13829 SW FERN STREET ADDRESS:
i:'reccrt,s\micrctlm\targets\buiIding.doc
CERTIFICATE OF
CITY TOCCUPANOF IGARD PERMIT #. . . . . . . CY
: MBTr;5---0110
COMMUNITY DEVELOPMENT DEPARTMENT DATE leSLIED:
13125 BW Hall Blvd.Tigmrd,Oregon 97223v6199 (503)639-4171 VARGELt 2S104FtD--R1vI0,i'5
3211'E ADDRESS,, . 1 13829 SW FFRN ST
SUBDIVISION. . . . t ROSE MEADOWS 7.m i t-,is- F,� -
BLUCK4 LOT. . . . . . . . . . . . . 1025
CLASS OF WORK. i NEW
TYPE-. OF USE. . . vQ&t-1
OCCUPANCY GRP. i5N
OCCUl'41INCY LOAD I I
Rem,4V411st PATH i
JAY MILLJE-P
p D Box 23Z,91
TIGUARD Oil 97281
Phone #t 664-7543
Contractors -- -
Phone #:
Reg 41. . ; 30101)
7hit.6 Certificate, grant -, 0VrLtpRncy of the Pbove v-pfev-enred puilding (-.vr portion
thereof and confirm3 th*t the hvilding has bipen insp'pr-ted r compliance vjith
the State of Oyepon, ESpecialty Codes for the l:
Ir psnt� Jqnd LISP tinder
which ttcl
r f"I'mod permit wase;-.
!ed.is;- ed.
0 ,It
. X79
'N' G,---i N-8--P'E'-C-T-O—R--------- RU I LD T Nfi OFFICIAL
PU1c1T* IN LON5PILUL)L14.) PLHGE
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rcc O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Coiling Sprink. Rough-in Apar/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
PosliBeam Mech. San. Sewer Gas Line ���
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:_ f Time:– AM PM
c• �l,�
Address:
Builder. J % — Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Dater
OVFQ DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
1+JA i nom,,,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Pec•O"Phone). (139-4175 Business Phone: 639-4171
Inspection,
Footing Susp, Ceiling S ___—�—�--
prink. Rough in Appr/Sdwlk"7 f t y
Foundation Plbg. Underslab
Mech. Rough-in Fireplace
Post'Beam Struct. Plbg. Top Out
Elec. Rough-in fTfR�.,
Post/Beam Mech. San. Sewer G �� '—�,
Gas Line
Plbg. Underfloor Rain Drain
Framing lum
Alarm Water Line
Insulation ��
Date Requested:
Underflr. Insul. Shear Wall <!!.
—�� I GYp• Bd. Elect. 9/1WIf �""
S Time: AM PM
Address:_ f �j �'� � C�
Builder:_
Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
�{ ) G•� ! f
Inspector:
�--- Date:�K
_APPROVED
__!:"DISAPPROVED rAPPROVED SUBJECT TO ABOVE
Call For Reinsp.
CrrY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (RAC-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
_
Footing Sus I
p. Ceiling Sprirk. Rough-in A r/Sdwlk
hlech
Foundation Plbg. Underslab pp
. Rough-in Fireplace
POSt/Beam Strutt. Plbg. Top Out F j
lec. Rough-in FINAL:
PostrReam Mec i. San. Sewer
Gas Line -Bldg.
'Ibg. Underfloor Rain Drain Framing
g -Plumb.
Water Line Insulation
Underflr. Insul. -Mach.
Shear Wall Gyp, Bd. �-
1 �-tE''
Date Recuested: �`
Time: AM PM
Address:_
Builder. _ J��1 C` — ---
Permit
THE FOLLOWING CORRECTIONS ARE RFOU RED;
_ck f
-------------
----_—__
Insper_tor:^ �'r
APPROVED ,DISAPPROVE 0 --
\PPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE �� .
Inspection Line ("Iec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Susp. Ceiling Sprink. Rough-inpvSduq
Foundatior Plbg. Underslab Mech. Rough-in Fireplace
Post/Bean Struct. Plbg. Top Out Elec. Rough-in FINAL:
Poa+t/Beam Meeh. San. Sewer Gas Line -Bldg.
Pibg Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: 7112- 12 Time: AM PM
Address:��� �� -7� 2 2
Builder: Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:_ , Date:
!APPROVED _DISAPPROVEDPPROVED SUBJECT TO ABO ..
_Cali For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_—_� ----- —
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Undersl?b 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 Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.)
