.unit, 3,400 1-1.75 mil.B'rli >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handling unit to 10,000 cfm 656 Air handling unit>10,000 cfm 1,170 Non-portable evaporate cooler 656 T Vent Can connected to a single duct 446 Vent system not included in appliance 656 emit Hood served by mechanical exhaust__ 656 _ Domestic incinerator _ 1,170 _ Commercial or Industrial incinerator _ _ 4,590 Other unit,including wood stoves, 656 inserts,ctc. (las piping 14 outlets _ 360 _ Each additional outlet 63 TOTAL COMMIE i—C $ VALUATION: i\DstsWermit Forms\Mecl1crmitAppl'g2 doe 01103 Permit µ — -- Address: Q7 93 166, Issued by: — Date: Statement: Information Notice to Property Owners About Construction Responsibilities Norte: Oregon Latin, ORS 701.0 -�14), requires residential construction permit appli- cants who ai a not registered Frith the Construction Contractors Board to sign the follovi-ing.statenteni before a btuilclingpernrit c,rn 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), creed 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 3A or 313: I own, reside in, or will reside in the completed structure. 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) Contractor regis. # I mill instruct my general contractor that all subcontractors who v;ork on the structure must be registered with the Construction Contractors Board. OR Fej/3 B. I will he my ossn general contractor. II'I hire subcontractors. I will hire only suhcontractors registered %%ith the Construction Contractors Board. It I change my mind and hire a general contractor. I will contract ssith a contractor %%ho is registered %kith the CCB and will immediately notit'Y the,)I'lice issuing this building permit ofthe name oaf the contractor. 1 herehy certify that the above information is correct and that I have read and do understand the Information Notice to Properh, Owi)ers about Construction Responsibilities on the reverse side of this form. (Signature ��t't,ernut applicant) — (Date) r I1'hite copi.to issuing agenci.her•nrit file, pink curt•to applicant) Electrical Permit Application Recrived A*OFFICE iilecUStn . Date/B 03 ' Permit No.: 7i' �00� '' City of Tigard Planning Apprbval Sign 13125 SW Hall Blvd. Date/By: Permit No.: Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: _ Phone: 503-639-4171 Fax: 503-598.1960 Post-Review Land Use Internet: www.ci.tigard.or.us Date/By: Case No.: Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: _ Supplemental InformAtion. TYPE OF WORK PLAN REVIEW Please check all that apply El New construction Demolition Service over 225 amps- EJ licalth-care facility Addition/alteration/re lacetnent Other: commercial ClIlazardous location ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in 1 &2-Family dwelling ❑Commercial/Industrial ❑System over 600 volts nominal one structure ❑ Accessory Building Multi-Family ❑Building over three stories ❑Feeders,400 amps or more P [3Occupant load over 99 persons ❑Manufactured structures or RV park _Master Builder Other: ❑F:gresfnighting plan ❑Other: JOB SITE INFORMATION and LOCATION Submit_sets of plans with any of the above. 1,�.�e �^,. The above are notapplicable to temporary construction service. Job site address: tae -1 _ lir'` FEE*SCHEDULE Suite#; -131dg./Apt.