14894 SW 116TH PLACE i
I
14894 SW 116th P1.
B
CITY OF TIOARD PERMIT #. PERMIT. . . . . . . MST944114
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 12/ 15/94
13125 SW HoW Blvd.Tigard,Oregon 97223*8199 (503)839-4171 PARCEL:
SITE P&DREGS. . . . 148134 SW 116TH PL
SUBDIVISION. . . . : HELM HEIGHTS ZONING: R-4. 5
YALOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :8
CLASS, OF WORV_ :NEW GARBAGE 0 1 SPOSALS. . : 1
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACKFLOW PRcF,01TRS. . : 1
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . :lZ'
6 i'URIES. . . . . . . . : 144-TER HEATERS. . . . . . : 1 CATCH BASiN,' . . . . :0
- 1 1" : . . . . .. I
LAUNIDRY TRAYS. . . . . . . SF FRAIN DRAIN,�
SINKS. . . . . . . . . . : 1 GREASE TRAPS. . . . . . . :0
LAVATORIES. . . . . :5 0THLR flXTURES. . . . . :0
TUB/SHOWERS. . . . SEWER LINE (ft ) . . . . 10
WATER CLOSETS. 3 WATER '-INE (ft ) . . . . : 100
1)1 SHWASHE RS. - - I RAIN DRAIN (ft ) . . . . :0
m-am.xv-t(s.
OWNEH:
I IF* 1550. 00 JF 12/15/04
GLORUE WALL
bbt�55 SW 10ROUDISR LOOP BPR'T E318. 00 JF IiE/15/114
BPLC 9 :5;31. 70 JF 1::/1`:,/')4
BEAVERTON ON 97007 135PL t 40. 90 JF 12/15/94
52.4-7384 SSDC $ e'80. 00 JF 1x''/15/94
5
0 R 1", s 500. 9V.' JF 12/ 1 /94
5
L;n MPRT 1 45. 0121 J+
1 1i/94
M.PLC f 11. 25 JF 12/15/94
t1bP( ,,. &2 Ij JF 1._'/15/`)x+
e je.L'J. 00 JF 12/15/94
f-1 L1 d t,e *cp)Ire
Name.
I t y - Ort jv A.) P C. 4, 1 1 jr-, 1,2/15/94
E.R01i 4, F381 00 1P. 1.=/1`.5/44
zip: Additional feel� Gtiown hei-o . . . .
Req
----w--- pEQUiRED INSPECTIONS
----
1i-tis pey,m].t 1sj .steed subject to thO I^F9--
,, Jations contained in the figav-d Mi-mP
ic:1Al F00 t/fUtAnd Insp Rain dr^,.Ain In'
[ ode, State of Ot-e. Sper_,ialty Codes and all post/13eal" Gtir^uct Water- Line in
other-, appl It.,able laws. All work wi 11 be done post/Bei:im Iviechan Appr-/5dw1k Inf.
in accordance with approved plans. Thi,a V-',1.m/,_mdsIab Insp M e C h;-1 r)i c a 1, 1"•' i •
I
permit w 1 11 ex p i V.4 e If work is 110 t started F LM/Und e v-f 10 0 1" P] ..t rn b F 111 A I
witl.)In 3.80 days Of issi-t-Ance, or if work i. i Mechanical InSP Building Fiy'A ;
si-lspended for, mor-e than 180 days. P11,,imb Tup Out Lt-osion CuTvtt-�
F1'aming Insp wtv-
F I-cplace Insp Craw!. Dr-ain
Gas Linn 1115P Ftg Dt,ai., Uiml t
Ins"I.At Ion Insp
.1
yp f.nsp
Authori Zed P1 1(mbing
o I C,i qn at r
ut-e
Lai I f ) inspk?c1t I On
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. r/ 1
Tigard, OR 97223 PERMIT #
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED
TDD No. (503)684-2772
CITY OF TIGARD Inspection (503)639-4175 ISSUED BY
PLEASE COMPLETE ALL SECTIONS
1. t OCA HON OI INS TALI ATION 4. TYPE OF WORK
Address RESIDENTIAL-Restricted Enemy Fee.