Date Requested:_��,1� Ic�_Time: AM, _ PM
Address:
fiuilder._ � i�S_ Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: �'r < < 9ze Cf4_ Date'
,APPROVED ____DISAPPROVED ,APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (RBC-O-Phone): 639.417.5 Business Phone: 639-417,
Inspection:
Footing
Susp. Ceiling k
Surin . Rough-in Foundation Appr/Sdwlk
Plbg. Underslab Mech. Rough-in
Post/Beam Struct. Plbg. Top Out
Elec. Rough in
post/Beam
Mech. San. sewer'� F:NAL:Plbg. Underfloor Rain Drain Cas Line -Bldg.
Alarm Framing
Water Line -Plumb.
Underfir. Insui. Insulation
Shear Wall -Mech.
e9uestec:
Date R ('YP• 6d. -Elect.
_
Address:�l= Q� —"� Time�AM
— — '�— ___—PM
��,� -
Builder
THE FOLLOWING COR Permit #:
CORRECTIONS ARE REQUIRED:
Inspector: --------
= Date
_APPROVFD ADISAPPROVED
APPROVED SUBJECT—TO ABOVE
Call nor Reinsp,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 6,39-4175 Business Phone: 6 1 1
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fir;�plac4
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -B'dg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul, Shear Wall
Gyp. B� -Elect.
Date Requested: _ Time: AM _IPM
Address: �L�����i�'
Builder:_ Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector. _ Date:�GL "—
C-APf-56VED DISAPPROVED _APPROVED SUBJ=CT TO APOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 !r
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:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain FFramina__ -Plumb.
Alarm Water Line Insulation 1 -Mech.
_
Underflr. Insul. Shear/Wall Gyp. B--d.----
d.__ __ -Elect. �
Date Requested: —O_-5 Time: AM V/ PM
Address: ,3 o? ,-e?-il _
Builder.
THE FOLLOWING CO ECTIONS ARE REQUIRED:
Inspector: Date.
–*PPROVED
S
—DISAPPROVED _APPROVED SUBJECT TO ABOVE
__Call For Reinsp.
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
COUNTY, PHONE:
NORTH FIRST, HILLSBORO, OR 97124
PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
Permit # 05066047 Proj*rt p . P00499:32 St:7tu.z APPROVED Faye 1 cf 1
App.litsd 04/05/95 ISsu.ed 04/05/d.�, Expires 11/27/95 06/01 /95 08 : 1,
]RES ELEC
P@r;ni t Title SFR -- NEW OOH
Ueacr. ipt lu%n Begun. 04/05/9 ,
Job Address 1.3829 EW FERN ST TI
Owner Name INSPECT ION - T IGARD RMg i nn 7)
Applicant Name T & M ELECTRIC INC~ .
Ph,^•ne number 649-6556 Valuation 0 Approved
Inspector Comments S Q � 3 � rA - p/-iL FGAW Re•je_cte!d _ __
IVx-k$SUI,T�'
R>•QUEST ERROR
Plumbing
MechRnical
a t r u c t r u a l
QEnorRl
I nrpact ed by :_ �'� __ - ----- Lt►te
Inspectic+r► Requerted -
* raver & Service 0403 1,-, AP ON IVR
UE+/01/95 ISI HP
05/31 /95 RI R11VP 34•-1481. C L
05/31/95 DN HS DNIVR LUT7 I RPI
0512S/9S r'N HS DNIVR LUT7 1 RPI
121 1 u 14-1480 C F
CITY OF TIGARD BUILDING INSPECTION NOTICE I
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdw'k
Foundation Plbg. Underslab Mean. Rough-in Firepli tce
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Lino -Bldg.
Plbg. Underfloor Rain Drain aminyC 1eb
� Plum .
Alarm Water Line Insulation -Met-h.
LMderflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date RequesteJ:_ ( q j r Time:____ AM
Address:
Builder.__? / "—��_ Permit #: ._-c) ( ' J
THE FOLLOWING CORRECTIONS ARE REQUIRED:
SCJ % LL:
Inspector: Date: —�S
APPROVED /DISAPPROVED _Ar PPROVED SU13JECT TO ABOVE
_Call For Reinsp.
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
(AUNTY, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
Permit # : 05066047 Nrc ject. St-atus AI-PRUVEli Paget 1 of 1
Applied C,4,105/9S IEa.:r.d 04/05/95 ExpirHe 11/21/97-. 05/31/95 05 : 01.