#: �- _ Number of Ins ections per permit allowed Project NI? ne: Drscri tion Qty Fee(ea.) Total f-w resldenlial•single or multi-family per Cross streetJDirectilms to job site: dwelling unit.Includes attached garage. -r0 1O6" Servlet Included: l 1000 sq.Il.or Icss 143.15 4 Each additional 500 sq.Il.or portion thereof 33.40 I Subdivision: Lot #: Limited encrily,residential 75.00 2 -- - - -- ---------- limited energy,non residential 75.00 2 Tax map/parcel M _ Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or Iccdcr 90.90 2 e.,r. ^7 f Services or feeders-htstallatloo, �l f� �1 alteration or relocation: —�,L,rr� �, _�t•� i i f 20(1 am s or less __ - 80.30 2 V 201 ams to 400 ams 106185 2 401 amps to 600 ams 160,60 2 (OWNER TENANT 0011 amps to 1000 amps _ 240.60 2 Name: '+ r a I,t 1 Over I(HIO amps or volts_ _ _ 454.65 2 —M /t� _ - Reconnect only66.85 2 Address: % . Temporal-%,services or feeders-Installation. City/State/Zip: alteration,or relocation: t_-1�O� 200 amps or less _ 66.85 1 201 amps to 40Um s a Phone �.��Ip_%S-,$J6Fax: amps 10010 Ivo.3o 1 APPLICANT I EJ CONTACT PERSON 401 to 600 ams 133,75 2 -- - Branch circuits-new,alteration.or Name: extension per panel: Address: _ � - A.Fee liar branch circuits with purchase of -- service or Iccdcr ret each branch circuit 6.65 1 city//State/Zip: Fee for branch circuits without purchase nr ----- service or feeder fee,first branch circuit I 46.85 Phone: _ Fax: _ Guch additional branch circuit 5.63 2 ---- - F-mall: I ►.m Te-- Q Misc.(Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 _ 2 --- — ---- Each 11 nor outline lighting _ 53.40 2 Job No: _ _ Signal circuit(s)or a limited energy panel, Business Name: alteration,or extension _ _ Page 2 2 - -- - Description Address: _ _ Cit /Stoic/Zl - -- Lach additional Inspection over the allowable In allof the above: _� —p Per inspection r hour mu: I hour) _ _ 61.30 Phone: 1''aX: Investigation tee — CCB Lic. #: �.1_Lie. #:--- - Other. -� - ---- riectrical Permit Frei* Supervising electrician Subtotal 8 signature reuired: _ Plan Review(25%of Permit FecZ S _ T Print Name: LtC. #: —_— State Surcharge 806 of Permit Fee 5 _ TOTAL PERMIT!FEE S _ Authorized Ate/ �otlrrc 'this permit application explres If a permit Is not obtained_ within Signature: {��• _ _ •_ Date: y IN dass after It has been accepted as complete. T� •Fre mrthodolog) set by Tri-County Building Industry Service Board. (Please print name) i\I)sts\Permit FormsT.IcPermitApp.doc 01/03 Electrical Permit Application -City of Tigard Page 2- Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ $75.00 Check Type of Work Involved: Audio and Stereo Systems* © Burglar Alar (-jaragc i)oo, ..pcner* Heating.Ventilation and Air Conditioning System* Vacuum Systems* Fj Other — COMMERCIAL WORK ONLY: _ Fee for each system.......................................................... $75.00 (S['-I:.OAR 919-260-260) check Type of Work Involved: Audio and Stereo Systems liuiler controls Clock Systems 1)uta-rclecommunication Installation LJ fire Alurm Installation MVAU Instrumentation Intercom and i'agini,Systems 0 Landscape Irrigation('ontrol* Medical ❑ Nut%c Galls ❑ Outdoor landscape Lighting* protectivc Signaling Other Numhcr of Systems * No licenses are required. Licenses are required for all other installations is\Dau\permit Forms\i'.Icl'ermitApppg2.duc 01103 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BLIP Received -- Date Requested— IQ—Z___— AM______-- PM BLIP Location l0 -7 6?3> __Suite MEC Contact Person M i r-A (1,e t_ Ph( _ (Q — W�4PLM __— Contractor A- Ph ( _.__—) ---- SWR - _ -- --.