_ f7aa V (FOR ALL SYSTEMS)
It State Zip Check Tyne of Work Involved:
PERMITS ARE NONTRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK
IS NOT STARTED WITHIN 18U DAYS OF IS:,UANCF OR IF WORK IS SUSPENDED FOR ® Audio and Stereo Systems*
180 DAYS ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Dour Opener'
El Heating,Ventilation and Air Conditioning System*
Contractor (� b �/ - tYpt'� Q� �- 0 Vacuum Systems'
Address ' SS ❑ C)iher- -�-�`
Date,Q�
COMMERCIAL-Fee for each system i4ajw
(SEE OAR 918-260-260)
Property Owner_�-�-�` Check Type a Work Invnlvy :
Contractor's Board Reg. No, --^ — -_ ❑ Audio and Stereo Systems'
Phone#
11Boiler Controls
❑ Cluck Systems
3. OWNER APPLICATION ❑ Dala Telecornmuni(alion Installations
❑ Fire Alarm Installation
- — 13 HVAC
Print Owner's N;cme --_-�-- Phone No
❑ Instrumentation
Address - -- —`- ❑ Inlerrom and Paging Systems
_�-_ Ell andscal)v Irrigation Control'
City Stale lip ❑ Medical
This Permit Is issued undrr OAR't ill 17U-17U This,ytplicant agrers to make only ❑ No ,e Calls
wstrided energy installations(100 colt.tnyn m lest under this 1 wrrnit and in do the
following: U Oulduor Landscape Lighrings
1. Only use electrical(icons-d prrsons to do installations whero#v(pord ((enain ❑ Protec:tivv Signaling
residential and other transactions are exempt from li(,imng.These have 11011tr+t
+slerisks(•).All others nerd licensing).
2. Call for an inspection when all(if tho installations untim this permit aro reauh
for;nspertion at 5011-6.1()r4171, ❑
7 PurrhAse separate penttils far all irisiallalions that aro not ready for inspection Number of Systems
whin the irspector is out to inspect under this permit
4. Assume responsibility fnr assuring that all corrections rr-qutred by the inspot tiu •h, "ns"s'u"n rltti114I i icrnu s.ter rryu{red for all other installations
are don-,and
5. Asvrmr responsiblllly for calling for A final inspvcti!tn whin all of the
ar orrcvii"rts S. FEES
rc cornplovd.
The person signing for this permit must he the applicant ora porn"" r7. Enter Fees � j
authorized to hind the applicant.
h. 5% Surcharge(.05 x total above)
Signature - — - —
TOTAL �7 CA�'
---
All c if other than applicant )- -
C- G)9 ,3 ENERGARCHP
Community Development RESTRICTED ENERGY ELECTRICAL APPLICA FION
13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT # ifl—P95= 0163__
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED 10IQ—
TDD
//me
TDD No. (503)684-2772
CITY OF TI(GARD Inspection (503) 63' •4175 ISSUFD BY ChcT—le__�c h�_ic�fl-
PLEASE_ COAMF_I E AL1. SECTIONS
1. LOCATI N OF INSTAL/L/ATION 4, INPF OF WORK
zwj -- ?ZM I�
ddrRESIDENTIAL —Restricted Energy Fee. . . . . . . . . S40.00
✓ L� IFOR ALL SYSTEMS)
City 61State Zip Check Tyne of Work Involved,:
PERMITS ARE NON-TRANSFER Z E AND NON-REFUNDARIE AND EXPIRE IF WORK ❑��U`rRIarAla
and Stereo System!.*
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
1b0 DAYS
2. CONTRACTOR APPLICATION E3 Garage Door Opener'
❑ I leatiog,Ventilation and Air Conditioning System*
Contractor Type _ ❑ b,truum S;stems*
/� � ❑ I tlher
Address
Date_ COMMERCIAL—Fee for each system , . . . . . . . . ;yau,00
,J,,� (SIF OAR 918-260-260)
Property Own,:r c�—J% l >�--— Q'�— Check Type of Work Involved
Contractor's Board Reg. No. �J� ❑ Audio and Stereo Systems*
/�
El Boiler Controls
Phone# _ t L _ ❑ (-.hoc k Systems
3. OWNER APPLICATION ❑ data Telecommunication Installations
❑ Fire Alarm Installation
c lS r1 17� ❑ I wx
Print Ownvr's Name Phone No
❑ Inslntmenlalion
Address — ❑ Inlercom and Paging Systems
❑ landscape Irrigation Control'
City Stale Tip ❑ Medical
This pernit Is Issued undrr OAR 41 R-12n-370 This al,pliranl agrees rn make only ❑ Ntlr!v Calls
w0firtrrl enroy inslallatiom ono volt amp•or Irss)undrr this permit and to do the ❑ Outdoor Landscape t ighling*
following:
❑ Pr deet live Signaling
1. Only its(,ilei trial lice +d persons In do inrdallalhns whore reyuiwol.ICrnain
residential and other tra iactinns aro exempt from,!i(emtng,llww have ❑ C11her
asterisks('1 All others neer)licensing). "`-
2. Call for an inspection when all of the installatn ms undrr this permit art,ready
(or Imprr-tion at 50.1.619-4 17 S
❑ _.------- ._ Number of Systems
3. Purchase separate permits 1w.,II instaIlati Drs IImt art,not wady for Inspection
whv�i the inspector is end h insluv t undrr this cornu No hr rnaw;ur required t u rnsv are required fnr all other installations
4 Assntte rrspnnsihilily fnr assuring that all rnrreriions required by the impector
are done,and
5. Aswniv responsibility(tit idling((it a final inspo two worn all of the corrections ), FEES
art,(orripleted.