Rfi.133E1,EC
Permit Title SFR NEW OTH
Description Bequn : 04/05/95
Job Address 13F,29 nW FERN ST TI
Owner Name IN3PE'CTIGN - TIGARU Region 1•a
Applicant Name T 6 Y ELF'CT.R I C INC .
Phone number 648-6556 Valuation, U Approved�
Inspector C,omment.r kejec.ted�
IVP-RESULTS
REQUEST ERROR I
I
r
t
Plumbing
Mechanical
Electrical .
Structrual
a*neral
Inspected by ._,__ _ __-_-- Date
Inspection Requested
Cover 6 Service 0403 E AP iN IV
05/31/95 RI RIIVR 34-1480 C E
05/25/95 UN iUNJVR LUT7 1 B:
05/224/95 RI R1IV11 34-1480 C E
CITY OF TIGARII Z'!ILDING INSPECTION NOTICEJ�
Inspection Line (Rec-O-Phonr,): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in
Foundation Pibg. Underslab g APPr/c�dwik
Post/Beam St,uct, Plbg. Top Out ec . Hough-in Fireplace
Post/Beam Mech. San. Sewer Elec. Rough-in FINAL:
Plbg. Underfloor c�_�Z�� -k Q76, -Bldg.
Rain Drain Framing Plumb.
Alarm Water Line
Insulation -Mech.
Undenlr. Insul. Shear Wall
Gyp. Bd. -Elect.
Date Requested:
Time: AM PM
Address:__ 7� ZJL –
Builder:
Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
-------------
inspec -
_ Date:
°PROVED ,DISAPPROVED r
// _-APPROVED SUBJECT TO ABOVE
_Call nor Reinsp.
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
Permit # : USU66047 Pr,--;jest # PU0469 32 :t-atus APPROVE;, Paqe 1 C:'1' 1
Applied . 04/05/9S IF:::ued "4/05/95 Expx rer. 10/02/9S Ur-:14/9 , (IT, 02
RESELEr
Tlerrnit. Title SFR - NEW GTN
fi,ercripticm Begun 04/05/95
jch Address 13829 ZW FERN ST TI
weer Name IN PEC.TIGN - TIGARU Region
-,,,pplic.ant_ Name T & M ELECTRIC INC .
nuurr,t;er 648-6556 valuation U
�p�ctc+Y 'crnrnents Rejected_
IVR-RESULTa
REQUEST ERROR
9-1K
PIumbing
Me�hatni�al
Electrical .
Structrual :
General
lnspected by: _
Tnspec_t.ion Requested:
+ Over & 1)40:.4 F AF vN IVR
05/24/95 RI RIIVR 34--148f1 i;
CITY OF TIGARD BUILDING INSPECTION NOTICE l
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-417
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:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. LShea` r'A/a 1 Gyp. Bd. -Elect.
Date Requested: $=�8 ��i'.� Time: AM PM
Address: 38 �—
Builder:— Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:_ Date:_-_/�—!"S—
C*PPROVED !DISAPPROVED _APPROVED SUBJECT TO ABOVE
`Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Businesa Phone: 639-4174-,
Inspection: 6.._
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. gid o'��y Elec. Rough-in FINAL:
Post/Beam Mech, San Sewer Gas Line
-Bldg.
Plbg. UnderflMr Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: / L __Time: AM [_�__
Address: � �j Z � �' 2,n
Builder: Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
In pector: i �� Date:
74�
PROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Flec-O-Phone): 639-4175 Business Phone: 639-41 1
Inspection:,_ - -
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Unders;ab Mech. Rough-in Fireplace
g
Plbg. Top CIA Elec. Rough-in FINAL:
am Mec San. Sewer Gas Line -Bldg.
nderfloo Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear yVall Gyp.Bd. -Elect.
Date Requested: / Time: XM PM
Address: -
Builder: Permit
THE FOLLOWING CORRECTIONS APS EQUIRED:
10//!;-/j
Inspector' Date:
OVED _DISAPPROVED __APPROVED SUBJECT TO ABOVE:
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NJTI ~�
Inspection Line (Roc-O-Phone): 639-4175 Business Phone. 639-4171
Inspection:,_,
Footing Susp. Ceiling Spr;nk. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. an. Sewe Gas Line -Bldg.
Plbg. Underfloor ainDrai Framing -Plumb.
Alarm rr nA Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elec..
