11747 SW 129TH AVENUE ADDRESS..
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CITY OF I IGARD
COMMUNITY DEVELOPMEN'T DEPARTMENT
13425 SW Hall B!vd.Tigard,Oregon 9722396199 (603)639-4171
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INS'C ION NOTICE
f.ity of Tigard Btsl_ldtog Depart trent
131;15 SR Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phoney 639-4115 Business Phones 639-4171
Inspections
Footing Plbg. Underslab Hoch. Rough-in ApprSdalk
Found. Plbg. Top Out Cas Line tINALs
Post/Beam "_ruct. San. sower Framing -Bldg.
Post/Boam Hoch. Rain Drain Insulation --Plumb.
Plbg. Underfloor Watery Lin C� Gyp. Bd. -Nech.
Dace Roquested:� / �� / �� �% !Time: AN $M
6L.4Addces�r�l l 1 T 2 / rte.' Permit #s_ qa — �� �G I
Bti,l lder s
TME FOLFOWING CORRECTIONS -OR REQUIRECs
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APPROVED E/IEAPPA^VED _ APPROVED SUBJECT TO ABOVE
Call For Reinsp.
y iSEECTION NOTA
city or Tigard Building Department 1
"125 OW Ball. Blvd. Tigard, Oregon 972231
Inspection Line (Ree-O-Phons)t 639-4`175 Business Phone: 639-4171
1napection:
Footing Plbg. Underslab Mech. Rough-in App.-/Sdwlk
?ound. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. --Meeh.
Date Requestedt u` —_ -Timet Am
Addreso. // i 7 / Permit #siJ310
Ruilder:_--
THE FOLIAWTNG CORRECTIONS ARE REQUIRED:
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Insp►ctor:/ natee�Z !G.
APPROVEn DISAPPROVED APPROVED SURJEt`T TO ABOVE
_Call For Reinsp.
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INSPECTION NOTICE
Cit-•, of Tigard Building Department
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1312r SBali Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phones 639-4175 Business Phone: 639-4171
Inspection:-
Footing Plbq. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Tap Out Gen Linn _1INALt
Poet/Beni Struct. San. Sewer Frami+ig _sldg.�
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Reguested: ( � _Time;
Address:, ` f C� ( Permit Iti�.�
Puilders
THE .-)TOLLOWING CORRECTIONS ARE REQUIREDs
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Inspectors,L , •--�^� Date:_ L
`_APPROVED DIS* D " " ROttED SURJIMT TO ABOVR
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Pled. Tigard, Oregon 97.223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Tnepection: _-
Footing Plbg. Underelab Mech. Rcagh-in Appr/Sdwlk
Round. P1Sg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Meeh. Rain Drain Insulation -Plumb.
Plbg. Underfloor � Water Line Gyp. Bd. -Hoch.
Date Requested: ':2/� 7 -!2,1_ 4-*-'
, _Time: . /_AH/ _PM
Address: /Z / `•7 7 �� Permit 1:cf2 -U/16 7
Builder: z
THE FOLLOWING CORRECTIONS ARE REQUIIEDs
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Inepectors_ --- - -- ---- _ Dates 7
APPROVED _ _ DI'APPROkIED APPROVED SUBJECT TO ABOVE
--':__Call For Reincp. �'� �'�
INSPECTION ' 'I- E
City of Tigard Buil. f Department
13125 SW Hall. Blvd_ Tiqard, 0.7egon 97223
Inspection Line (Rec-o-Phone): 639-4175 Bvsiness Phone: 639-4171
Inspection•__` —�—
Footing Plbg. Underslab Hach. Rough-in Appr/Sdwlk
Found. P1Lg Top Out Gas Lire FINALS
Pont/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam HB•_h. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Mach.
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Date Requested:_] b Z !7. LL�Z Time: _X—AM _ PH
Address: T(" Permit 113or ` L 'Gnf(C' 7
Builder: V�,�l .__ ;5Si/��
THE P11-LOWING CORRECTIONS AAE REQUIREDt
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Inspectors_______ / -_I _ Dater 6 l� 71
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 Chi Ball Blvd. Tigard, Oregon 972.23
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Tnspecticn•
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. 1,)p Out Gns Line FILIAL:
Post/Beam Struct. San. Sewar Framing -Bldg.