— 11 UILUING Tenant/Owner __-_- —____ __ ELC Foottrt9 ELC - - — Foundation Access: Ftg Doainyv ELF! Crawl Drain K Slab Inspection Notes: SIT Post&Beam 5 Shear Anchors Ext Sheath/Shear �� - Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler - Firo Alarm Susp'd Ceiling Roof I r al PART FAIL ING ---- Post&Beam Under Slab ------- -- ----- Rough-In Water Service - Sanitary Sewer Rain Drains — --- -` — Catch Basin/Manhole Storm Drain �' _--- ----� Shower Pan Other. _ �------- �-- - - 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 Reinapeclion fee of 5; required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE [� Please call for reinspection RE:— __ _ �] Unable to inspect-no access Fire Supply Line ADA Dab Inspector _— Approach/Sidewalk Other- Final therFinal DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (S03) 639-4175 �Ms _t___& d 15'7— INSPECTION DIVISION Business Line: (5031639-4171 BLIP — q �(v AM- - PM - - -- Received -----------Date. Re nested___ Location __ (o 74 3 — l vG#`'�_✓_e- - Suite MEC - --- - - - Contact Person '!��G"' -- - __ Ph S0 Lt(P PLM ( ) �n . -- Contractor _ - Ph - SWR -__ --- - -- .— Tenant/Owner - BUILDING Footing ELC - Foundation Access: ro ELR Fig Drain Crawl Drain - SIT - Slab Inspection Notes: 30, 'o o Pew% Post&Beam D Shear Anchors r)e I Ext Sheath/Shear Int Sheath/Shear Fra.ding ---- - -------------'-�---- _ Insulation - I' Drywall Nailing -- - - -- - - Firewall Fire Sprinkler _---"----- -- - Fire Alarm Susp'd Ceiling -"- Roof Other:�_--_--- -- - --- Final -�- PASS PART FAIL �- Post&Beam ---- ----------- __-- Under Slab --------- - �- -- Rough-In --_ - ---------- Water Service --- Sanitary Sewer _ -_ ------ -- Rain Drains - ---------� Catch Basin/Manhole -- Storm Drain Showei Pan - - -- -_-- -- -- - v--- Other: -- Final __ -_ -- -- -_ --------- -- ---- -- -- PASS_ PART FAIL _ MECHANICAL - -- Post&Beam -- _-_.--- Gas Line _----.-.--_.- Smoke Dampers - Final PASS PART FAIL - -- EL ECT RirAL - ---- ---------.. __- -- ----- --. ---� Service --_- Rough-In ----- -- - - ----------- - UG/Slab _ Low Voltage F e Alarm (� Reinspection tee of$ - required before next inspection. I ay at City Hall, 13125 SW Hall Blvd. _\ AASSS�-PART FAIL _ Unable to inspe:,t- no access Ll SITE Please call for reinspection RF:__-- Fire Supply Une ADA Inspect r Approach/Sidewalk Data Uther ___ Final DO NOT REMOVE this Inspectior. s6.;ord from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: 3) 9-4175 INSPECTION DIVISION Business Line: _4171 MST BUP Received Date Requested _ ? AM PM BLIP Location 7 C1 1 „ MEC Contact Person _ Ph(--) PLM Contractor Ph( ) SWR _ BUILnING Tenant/Owner ELC Footing _- Foundation ELC Ftg Drain Access: Crawl Drain ELR Slab Inspection Notes: SIT Post&Beam Shear Anchors - Ext Sheath/Shear Int Sheath/Shear i FraNLig sulatiorl Drywall Nailing C jV �, 5 / y'' J •�G� ��,�� Firewall � \ Fire Sprinkler Fire Alarm n �� ,• Susp'd Ceiling ��_, �• Roof t' Other: f Final' PASS PART AIL PLUMBING Post&Beam Under Slab Rough-In Water Service Sanitary Sewer _ Rain Drains - Catch Basin/Manhole Storm Drain - Shower Pan - - Other: — Final - P p T FAIL -` MECHANIC i os earn Rough-In _ Gas Line - J Smoke Dampers _ in ASS PART FAIL ----- - T_RICAL_ Service W - Rough-In --�-' UG/Slab - ----- _ Low Voltage Fire Alarm Final _PASS PART FAIL El Reinspectlon fee o1$ -required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE [] Please call for reinspection RE: Fire SuPPY I ne Unable to inspect-no access ADA ..._, Aporoach/Sidewalk glib—�-~y� � Inspa for �fti'act Other: _ Final DO NOT REMOVE this Inspection record from the job site, PASS PART FAIL