Date Hequested: 4�1 �� Time: AM _XPM
Address: 13 O c3 �L_�—Z;6 -- ---' — —
Builder: Permit 0:_ 7 _J — r
THE FOLLOWING CO'aRECTIONS ARE REQUIRED:
Inspector /� -6 ___ Date:
,DISAPPROVED APPROVED SUBJECT TO ABOVE
)ZAPPROVED
Call For Reinsp.
CIT`! OF TIGARD BUILDING 1ASPECTION NOTICE
Insp4ction Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
� /
Inspection.-
Footing
nspection:Footing Susp. Ceili—ng-t Sprink. Rough-in Appr/Sdwlk
oundatio Plbg. Underslab Mach. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. Sari. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Meeh.
Underflr. Insul, Shear Wall �^ Gyp. Bd. lect.
Date Requested: Time-/--�j����_ Time: AM PM
Address:
Builder: - ''Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i v•i�� -��h @ Al L 11P41 Lz_
"�5 1,�- /1 •cid vac fes,2 r5 5.'z,,.�
Inspector: Date:
APPROVED DISAPPROVED t—PPROVED SUBJECT TO ABOVE
Call For Reinsp.
DEPARTMENT OF LAND USE&TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
COUNTY, 155 NORTH FIRST,HILLSBORO,OR 97124
INSPECTION REQUESTS: 603/840.3681/693-4415
OREGON XXXXXXXXX--> 640-34 /()
Page 1 of 1
Date 04/06/55
Time 1'1. : 41
rmit 'Type rlesidential Electrical Permit Permit # 05066047
Emit Status APPROVED Applied 04/05/913
tus Address 13b29 SW FERN ST '1'I Issued 04/05/95
Emit 'Title Si•R - NEW Completed
rmit Uescr . To Expire lU/UZ/y +
oject 'Title 51r'K - NEW Project # P0U48932
oject Uescr. * EROSION
rcel Number 251'1'1 - .Land Use District
luation U
gal Descr.
tier INSPECTION - 'TIGARD Construction OTH
plicant Name 1' & M ELECTRIC INC, classification 900
piicant. Addr. : 833 NE BALDWIN ST Occupancy R3
HILLSBORO, UN 9'/124 Validated by LG
E_-licant Phone: 648-bb56 Inspector Area
Fee description Units Fee/Unit Ext fen Data
square rootage (Enter Sq. E't . j 2000 160 . 00
Subtotal Electrical E'ees : 160 . 00
state Surcharge of 5% 8. 00
Totai Electrical Fees : 168. 00
**� Fees Required *** *** E'ees Collected & Credits ***
Method Check # Receipt No . Date Payment
CK 4089 04/Ub/9b 168 . 00
tees : 168 . 00
Adjustments : . 00 Total Credits : . 00
Total Eees : 168 . 00 'Total Payments : 168. 00
Balance Due : . UO
NOTICE: This permit becomes null and void H the work or construction for which It Is Issued Is not commenced within 180 days. Once construction has started,
the perm;t becomes null and void If construction Is Interrupted for s period of 180 days. 1 certify that the Information preseuted by the applicant and
his agent or agents In support of this permit is true end correct to the best of our knowledge. I acknowledge that the Building Department's rellanca
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing.:re cons rction and use
of this building or structure will be compiled with whether or not specified on the plans or notou on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easemants. I further '-one that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various times during the process of cor,etruction and the building
Inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until all;nspectlon requirements are satisfied and
approval Is given by the Building Official. 1 further acknowledge that a Ilan may b�planed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requirements.
Appucmrs SIANATURB
WASHINGTON COUNTY F.LECTR I CAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section APPLICATION
155 North First Avenue, 11350-12
Hillsboro, Oregon 97124
Information: (503)640-3470 Fax: (503) 6934412 fD�
Permit
PLEASE PRINT
Number DatePlease complete all.sections, I through 5. .
4. Complete Fee Schedule below
1. Location of Installation Number of inspections per permh allowed
Address ! 3 5f z9 S IZJ f&'-j / S-T Service included: Items Cost(ea.) Sum
Buildo. �/✓)
ingg
City Suite lJA. Residential-per unit
j � � _a.J ,
1000 sq.ft.or lose $110.00 4
Tenant Name Each addiliunal 501`sq.it
tit commercial) or portion thereof $25.00
rjt, Limited Energy -- $25.00 1
Map No. � Tax Lot Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page:- Section:__
Directions - -- N. Services or Feeders
Installation,alterations or relocation
200 amps or less $60.00 2
Commercial❑ Residential-ad 201 amps to 400 amps $90.00 2
401 amps to 600 amps _ $120.00 2
2a. Contractor installation onl Ov amps to 1000 amps $190.00 2
Over 1000 amps or volts $340.00 2
Electrical Contractor_ 1'�4-2r <La4zq, Reconnect only $50.00 2
Address r.� IS A
City- QomState_ 4 `IP C. Temporary Services or Feeders
Date Job Number _ Installation,alloraJon or relocation
Pr operty Owner __._-T-z,.4_M lob amps or less $50.00 2
Contractor's License No. 31-/ C _ 201 amps to 400 amps $75.00 2
-- 401 amps to 600 amps $100.00 2
Contractor's Board Reg. No. _ - Over 600 amps to 1000 volts see'B'above
Signature of Su r lec' _ -.- _ D. Branch Circuits
License No, Phone No. ASID Now,alteration or extension per panel
a) The fee for branch circuits with
2b. For owner Installations: purchase of service or feeder lee.
Each branch circuit $5.00 2
Print Owner's Name r __ tone a. b) The fee for branch circuits without
purchase of service or feeder fee.
AT(fess First branch circuit $35.00 2
Each add of branch circuit._- $5.00 2
E. Miscellaneous (Service or Feeder not included)
Each pump or itrigation circle-- $40.00 2
The installation is being made on property, I own Each sign or outline lighting $40.00 2
which is not intended for sale, lease or rent, signal circuit(s)or a limited
energy panel,alteration
Owner's Signature or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection `_ $35.00
Per hour __- $55.00 _
Please check appropriate Item and enter fee In section 5B. In Plant ^- $55.00
e_4 or more residential units in one structure 5. Fees
_Service and feeder, 800 amps or more
System over 600 volts nominal A. Enter total of above fees $
Classified area or structure containing special 5% Surcharge (.05 X total fees) $
occupancy as described in N.E.C. Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $ --
above apply. Not required for temporary construction Subtotal $
services. F1 Trwl Account $ _
Balance Due $
For inspections call This permit become null and void If the work authorized by the perm"Is not commenced
640-3561 or 693-4415 within 1e0 days from date of Issuance of such permit or If the work authorized la
suspended or abandoned at any time after work in commenood for a period of tb days,
24-hour recorder, one working day in advance of need Ekectrical Permits an non refund.ble and nondransferabic
8/94
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
oo
��ti ll ,) Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
un Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Pibg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: S `/ Time� AM ppb
Address: fir;
Builder: �f Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
o _ c�,� A"I/_
c ^ �r ti......... ,
Inspector: Date:
_APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
�} _Call For Reinsp.
A lv C
P
CITY OF TIGARD PERMPLUMBI11#
I , 6. . . .
E .RMIT. . : MST95-0110
COMMUNIT! DEVELOPMENT DEPARTMENT DATE ISSUED: 03/20/95
13125 W Hall Blvd.Tigard,Oregon 97223*8199 (503)839-4171
PARCEL.: ;2',1jJ-04BD-RM0'_:'5
SITE ADDRESS— : 1.3821) SW FERN )l
SUBDIVISION. . . . ROSE MEADOWS ZONING., R-7
BL-OCK. . . . . . . . . . . L-OT. . . . . . . . . . . . . .0%`�"j
CLASS OF WORK. . aNEW GARBA(3E DISPOSALS. i
1'YPL OF USE. . . . .SF WASHING MACH. . . . . . . : 1 BACKFLOW PIREVNTRS. . : l
OCCUPANCY GRP. . :R3 FLOOR DPAING. . . . . . . :0 TROPES. . . . . . . . . . . . . . ..121
STORIES. . . . . . . . sl WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :0
FIXTURES------- LPUNDRY TRAYS. . . . . . :0 5F RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . 31 GREASE TRAPS. . . . . . . tO
LAVATURIE5. . . . . :J OTHER FIX TURES. ,. . . sO
I Ob/sviow'awi. . . . , SEWER L I NE ( f t )
WATER CLOSETS. . sE WATER LINE
DISHWASHERS. . . . el RAIN DRAIN (ft) . . . . s0
Remarks : PATH I
CJWNL-.R: -FEES____--.--___
JAY MILLER C-14M f 180. 00 JD 03/20/95 95-26-3110
P U BUX 1e3291 SWM $ 100. 00 JD 03/20/95 95-263110
BPRT $ 455. 50 JU 03/aO/95 95--263110
TltiARD OR 97281 BPLC $ 50. 00 KAR 03/13/9b 95-e6E?71
Phone #: 684-7543 L15PC $ C"3. 2 B JD 03/20/95 95-2631. 10
PARK 6 500. 00 JI) 03/20/95 95-263110
MPRT $ 40. 50 JD 03/20/95 9t - 26.3110
eon MPLC $ 10. 13 JD 03/20/95 95�J2631 10
N,--t in e M5PC $ W 11)
Aridress: '5 2B_rH $ 195. 00 JD 03/20/95 95-e63110
City.. 5 ta t e P")P1•c 1)" 75 JD 03/2111/95 ')5--: 10
mc�
Zipz lbi�t-09,W5_',11 or i e# EROS $ 1b4. 00 JD 03/20/95 95-263111,11
Rey ndditionAl fees not shown liere.
-------- REQUIRED INSPECT IONS
This permit is issued subject to the reg-
ulations contained in the Tillard Municipal Footing Insp Insulation ln�.[,
Cotic,, "it ate o r r3j-e. SpectAltV Corea pnt.j Ail FounoAtion Insr (3yr B-1r(I Tnsp
ather applicable laws. All work will be done Posty'Beam Struct Rain drain Insp
in acuot-danCe with approved plans. This Post/Beam Mechan Water Line Inrip
permit will expire if work is not stArted Crawl Erain Water Servir-P In
within 180 days of issuance, or, if work is Plm/undsl Inip Appr/Sdw1k Insp
su,.-,pended for, more than 180 days. FILM/Undert I oor Mechanical Final
Mechanical Insp Plumb f`:inal
Plumb Top Out Building i-incl
Framing Insp Erosion Contrel
Fieplace Isp
14Fir
^e
3as Linn
e Tnsiip
,Iuthorized Plumbing' Lontrw6tor Signature
for inspec-tiayi 6394175
,iritractor Notes :
MASTER FSE RM 1 T ✓
C11Y
OF T' PERMIT #. . . . . . . : MST9 1--01 10
COMMUNITY DEVELOPMENT dpARPDATE I aSUED: rh31 0/ge,
13126 SW Hall BNd.Tigard,Orpon 97223.8199 (603)630.4171 PARCEL: 2S 104BD-R110c'S
TE ADDRESS. . . : 131329 SW FERN S-I
;UBDIVISION. . . . : ROSE MEADOWS ZONING: R-7
is�L.00K. . . . . . . . . . . LOT. . . . . . . . . . . . . :025
BUILDING -._________________--..---._____ww___-_-- .
REISSUE:IIST9S-0020 DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
CLP4SS OF WORK. .-NEW BEDRMS:3 BATHS:2 GARAGE& . . . . . . . . . .413 sf
TYPE OF USE. . . -SF FLOOR AREAS--__-______ REQUIRED SETBACKS-
TYPE OF CONST. :5N FIRST. . . . : 1636 st LEFT. . s5 ft RIGHT. ::, ft
OCCUPANCY GRP. :R3 SECOND. . . s 11) s f FRONT. -21a ft REAR. . ::34 ft
1 I UR I ES. . . . . . . : 1 F I NBSMENT:O s f RE(,U 18ED--------------------
HEIGHT. . .