Ion pt-rsnn signing fur t �permll must hr the applicant or a person a• Inter Fees $42,610
nrrllrun.ed In hind th rplkant. -
-- ±-r — ----- ---
,_. h. 5% Stlrc•harge (.05 x Intal above) $ t4, U
Signalure/''� Z� 4 ,r,
TOTAL $ ��/ (J
Authority if other than applicant — —_
FNERGAP.CHP
ELECTRICAL PERMT
CITY OF TIGARD PERMIT #: ELC96—I0194
COMMUNITY DEVELOPMENT DEPARTMENT
DATE ISSUED: 04/05/96
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PARCEL. 2SI10BD--03100
SITE ADDRESS. . . : 14894 SW 116TH P,L
SUBDIVIjION. . . . : HELM HEIGHTS ZON1NG: R4. S
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :8
Project Description: Install two branch circuits.
-------------------------------------------------------------- -------------------------
UNIT------ ----TEMP SRVC/FEEDERS------. ---------MIOCELLANEOUS------
1.000 SF OR LESS. . . . : 0 ,1 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADDIL 500SF. . . : 0 201 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 (.01+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
V I LE/FEEDER--.-- -----BRANCH CIRCUITS——— ----ADDIL INSPECTIONS -
0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : v)
201 400 amp. . . . . . : 0 13t W/O SRVC OR FDR. : I PIER 1-40LIR. . . . . . . . . . . . o
401 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: I IN PLANT. . . . . . . . . . . : 0
601 i000 amp. . . . . : 0 -------PLAN REVIEW SECTION--------_—_—_-__
1000+
ECTION----------------
10004. amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR 225 AMPS. . : CLASS AREA/SPIEC OCC. -
Owner,: FEES
MICHAEL. KELLER type amount by date r-ecpt
14894 SW 116TH AVE PRMT $ 40. 00 CJS 04/05/96 96-2771179
5
TIGARD OR 97223 PCT $ 2. 00 CJti 04/05/96 96-277871)
Phone #:
Contr-actor-:
TUALATIN ELEL:TRIC $ 4c. 00 TOTAL
PO BOX 655
REQUIRED INSPECTIONS
WILSONVILLE OR 97070 Wall Cove-r- Elect' l Final
Phone #: Elect' l Service
Ray #. . 11 6!36 r0
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will Op done in accordance with
a*oproved plans. This permit will expire if work is not started
withir, 180 days of issuance, or if worl� is suspended for sort
than 189 days, Issued By
INSTALLATION
The installation is being made on property 1 own which is not intended for-
sale, lea-,e, or, rent.
OWNER' S SIGNATURE-
DATE.
INSTALLATION
SIGNATURE OF: SUPR. ELECIN: 0"0 DATE:
LICENSE NO:
Call for, inspection --- 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # El-If 96 - 019 1-1
Date Issued y-S 96 _ _
Phone (503) 639-4171
CITY OF TIOARD FAX (503) 684-7297
TDD No (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development_/ e.'__ Number of Inspections per permit allowed
Address_ r L `� 1 �7.�"r . ( 7-6 Service included Items Cost(ea) Sum
City/State/Zip VtTz 1 z 4a. Residential -per unit
1000 sq. ft or less $110.00
Name (or name of business) Each th netereof sq n or
portion on(hf $2500
Commercial ❑ Residential Limited Energy $25.00
Each Manurd dome or Modular
Dwelling Service or Feeder $6800
2a. Contractor installation only:
4b. Services or Feeders
Installation,alteration,or eloratton
Electrical Contractor T 0 d-LL- r--,,,T L Vim - _ 200 amps or less $6c 00
Address
'P4:-2. l3 C--).,c C� c� _ _ 201 amps to 400 amps $8000 _ 2
-- 401 amps to 600 amps $12000
City _ �l Stated Zip_ 1"7 07�� $te000 2
601 amps to 1000 amps
Phone No �_ 5 ___ Over 1000 amps or volts $340.00 2
Joh N0._(Vj, 0 Cr I S C..- _ � Reconnect only $5000 � 2
contractor's license NO. '?) _ 2�r,_ L 4c. Temporary Services or Feeders
Contractor's Board Reg. No.__ r Insta:�tlo�,34er T, •1�rstlon
Signature of Supr. Elec'n 200 awn. -'-is,
License No.� _ Ph U5 201 amps to 400 amps 700 ��`_ 2
401 amps l0 600 amps $7500
$755.00
Over 600 amps to 1000 volts $100 or,
2b. For owner installa ons: see 'b"above
4d. Branch Circuits
Print Owner's Name.e__„T_ New.alteration or extension per pane
Addi ass _ a)The fee for br inch circuits with
purchase of service or feeder les.
City _ State___ Zip Each branch circuit $5 00
Phone No. _ bI The fee for branch circuits without
The installation Is being made on property I own which is purchase of service or feeder fee.
not intended for sale, lease or rent. First branch circuli 1 $35 00 � -J
Ear i additional branch cireult 1 s5 00
Owner's Signature 4e. Miscellaneous —T
(Service or feeder not included) 2
3. Plan Review section (If required) Each pump or Irrigation circle $40.00 2
Each sign or outline lighting $4000
Signal eircult(s)or a limited energy 2
Please check appropriate Item and enter fee In section 6B. panel,alteration or extension $4000
4 or more residential units in one structure Minor labels(10) $10000
_ Service and feeder 225 amps or more
_ 4f. Each additional Inspection over
System over 600 volts Nominal
the ali
Classified area or structure containing special occupancy inspection
In any of the above
y as described In N E C Chapter 5 Per inspeection 5 00
$5
Per hour $55 00
In Plant 55500
Submit 2 sets of plans with application where any of:he above
avoly. Not required for temporary conistruction services. 5. Fees:
6a. Enter total of above fees $
NOTICE 5%Surcharge (05 X total fees) $
PERMITS BECOME 1101D IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT GuMMENCED WITHIN 180 DAYS, OR IF 6b, Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review If required (Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account #
$
Balance Due $ LIZ
CITY OF T i GARS MASTER PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT M,5 T 9 4-04 1
'13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PERMIT #. . . . . . . ..
DATE ISSUED: 12/ 15/94
F!f,:i r
U'fTE ADDRESS. . . : 14894 SW 116TH PL ZONING: R-4. 5,
SUBDIVISION. . . . : HELM HEIGHTS -G
BLOCK. . . . . . . . . . : ___L01.. . . . . . . . . . . .
BUILDING BASEMENT . . . . . . :0
REISSUE: DWELLING UNITS: 1 ARAGE. . . . . . . . . . .513
CLASS OF WORK. :NEW BEDRMS:3 BATHS-2, G
TYPE OF ijSE'. ;SF FLOOR AREAS REQUIRED SETBACKS-
: 10 ft RIGHT. : 18 ft
TYPE OF CONST. :5N F I RST. . . . : 1592 Sf LEFT—f F-RUNT. :20 f t RE'AR. 40 ft
UCCUF--IANCY OPP. :R3 SECOND. . . : I 15
FINbC3MLNr: 1042 f REUU I RED--
S'l U R I ES. . . . . . . i� 2786 1� SIYIOI-�L DEJECTORS. ;y
HEIGHT. . . . . . . . .a4 ft 25 211 15 0 PARKING SPACES— : 1
FLOOR LOAD. . . . :40 p5f VALUE. . .
Remar,ksz PATH I PLUMBINU
------- BACKFLOW PREVNTRS.
FLOOR DRnING. . . . :0
SINKS. . . . . . . . . . . 1 WATER HEA'rERS. . . T R APS.. . . . . . . . . . . . . . .0
TUq/SHOWLRS. . . . ;4 LAUNDRY TRAY',:i. . . GRE.-,ASE TRAP5. . . . . . . :0
WAiii.R LLOSETS. . '- L SEWER LINE (ft ) - :0
�j(i'm-R 1_11\11-1 (ft ) . : 1.00 OTHCR FIXTURES. . . . .
GARBAGE DISF'. . . : 1 RAIN DRAIN (ft ) - %O
WASHING MACH. 1. 5F RAIN DRAiNS. - 1 FEES -
M L C H A N I C A L tyj,��e amo'..tnt t)Y da-te recpt
TYPL UNIT H1'RS- :0 T I i*-' 1,:�/15/94
FUEL S 1550. 00 JF
VENTS . . . . . :0 jf7, 4
B TLJ VEN'F FAN5. . : 4 BPRT 13113. 00
MAX INPUT-011 BF-LC: 5_3 I. 7 0 JF' 12/15/94
FU R N 11210K :0 H 0 0 1)G. . . . . . . 1 40. ')0 IF 1 15
FURN =1 OOK WOOD!-�TOVEG. .0 B3PC �:80. 00 IF 12/15/91"
FLUOR FURN- , CLO DRYERS. : I 5SOL Jr" 1
OTHER UNITS-1 I PORI,, too. Oki
1,10IL/cMP SHF': GAS OUTLETs: 1 MPRT $ i►5. LAO JF' 1a/15/94
_...._.--MP1.1_ $ 11. 25 J F Id/' 15/94
jwnell: M5PL $ 2. 25 JF 12/15/94
JF.,AJRGE WALL 3B 111 $ 25- 0 17) JF 16./ 15/144
Ja SW 71]ROUIDISR L.00F-' PI)FT, 11. 2:`.1 JF 12/15/94
ERC]', 88. 00 IF I ;i 15/1]4•
,_L.J)VCJ1T()N OR 91007 E.RFG Z,8. 60 JF 12 1:;/94
-
1-'h ane #: 5,2'4`1,384 IF 12 1.5/94
L cint t-ar:t or,t
(jLUH0E. WALL.
b,:55 "3W I'UJtGIUOISE LP
OR 910070000
6�4--7304.
Phone #' 7:1
e q L 39 2, $ 41 (,0. 7Y.5 TOTAL
?his
INSPECTIONS
his permit is issued Subject to the regulations contained in the eptscP Insp
Codes and all other J%'o d .1 n 5 P
I municipal Code, State of are. Specialty Co /its am ti,Ltrt Gas Line Insp
ligart ith Approved Post . .? 5
applicable laws, Ali work will be done in accordance W Post/Fivam Mpr-harl In'sl.tlAticiri Insp
app work is not started within 180 Insp
plans. This permit will expire if fL'j m/undr,lab iyp Doar-d Insp
I days of issuance, or if work it suspended for #or*# than IN days. I'i.M/Un(let-f lcov' tlajn d+-Aln iTISP
insp Watiyv Line In9p
1 'ev'rnittee '5iql '[0p utkt App,r,/Sdw1k Ins;t!
LAY -.
CITY OF TI�ARQ SEWER CONNECIION
COMMUNITY DEVELOPMENT DEPARTMENT FERMI T
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PE RM I I #. . . . . . . : SWR94-06y.
I
DATE ISSUED: 12/15/94
511"E ADDRESS. . . . 141304 SW 116TH F'!_.. PARCEL:: 2S110SD--0310Q)
SUBDIVISICSN. . . . : HELM HEIGHT'S ZONING: R-4. 5
BLOCK. . . . . . . . . . ! LOT. . . . . . . .
TENANT NAME. . . . ,
LJSA NO. . . . . . . . . . : FIXTURE UNITS. . . .-
GLASS OF WORK. . . "NEW DWELL-I NG UN I T'S. . . i I
I YPL OF USE. . . . . :rjF NO. OF' BUILDINGS: 1
I NSTALL 1"(PL. . . :BUSWp IMPERV SURFACE. . : C
"(�Marks : PATH T
F--EEG)
OLOROL WALL t y PC.) amol.int by date rL.-Cpt
6bbt'.)b SW 1URQUOISR LOOV, F-'R MT '21200. L40 JF 12/15/94
BEAVERTON OR 1)700 1 Iii D -> 3'3. 00 JF 12/15/94
PtWlle #.- 5247,t,64
Uuntv-actor:
CONI'RACTOrNOT ON l" ILE'
Phorie
Reg 7i 00 T01"AL.