Past/Beam Mech. Rain Drain \n oulation -Plumb.
Plbg. Underfloor Water Lina Gyp. Bd. -Hach.
Date Requenteed: ^� _Time: _�AH �___PM
Address: /. 1 // . -5 C.tJ z�; �� it # �� �
Pe it 1e . %�� /6 7
Builder:
THR FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: _ Date: S
APPROM DISAPPROVOD /'__*/APPROVMlD susia f TO Aom
Call Mor Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc--O-Phone)s 639-4175 Business Phone: 639-4171
lnspectiou•—_
Footing Plbg. Underslab Mech. Roigh-in Appr/Sdwlk
Found. --,� Plbg. Top Out Gas Line FINAL:
P7s1$eam Str_vct; San. Sewer Framing -Bldg.
Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Mech.
Date Requestsd: , l� ��`7 '��� Times / AM PM
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Address: [ Z 2`'7� ����J�L ermit is _z�/
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspecto : Date.-
"PROVED
ate:APPROVED DISAPPROVED APPROVF.0 SUBJECT TO ABOVE
Call For Reinsp.
IN:rECTION NOTICE
City of Tigard Hul)--ing Department
13125 SH Hall Hle-2. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection-
Foot Lng�)
nspection•Footingl) Plbg. Unders,ah Nech. Rough-in Appr/Sdw].k
(Found,\ Plbg. Top Out Gas Line FIltAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Ream Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requested: U2 I '7 r1z()( Time: /2ayr11gM 7 PM
Address: o 1�I �2�1 : ` _ Permit �s IJ1�f I Z �� l
Builder:
THE FOLLOWINU CORRECTIONS ARE REQUIRED:
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Inspector: -- — DaLe:_G / J-
v APPRMD OISAPPROVLD APPROVED SUBJECT TO ABOVE
—_Cell For Reinep.
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CITY OF T I GARD — PFC;F I PT OF PAYME='NT RF'CE I PT NO. :93—F.'14093,
CHECK AMOUNT s 216. 2 W,-
N IME' FMSE HEAl I NG Cil CASH AMOUNT s 0. 0
AIillRLSti C 9945 NE: 6TH PR PAYMENT DATES s 06/03/9`
SUBDIVISION »
PORTLAND, OR 9 72 1 1—
ruRP05E OF DAYME:NT AMOUNT PAID PURPOSE OF PAYMENT {AMOUNT PAIL)
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MECHAN ��_:AL. rE 25. 00 ST. BUILD PER 1. 25
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11747 SW 129TH PI...
TOTAL AMOUNT PAID — — — ) 26. c5,
111 pibC
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit #
Tigard. OR 97223
(503) 639-4171
Table 3A Medianical Code QTY PRICE AMT
Job I I L} I a,q-L JQ 1) Permit Fee -0- -0- 10.00
Address a
f t�3 2) Supplemental Permit 3.00
«
Furnace
to 100,000 BTU
1) ind.ducts a vents 6.00
M Furnace 100,000 +
Owner 2) ind.ducts&vents 7.50
�• ZIP Floor Fumanoo
3) incl.vent 6.00 _
«�• «
Suspended beater.wall hoater
4) or floor mounted heater 6.00
«• oV nt not ind.in
Occupant 5) appliance permit 3.00
c,�s■« Repair of heating,re�ig. —
6) cooling,absorption unit 6.00
Boiler or comp,heat pump,air ccinc�
7) to 3 HP absorp unit to IOOK BTU 6.00
�•�b*•� Boder or comp,heat pump,air:ond.
qqqS - 8) 3-15 HP absorp unit to 500K BTU 11.00
Contractor Boiler— or comp, heat pump,air co
�a ' 9) 15 30 14P absorp unit.5-1 mil BTU 1500
�• Ur -N° Boiler or comp,hear pump,air oond.
a 10) 30-50 comp,
unit 1-1.75 mil BTU 27..50
tw:e y ac ow go tat have ria tFis aapp icauon,that e nr Boiler or comp,,h at pump,air co
information given is correct,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50
of the owner,that plans submitted are in compliance with State Air handing unit to —
laws,that I am registered with the Construction Contracto('s Board, 12) 10,000 CFM 4.50 .