___.___.__---__--_..._HEIGHT. . . . . . . : 16 ft TO1 AL--•-------1 163E s t SMOKE: DETECTORS. :Y
f-L.UOR LOAD. . . . :40 psf VALUE. . . . . ! : 112504 PPRf(ING SPP,CES. . : 1
Remarks : PATH I
--------------- PLUMBING
PLUMBING
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 'iACKh'LOW PREVNTRS. . s t
LAVATORIES. . . . . .3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . 10
TUD/SHOWERS. . . . :c: LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WOfER CLUSETS. . s2 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . 10,
DISHWASHER'S. . . . : 1 WATER LINE ( ft ) . : 100 OTHER FIXTURE S. . . . . :0
GARBAGE DISP. . . si RAIN DRAIN (ft) . :O
WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1
MECHANICAL -___-_---._____ .__._.___-______________ FEES --
FUEL TYPES--- -------- UNIT HTRS. . :O type amount by date rer_pt
/GAS/ / / VENTS . . . . . %0 SWM $ 180. 00 JD 03/20/95 95-263110
MAX INPU1 s0 BTU VENT FANS. . :3 SWM t 100. 00 JD 0:3/20/95 95-263110
r-URN ( 100K . . -. 1 HOODS. . . . . . : 1 BPRI f 465. 50 JD 03/220/95 95-2:63110
FU11N ) =100K . . :0 WOODSTOVES. :0 DPIL-C 1, 50. 00 KAR 03/ 13/93 95-2621,7-71
FLUOR TURN. . . . s@ CLO DRYERS. : i B5PC f 23. 263 JD 03/20/95 95--263110
L{UIL/(,MN ( 314P:0 OTHER UNITSs 1 PARK 8 300- 00 JI) 03/20/95 95 -J163110
GAS OUTLETS: 1 MPRT f 40. 50 JD 0:3/20/95 95-263110
Uwner: t 10. 13 JU 03/20/95 95--26311 ►
,;AY MILLER M5PC $ 2. 03 JD 03/20/95 95-2631. 10
{= U BOX 23c'41 2BTH 4 192. 00 JI) 03/20/95 95-263110
P5PC $ 9. 75 JD 003/210/95 95-263110
TIGARD OR 97281 Lr?os f 64. 00 JI) 03/217/95 95--0`6.3110
P.-lone Vii: 684-7543 ERPC F 20. 80 JD 03/2'0/95 95--2:63110
Lontractor: -________.__-____._____-----..__---.---ERf'1 ". 24'x. 80 JL', 03/20/95 95--alcl3110
JAY MILLER T If= 1550. 00 JU 03/2'0/95 95-263110
PO LAUX a30459
T 16ARD OR 97281
Plia,ie #: 684-7S' 3
Reg *i. . : 3@109 _._________-------------.------_-_-.__-_..___._
t 3i:'31. 79 TOTAL
This pereit is issued subject to the regulations contained in theRECA)IRED INSPECTIONS -----
Tigard Municipal Code, State of Ore. Specialty Codes and all other Footing lrtsp, F'lumb "Op t)ut
applicable laws. Al; work will be done in accordance with approved Foundation Insp Framing Insp
plans, This pereit will expire if work is not started within l88 Post/Beam Str-c.(ct Fireplace Insp
days of issuance, or if work is iuspen " f"'
Bore th 19? days. Post /Beam Mer:han Vas Line Insp
UV- V41 Lr-akin InStAlation IrEp
Film/e_It)dslab Insp Gyp 13orar d In1p
PL.M/Underfloor Rain drain Insp
Mechanical Insp Water, Line fnsf
Call for inspection - 639-4115
SEWER CONNECTION
CITY OF TIGARD ERINIT
PERMIT #. . . . . . . s SWR9t, 00.0;-
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED:
13126 SW Hall BNd.Tigard,Oregon 97223.9199 (603)639-4171
PARCEL: 251048L'--RMN.::";
S1. fL ADDRESa. . . . 13P",J "W FERIN 'OT
SUBDIVISION. . . . : ROSE MEADOWS ZONING: R—"I
VLOCK. . . . . . . . . . . I.oT. . . . . . . . . . . . . .025 t
TENANT NAME. . . . . :
UbO NO. . . . . . . . . . . FIXTURE UNITS. . . .
CLASS OF WORK. . . :NEW DWCLLING UNITS— : 1 `
TYRE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . :SUSWR lh'il"i PV S'UkFACE. .
Remarks : PATH I
Uwner: -----_---.--.--_------_------•----------- p .A---------------- Ek_`_
JNY MILLER type mor-rnt by date rec t
►' U NUX 2,3291 PRMT $ 2,200. 00 JD 03/20/95 95--263110 i
INSP $ -5,. 00 7D 03/20/95 95--•131631. 10
TIGARD OR 97E81 I
Rhone #i 684-754.3
Contractor. ----•—_------_____._----- --____--
i
"UN 1 NPCI UR NOT ON FILE
t=hane #: 4 2235. 00 TOTAL
Reg #- . .
RE.O.UIRED INSPECTioNis --- _._
This Applicant agrees to comply with all the rules and regulations aewev- Inspection
.f the Jnfied Sekage Agency. The pereit expires 180 days frog
the date issued. The total amount oaid will be forfeited if the �-
persit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the eeasereeent
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" pereit aue the Agency will in all a lateral, •
I'er-mi ttee Ei or—Atur,e .