REUUIRF—L) INSPECTIONS
This Applicant agrqps to comply with all the rules and regulations
of the Unified Sewage Agency. The pet-sit exPVes 180 days from
the date issued- The total amount paid will De forfeited if the
Derait expirps. The Agency does rmt guarantee the accuracy of the
sine sewer laterals, If the spolel, Is not l0cat#0 at the measurement
given, the installer shall prospect 3 feet in all directions from
the distinct given- If net 50 located, the installer shall purchase
a "Tap and Side Sew" Permit and the Agency will instail a lateral,
in i t t e P 15 J,qnat
r By -
L a I j f 0ln5PeCt i0 639—•4115
97 C-1 7 0 0
Residential–Building Permit Application
City o; Tigard ----- —A __. -
13125 ;.:W Hall Blvd.
Tigard, OR 9723
(503) 639-4171
" Jobsite Address: ��/ oy/ f S 4)
J aOffice !ae Only
Subdl ilslon: T �fJ2 A-, -e-- �_ Lot#
Valuation: /s V, Plancic/Rec # "�'
Owner: Cl. z; Z-1 A- i- Reissue of
Address: ^.� 5�..? ,TL�L/L LN-D e>-^ Low Map & TL #
provals Requir
Phone: /l
Planning_
_
Contractor.
E ngineering T
Addre,s: _— - _ _-_-- Other
Phone:
Items Requlmd
Subcontractors
Contractor's License #
(attach ca:py of current Oregon license) Truss Details
ubcontractors: Other _
Plumbing: < <
4echanical:
(attach copy of current OR Contractor's I ieense)
hltect/Engineer: L)A A,,� t� ,i , ,-tel. !;NN i/r✓rit.,w4.
,ddress: � r ' 2
'hone:
OMMENTS:
�.,.. L_...•, �,c„_._. x,....14 __ .� �� `f
W icant ignature & Phone number
9ceived by: .� V Date Received:
Permit ## Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) ,d -
Plumb. Permit (PLUMB) - _
lei
Mech. Permit (MECH) —
State Tax (TAX)
Bldg: ���
Plumb:
Mech: 2 ,/
Plan Check (PLANCK)
,-v �,
Eldg: .3/.. ;7 o
PI-:r:,. __
N,.ch: //, Z
V� 72G'ca
Sewer Connection (SWUSA) .--------
3 ' '
Sewer Inspection (SWINSP) — .--------
d�
� v c
Parks Dev Charge (PKSDC) Cv
Storm Drainage Chg (SDSOC)
Residential TIF (TIF-R) _/ / --------- / v
1
Mass Transit TIF (T-IF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
VUR u WV 1 c�� A b �
''rr'� r �
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tXPTIFICATE OF-
OC
CITY OF T I GARD PERMIT #. . . .
CUPANCY. . . : MST'14041.2
COMMUNITY DEVELOPMENT DEPARTMENT VATE ISSUED: 10/1213/1)5
13125 SW Hall Blvd.Tigard,Orogon 9722398199 (503)639-4171 PARC17_71...: 2S 1 1 MAD,.0y1.12.10
SITE ADDRESS. . . 14894 SW 116TH P-'L
SUBDIVISION. . . . HELM HEIGHTS 701\1I NG:P-- 4, 5
BLOCCK. . . . . . . . 1-01.. . . . . . . . . . . . .
CLASS OF WOW. :1*4F-W
TYPE OF USE. . . :SF
UCCUF44NICY GRP. :R3
0-rllf:,ANCY LOAD.E!24 4
I LNW4 T NAME. . - ".
Po—wk% : PATH I
GEOR(5E WOLA_
8555tj ('3W TURIDUOISR LOOP
BEAVL.RTON 014 1711107
Phonp #.- 5247384
U
G&ORCIE. WALL
amis sw 'rupotioisr F.F:,
BEOW-JiTON OR WOO; 0000
Phons- #- 51'%.'4 7--1811
Rey R.