that the number given is corroct- (If exempt from State registration, Air handing unit
please give r:baso ')elow.) 13) 10,000 CTM+ 7.50
Non portable
14) evaporate cooler 4.50
Vent Ian connect
15) to n single duct 3.00
Ven' anon system not
{'� ) 16) included in appliance permit 4.50
Hood served
17) m
edhanical exhaust 4.50
esenbo work now addition� at�tion repair GommerciaJ or indi stria
to be done re:idential®- non-residential Q 18) type incineratnr 30.00
.xisting uao of Other i.e.,woodstove,water
building or property 19) heater,solar,clothes dryors,etc. 4.50
Proposed use of 20) Gas piping one lo four outlets 2.00
building or property
� 21) More than 4-per outlet
Type of fuel -oil 0 natural gas O LPG Q elnctric n —�
OTIC- n
Minimum Fee$25.00 SUBTOTAL �5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE27
IF CONSTRUCTION OR WORK IS SUSPENCED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIMI: PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED.
TOTAL fp,
Special Conditions -- — -— — __ --
-- — ---------- Datp. issued�- -- by —
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C YOF TIFARD, G�iY _
- Of TLA PlJ r�Lll I by r F:RM 1'f
COMMUNITY DEVELOPMENT DEPARTMENT 0"0001 FPM I T #. . . . . . . e BUF='9 -rt11 b/
13126 SW Hall Blvd. P.O.Boot 23397,TIp re,Oregon 917223(603)63"175
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b,:,':i -f} i. /.i. i1 FE: ISCOUEU: 06/19/02' --.�
S11E ADDRESS. . . : 11747 5W 129TH PI_ PARCEL: 1S133DD-0100f/.
aUBD I V I S I ON. . . . : VILLAGE AT SUMMER LAKE PAr!K 2 ZONING; R-4. 5
BLOCK. . . . . . . . . . . LOT. . .. . . . . . . . . . . 49
RE:ISGUE: FLOOR AF<(rA 7-- - __.__.__._ EXTERiOR W(,LL CONSTRUC-1' 101,1
CLASS OF WOUK. :ADD FIRST. . . . :275 s f N: S-. E: W.
TYPE OF USE. . . :SF SEC'OND. . . : S PROTECT OPCNINGS''----_..____ ._...
;'YPE. CIF' CONST. :5N THIRD. . . . : sf N: S: E: W:
OCCUPANCY GRP. :R3 TOTAL- _ -- : 27 5'F ROOF CONST . f= I RE, REI
OCCUPANCY LOAD: BASEMENT. : S f AREA SEF. RATED:
STOR. : 1 1-iT. : 14 ft GARAGE. . . : sf OCCU SEPI. RATED:
PSMT?: MEZ-L'' : REND SE'T> ACKS—--_---- RE tU I RED_—____..__,._--•--___..___
FLOOR LOAD. . . . :40 p�,1- LEI=r: ft RGHT: 7 Ft FIR SPKL_: SMOK DET. . .
DWELLING UNITS: FRNT: ft REAR:36 ft FIR ALRM: HND' ICP
BEDFIMS: BATHS: IMF' SURFACI=:: PRO CORR: PARKING:
VOLUE:. $: 121650
He marks: ADDING 27,.5 SO FT ROOM PATH I CONST RUCT I ON
O,viner; _._.__ _.._ _..___.__.___....___ .__.. _..._ _.....__ FCLS
DENNIS AND SUSANA MITCHELL •type amo�.lrlt by date recpt
t ,,r7 SW 129TH FSI_ PRMT �-f8. 50 JL1I 0611. 11)2 —
PLCK 64. 03 JLH 06/05/92 ca'
11.,i4RD OR 97223 5PC:T 1. 4. 97:, JI_.H 06/ 11/92 -
Phone #: 378-3423
Contractor:
1=1lo n e #: + 167. 46 TOTAL
RL(JU I KED 1 NSPELT 1 ONS
lnis permit is issued subject to the regAitions contained in trop �:'uot/foarnd Insp
Tigard Municipal Code, State of Ore. Specialty Code. ino ali ether Post/beam Insp
applicable law;• All work will be done in accordance with Framing Insp
aoprovod plans, This permit rill expire if work is not started I r1 s 1.1 l at i on Insp _�—
within 160 days of issuance, or if work is suspended for more Gyp Board Insp
than I88 days. Rain drain Insp
F- i na l I n spec. t i un
h•'�'1 fill.t'� r�E+ f.?1lJflc�tC.lf't+ : .. , — { ,
Call for, inspection — 639--4175
CITY OF TICARD RFCFIPT' oF r,AymEwr RECRIPT NO. r 92-22837;,
CHECK AMOUNT : 115. t3
NAME s MITCHF- 1_, SUSANO AMOI..),qT 0. 1210
ADDRESS a 11747 VsW 1iF'.9TFl FIL. PAYMENT DATE I /9;
51J81)1 V I S I(IN
TIGARD, OR 9-7223...