Call for- i.nspec_tiori 639-4175
I
I1
t
CITY OF' T I OARD -- RECEIPT OF! P'AYME'NT Rf=.CF I PT NO. 195-26 31 10
CHECK AMOUNT a 5416. 79
NAME: a JAY MILLER LALDFi, INC. C;ASIi AMOUNT a 0. 00
ADDRESS a PO BOX 23291 PAYMENT DATE a 0:3/PO195
SUBDIVISION a
PORTI—AND OR 97281—
PURPOSE, OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
�aUILI)1NO PERM MfiTu�`,-011rd _ � 465. 50 PLUMBING PERM __- 195. 001
MECHANICAL PE 401. 50 ST. BUILD PER 35. 06
FLAN CHECK FE 10. 13 SEWER USA SWR95--010C• r200. 00
SEWER INSPECT 35. 00 PARKS SDC 500. 00
RETSIDE:NTIAL.. 'TRAFFIC' FEE, 1430. 00 MASS TRANSIT TIF FEEL; 120. 00
H2O QUALITY FACILITY FF'E 180. 00 H80 QUANTITY FACILITY FETE 1.00. N0
EROBION CONTROL PF RMITFEE 64. 00 EROSION CONTROL PLAN CK. E0. 80
EROSION CONTROL 20. 80
I,3629 SW FERN CST
E..
R SMEADOW LOT P5
1-("I T AL AMOUNT (=SAID 5416. I9
City of Residential Building Permit Application J�� ��►,�
�! �
T!9and
13125 SW Hail Blvd.
Tigard, OR 97223
(503) 639-4171 ST
Jobsite Address: Wt
h
L '
" Office Use OnIY
Subdivision:�0 jMj/ieiLkJ Lot# J
Plgrick/R-sc#
Valuation: 3.
s
Comer got? Y Permit# AN
Flap Lot? Y Reissue of �01 P" ' '
Mi & TL # + '
Owner: hC
Approvers Required
Address: �- Planning
01 -- Engineering
Phone: P, 'y'-7 Other
Contractor: Items RedUlr#d
Address:
Subcontractors
-- Truss Details
Phone: Other
Contractor's License# I ecl
(attach Copy of CL Tent Oregon license)
Contact Name & Phone: n
Subcontractors: Architect/Engineer:
Plumbing: ki W Affq�, C Gin c�dn,Cr/"ddress:
Mechanical:
(attach copy of current OR C tractor's License)
Phone:
JOB DESCRIPTION:
Applicant Signature & R171bnen ber
Lq -
Received by: Date Received: 1
WNWORDCOMOMMSAPP
Permit N Account Description Amount Amt. Pd. BIll. Duo
Bldg. Permit (BUILD) L�^l/ G} fZ
Plumb. Permit (PLUMB)
Mach. Permit (MECH)
State Tax (TAX)
Bldg: 3
Plumt: --
Mech: 4
Plan Check (PLANCK)
Bldg: 01
Plumb:
Mach:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R) d / v
Mass Transit TIF (TIF-MT) Zv' 20
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WQUAL) �—
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
PLOT PLAN
JAY M1L1.611.LUILDRIt,INC.i'O IIOE 9J9U1 TIOAIW,Olt 07901
' SOD -'1 4J 1, 1 U04•UO71
LOTp 2 BmW)IVISIOn ,`L
Scale.1/8".1' Mulest Downspouts and ciawlepsco drain to street. 5 c?
Idai-Ms eTMiowny appivacli to cll7 c0ile.
(00,00 e / 103, D
I o' P- v rT r L 1 2
� .ILS
10 •�O oIT
Gvewl Priv\ \
Jd ,
I
to x16 i
Opak SIS/j 1F.�rvali�l
y`
SIS�
O O
O n f 11?
O 1
r �
/.
No
El
FL l�
1e4.0o
� 4
1 F'UJie^ �/ ��� \ 1A1Irr
Srwf'a 0 \
/03, UFeEn
—
C�
CITY OF TIGARD --- R1:CFIPT OF PAYMENT RE-,.*C'EIP-T NO. t95-262771
CHECK AMOUNT bo. 00
NAME JAY MIl. LER CPSH AMOUNT 0. 00
ADDRESS Pf-YMFNT DATE a 0311 3 9!5
SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
V,I.-.AN CHECK FE
13a2g SW 13STIA AVE.ROSE EADOW LOT
TOTAL AMOUNT PAID