I t'' COL & Cel"tifiet that the ahbvVe t'e f I'e 1.1 C V k4t i EJ I I t-k r t 1, or)
thpr-e0f has been Irlspecter.1 for- ompliance witlt Cllr
Tlqald 81,01ding Code
for- tf�e gvoijp and divi,sion of occupancy and o.tsp for' which the Ab0\/e
fct-enced pev-mi-t was 195kted, and occl.ipancy is het-eby Uvanted.
L -�v�1N0 1=tt'r"W1 i A t
PIO','�l IN CONSPICUOUS, PLACE'
CITY OF TIGARD BUILDING INSPECTION NOTICF
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 l
Inspection: I
Footing Susp. Ceiling Sprink, Rough-in Appr!S
Foundation Plbq. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San, Sewer Gas Line Bldg.
Plbg. Underfloor Rain Drain Framingum .
Alarm Water Line Insulation - ech,
Underflr. Insul. Shear Wall Gyp. Bd. -Elect
Date Requested: /D/3�%�_ Tirr,e: Ity AM PM
Addi ess:_ ��T cry''
Builder: Permit #: ' 7 -C
THE FOLLOWING CORRECTIONS ARE REQUIRED:
7In � 7 ector: Date: / f�
t APPROVED DISAPPROVED —APPROVED.— _ ED SUBJECT TO ABOVE
—_Call For Reinsp.
CITY OF T I CARD �'
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. -pard,Oregon 9722398199 (503)639-071 PLUMBING r-'ERMIT
PERM I T :4. . . . . . . : r-1-M95-0,247
635-4171 DATE ISSUED: 09/06/9-1,
r-'ARCEL,:
' TE ADDRErG. . . 14894 9W I IGTH PL
Zr)I V I SI ON. . . . HELM HEIGHTS ZONING: R--4. 5
OCK. . . . . . . . LOT. . . . . . . . . . . . .
-ASS or WORK. , :WWW'& CARBAGE: DISPOGAI-5— MOBILE V401111E SPACES. :
,'P,E OF USE SF WASHING MACV-1. . . . . . . . BACKFLOW PlREVaNTRS. .
[
JL ,INCY GRP,. P7, FLOOR r)FynINr
sTORIES . . . . . . . : TRAPS. . . . . . . . . . . . . .
WATER HEATERS. . . . . . : CATCH BASINS. . . . . . „
FIXTURES- LAUNDRY TRAYYS. . . . . . : SF RAIN
'SINKS. . . . •
z':3)INKS. . . . . . . . URINALS. . . . . . . . . . . . .. GREASE 1*R. AP,S. . . . . . . .
L A V A T 0 RI[' OTHCR rIXTUpr-r�
TUB/SHOWr
. : 1 SEWER LINE (ft ) . . . .
1—ITER CLOSETS. . : WATER LINE (-Ft '� . . . .
01SHWASHERS. . . . : RAIN DRAIN (ft )' . . . .
Remtap�ks -. 111sta11 bat1,)V,r)0rl
--- FEES
.,EORGE- WAu.- ypp FAMOI.)"It IDY date )-E-pt
8555 5W TURQOTSE LOOP, PPMT c,7. 00 TnD 09/06/95 95-c'70193
!3EAVEPTON 017, 97007 95 "'7111'1-3
...ont r,-.Ac-t or
'-3 & P PLUMSING
1592 SE 51ST
ITL.LLPORO OR 9712--
SOM-640—L-311
.,X1. 7L!5 TOTAL
01r"407
his peritit 15 issued Wbject to the regulations ccntained in the -R 0(.- K.-'00-TRED INSPECTIONS
gl-l—ln Tritp
'iVard Municipal Code, State of Ore. Specialty Codes and all other PILM/Litiderf I o()r,
ri.pplicable laws. All tiork will be done in accivdarce with 70p out: Insp
,oproytd plans. This pewit will ex if work is not started F i ri a I Tro s,pt? ri
,,ithin 180 dayi of issuance, or if work is suspenJid for tore
ham ISO jays.
1 0
CA ' I f Ot- ins PeCt ion 639--417`,';
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SVS/ gall Blvd. Permit #
Tigard, OR x7223
(503) 639-4171 J
MINIMUM $25.00 PERMIT FEE + ST, SURCHARGE
New Single F Mlly Residences 0.9al
mea.. ❑ 1 RATH HOUSE $140,00 ❑ 2 BATH HOUSE$195.00
Job 'c�y / ❑ 3 BATH HOUSE$225 00
Address COMM. =+• Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
N. •la n.m..f flu.nnfr) FIXTURES QTY PRICEA. AMT
— Sink ( 9.00
°h•n• Lavatory 900 a �=
Owner SSS a _ l! Tub cr Tub/Shower Comb 9.00
an,s•I• ZIPShower Only 900
nk Water Closet 900
^— wm•ian.m•.f.u.«.al Dishwasher - I 9.00
Garbage Disposal t 900
Occupant 1..
p M.YnyHh.... i Washing Machine 9.00
Floor Drain 9.00
Water Heater 9.00
Laundry Room Tray 900
N.m. Urinal 9.00
1 Other fixtures (Specify) 900
MM•Or0 Add.
Ph; 9.00
Contractor — 9 00
IsyJ s� sly "., .T __.
ueysuu n
900
Sewer 1st 100' 3000------------------
—
1bu Negwhabn N.. ^r Mu T...w, Sewer-ea. Addit. 100' 2500
Water Service 1st 100' 3000
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. ?00' 2500
information given is correct, that I am the owner or authorized agent of --
the owner, that plans submitted are in compliance with State laws, that Stora 8 Rain Drain 1st 100' 3000
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit 100' 2500
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space !y- 25.00 `
Back Flow Prevention
Device or Anti-Pollution Device 900
�,.w. , «« .n / •f• Any Trap or Waste Not��—
Connected to a Fixture 9 Or
Desctibe work new 0 addition (_) alteration repair Catch Bann 900
to be done residential ,('D non-residential O Insp of Exist. Piumbuig _ 40 00/hr
Specially RequeslPd Inspections 40.00/hr
Existing use of Rain Drain, single family dwelling 3000
huilding or property _--_ __.�
Residential hackficw prevention
devices 15.00
Proposed use of — ^—�
hudding or propeoy .__ •(F-xcept residential back/low
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, CR IF 54o SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED ------FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
PLAN REVIEW 2590 OF SUBTOTAL
COMMENCED
-- — — TOTAL
Special Conditions _
— --�--- Date i55Ued �--`— -----_–'by
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Kour Inspection Line: 639-4175 Business ine: 639-4171 BUP
K
'� PM BLD
_ Date Requested---__ -- ------
Location l __ 'r,✓ ` / Su,te MEC _
_ — -- — -
Contact Person __. Ph PLM—
F SWR --
Contractor _ — ----- —
ELC
BUILDING Tenant/Owner _ --- - - —
Retaining Wali— ELR
Footing Access. FPS —..
Foundation
Ftg Drain - SGN _
Crawl Drain Inspection Notes: SIT —WOO
Slab
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing —
Insulation _-
Drywall Nailing _-_-
Firewall __---------- ,-_---.__ ---- - -
Fire Sprinkler
Fire Alarm ------
Susp'o Ceiling _
R of
PART FAIL ---
BNG ---- -- -- _�_� --- ------ _---
Post&Beam I -- --- -._----- --
Under Slab ---- --
Top Out
Water Service
Sanitary Sewer
Rain Chains -
Final
PASS PAR FAIL -'�------------ ---------
-- -- -- T MECHANICAL --
Post& Beam
Rough in
Gas Line
Smoke Damperti --------._—_._—._--__—._.-_ ------__
Final -
PASS PART FAIL -
ELErTRICAL - -- -FService
gemFina -
PASS PART FAIL - T
91TC
Backfill/Grading —
Sanitary Sewer _
Storm Drain Reinspection fee of
required before next Inspection. Pay at City Hell, 13125 SW Hell Blvd
[ j
Catch Basin [ j Please call for reinspection RE: _- _ a to inspect-no acc ss
F re Supply Line
ALA �
Approach/Sidewalk nate, Inspector xt -- —
Other
ir-117719T—
S PART FAIL J Dr NOT REMOVE this site.
irlsper�tion record from the jt +
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-417:5 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 FINAL:
-Bldg.
Post/Beam Mach. San, Sewer Gas Line plumb.
Plbg. Underfloor Rain Drain Framing .Mach.
Alarm Water Line Insulation
�r�
Underflr. Insul. Shear Wall Gyp. Bd. IM-
Date
�' � Time: AM Lam(,' M
Date Requested: -
Address:_ /�"f
Permit#{t' <,T S
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED: Et rZ"I
Date: S
Ins ector / 111,
APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
7
Call For Reinsp. /