111JRpUtjF OF PAYMENT (WOUNT PAID PURPOSE OF PAYMFNT f)MOUNT PAID
98. 50 PLAN CHECK FE
SUILD, PEP 4. 93
TOTAL AMOUNT PAID 115. 13
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13M SW 11 all Blvd. PLNCK/RECT # � _�
C.411TY O TIG��RD PO Box 23397
COMMUNITY DEVELOPMENT DEPACprd.Oregon97223 PERMIT # ,���Z - �l6
(503)63"171 DATE ISSUED _
JOB ADDRESS: IIS y 7 `�i�. l �. `tI` ��uc� TAX MAP/LOT 45/ L2 n c;louc'
SUB: &fidCLOT: -ell LANU USE: ---.
VALUATION:
OWNER SPECIAL NOTES
NAME: (�c nn �;� S�s��� it'liREISSUE OF:
ADDRESS: 1 17 Ll7 51^- I a `l Plate - LAST REISSUE:
7 �- �u"k ei( C1-7 a a _ FLOOD PLAIN/
PHONE: Sa i-55 N _ SEN., DIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAMF.: '"'^Q r PLANNING: _OIV''1��'
ADDRESS: ENGINEERING:
_ FIRE DEPT: _
PHONE: — - OTHER: NO -11A ✓��
CONTR. BOARD #: _ EXP DATE: .^ —
ITEMS REQUIRED
SUBCONTRACTOR_S: PLUMB: -72t7�/ LIST/SUBCON I RACTORS:
MECH: _ L2vh _ . _ BUS TAX:
ARCII!ENGINEER CALCULATIONS: —.
NAM, : _ 0—nor _ _ TRUSS DETAILS:
ADDRESS: _ _ OTHER-
PHONE:
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`" PROPOSED BLDG. USE: �e�k
COMMENTS:
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APPLICANT IGNATURE
Received By: _ Date Received:
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►<MIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees -
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees /'
30-230 01 State Building Tax (5%) 4,3 ` , 9 3
Building `� 1
Plumbing
Mechanical
10-433 00 Plans Check Fee
Bui16:-ire 64,6--
Plumbing
Mechanical
10-230 06 Fire —
30-202 00 Sewer Connection _ _ —
30-441 00 Sewer Inspection -
25-448-02 Commercial TIF Fees _
2: -448-04 Industrial TIF Fees —
25 -440-06 Institutional TIF Fees _
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees -i — —
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Bev Charge (POC) _
31 -450 00 Storm Drainage Syst Bev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of) _
7.4-445-02 Water Quantity (Fee in lieu of)
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nm/3587P.W11F
Permit No: eld rJ 4c 7
Address:
Issued by: Date: Z
--FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board t(,
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, exem,)t from registrati )n
under ORS 701.010(7), need not submit this statement. This statement will be
fled with the permit.
Fiii in the —1plicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
I own, reside in, or will reside in the completed structure.
. I 1 I understand that I must register as a constriction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.1 I My general contractor is ----_ - -_ - -_-- --- - _- ---- ,
Contractor registration number--
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umber _I 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. f I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
CL and I will immediately notify the office issuing this building permit of the name of
the contractor.
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> I hereby certify that the above information is correct and that 1 have read and understand
the Information Notice to Property Owners about Construction Rejpc isibilities on the
reverse side of this form.
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Signature of Permit Applicant - Date
CONSTRUCTION CONTRACTORS BOARD
0244,1 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT