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13165 SW HOOD VISTA LANE 1311 5 S w f1�Od v ; s b? . A lima 9, mmulmoodur , d 4-- tlx : 1exj R _j 1 5 8 4 SF# SUIL,DING SETBACKS: FRONT OF STRUCTURE: 151 -011 105 . 6 N 89 D 5z E REAR OF MOUSE: 20' -0" h SIDE CORNER DOUSE: 10' -0" SIDE YARD: 5' -0" O co U t O Q O 00 1 w / cr) Ci c I c o Lo YN o CDc° P C F_jL 6 1 i I r O 1 SETBACK -�/ u. I I , �I � I� �� I � � c�w I O I I I! II ('0 s U) 5 6 j t co ' N 8 D 54 0 E el4 7-0 Mae •,.. oar. �eNe cin -r.�000 GOP`t'RIGI-It G� 2003 STREET SMART NEIGHBORHOODS C E I V E D JUL 2 ) 2003 CITY OF TI'GARD NOTICE: - - ICI IIII I IF T I .._._ , H I - E PRINT OR TYPE III I ► III I . . _ . . _. . . . _ .. EON ANY I III III I I I I I I I IIITC� I ��r r1�� >�► IIi III , III III III III III ! If ! II ! � l III III T� r �1 LLQ--rl � T� I ( l � I I � 1 1 ( f f I I I I i I ( I I I � II r >" I III I IIII K IMAGE IS NOT AS CLEAR AS THIS NOTICE, 1 3 I711111 ! I IT IS DUE TO THE QUALITY OF THE __ --'__-- _ __ __- __ _ _-_— _ __ __� _—�- --- 11 12 , No.38 �1cn.w�r.rco.rw. ;y'. .•d+ ._ j ORIGINAL DOCUMENT V 61 8 i L T 911 5T i E T ZT I T I 6 8 L 8 9 $ E ?; IORION I Illlllil lilt IIII Illi IIII ILII lifl Illl Ilii liii�!11111II 11111111 IIII_ IIII iliL�IIII,I111 IIII ILII IIII ILII III! ILII Ilil ILII lill Illi IIII IIII IIII IIII IIII IIII IIII IIII ill( 111 lll Ill_ I IIII IIII IIII Illl l.l.11 � 1. .11 1 r-•. ,, w vs GA 2 O O v C —� rD Y Z m ,. . ,, . , .,. CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR20f13-00299 13125 SW Hall Btvd., Tigard, Or 97223 (503) 639.4171 DATE ISSUED: 9/16/03 SITE ADDRESS; 13165 SW HOODVISTA LN PARCEL: 2SI09AB-10000 SUBDIVISION: RAVEN RIDGI ZONING: R-7 BLOCK: LOT: 029 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF Owner: _ _ PEVZNER CONSTRUCTION = _ _ FEES 13470 SW TAPADERA ST Description Date Amount BEAVERTON, OR 97223 ISWl1SAIS•.erCbnnect 9/16/03 $2,400.00 [SWUSA] SwrCrnincct 9/16/03 $0.00 Phone: 503-888-6405 ISWINSI11 Swr Inspect 9/16/03 $35.00 IS"IINSI'l Swr Inspect 9/16/03 $0.00 Contractor: _ Total $2,435.00 Phone: Reg #: Required Inspections This Applican! agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement 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" Perm Issued by: . :.�� 'c �.c-ot 4.4 Permittee Signature- Call (503) 639-4175 by 7:00 P.M. for an inspection needed the dgCbusiness day CITY OF TIGARD MASTER PERMIT PERMIT#: MST2003-00374 DEVELOPMENT SERVICES DATE ISSUED: 9/16/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 13165 SW HOODVISTA LN PARCEL: 2S109AB-10000 SUBDIVISION: RAVEN RIDGE ZONING: R-7 BLOCK: LOT: 029 JURISDICTION: 'I'I(i REMARKS: New SF detached, Path 1. BUILDING REISSUE: SSN3142 STORIES. 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1.630 of BASEMENT-. of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,512 of GARAGE: 697 of FRONT: 15 PARKING SPACES TYPE OF CONST; 5N DWELLING UNITS: 1 THRD of RIGHT 5 OCCUPANCY ORP: R3 BDRM: I BATH: 4 TOTAL: 3,112 of VALUE: 309,415.90 REAR 15 PLUMBING SINKS. I WATER CLOSETS: I WASHING MACH: I LAUNDRY TRAYS: I RAIN DRAIN: 100 TRAPS LAVATORIES: DISHWASHERS: I FLOOR DRAINS. SEWER LINES: I0) SF RAIN DRAINS: I CATCH BASINS: TUBISHOWERS. 4 GARBAGE DISP: I WATER HEATERS I WATER LINr_S: 101 BCKFLW PREVNTR: GREASE TRAPS, MECHANICAL OTHER FIXTURES, _ FUEL TYPES FURN�100K. BOILICMp<3HP- VENT FANS: CLOTHES DRYER: 1 FURN>=100K. I UNIT HEATERS. HOODS: I OTHER UNITS: I MAX INP: btu FLOOR FUP.NANCES: VENTS. I WOODSTOVES. GAS OUTLETS: 4 ELECTRICAL- RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS _ _ MISCELLANEOUS _ ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp 0 - 200 amp W/SVC OR PDR PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp. 201 - 400 amp 1 st WO SVCIFOR: SIGN/OUT LIN LT PER HOUR LIMITED ENERGY: 401 - 600 amp-. 401 - 600 amo LAADDI,BR CIR: SIGNAL/PANEL: IN PLANT MANU HM/SVCIFDR 601 1000 amp, 601 alnp%.1000v MINOR LABEL: 1000.amplvoll: PLAN REVIEW SECTION Reconnocl only: >=4 RES UNITS. SVCIFDR>-225 A. >600 V NOMINAL: CLS AREAISPC OCC ELEC1 RICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL B.COMMERCIAL AIJDIO&STEREO- VACUUM SYSTEM: AUDIO&STEREO. FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT. BURGLAR ALARM. OTH: ALL-ENCOMP BOILER. HVAC, LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK. INSTRUMENTATION: MEDICAL: OTHR. HVAC: D'TAJTELE COMM. NURSE CALLS: TOTAL 0 SYSI EMS: Owner: Contractor: TOTAL FEES: $ 8,239.91 PEVZNER CONSTRUCTION PEVZNER CONSTRUCTION LLC This permit Is subject to the regulations contained in the 13470 SW TAPADERA ST 13470 SW TAPADERA ST. Tigard Municipal Code,State OR. Specialty Codes and BEAVERTON.OR 97223 BEAVERTON,OR 97008 all other applicable laws. All work will be done accordance with approved plans. This permit will expire If work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rLtles adopted by the Phone: 503-888-6405 Phone: 503-313-2466 Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through 952-001-0080. You Rog 0 LIC 14885 Z may obtain Copies of these rules or direc'questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Grading Inspection Post/Beam Mechanica Plumb Top Out Exterior Sheathing Inst Gyp Board Insp Sprinkler Rough-In Sewer Inspecf1un Underfloor insulation Electrical Service Low Voltage Rain drain Insp Sprinkler Final Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line Insp Storm drain Insp Appr/Sdwlk Insp Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water I Ine Insp Elecool Final Issued By : ,_ L� iL.�s�J t >�CL t. Permittee Signature Gall (503) 639-4175 by 7:00 p.m. for an inspection needed the, x business day T6 Pz R OFFI(I USE ONLY BuildinPermit Avlication ` Received Building 747 Date/By: a k ( Permit No.: 1`!1 �-C6 J Cit of Tigard 1' Planning Approval Other o City garDate/By: Permit No.: W3'tea 13125 SW [fall Blvd. Plan Review Other N0 Tigard,Oregon 97223 Date/By: PenTlilNo.: Phone: 503-6394171 Fax: 503-598-1960AA Post-Review land Use Internet: www.ci.tigard.or.us Date/BX:: Cese No. g (:nntact ''�sy: Sec Page 2 for 9- 24-hour Inspection Request: 503-639-4175 Name/Method: rte' Supplemental Info motion N TYPE OF WORK REQUIRED DATA: New construction Demolition 1 &2 FAMILY DWELLING 4Addition/alteration Other: y, CATEGORY OF CONSTRUCTION Note: Pemut tees'are based on the total value of the work performed. Indicate I & 2-Family dwelling 7 commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application. Accesso Buildin Multi-F�mil El Master Builder Other: Y Valuation........�..`� 5 f, .............................. $ ,�U �IJ.- JOB SIT ..NFntati+A'r.rnwr--A i noATll11V � No.of bedrooms: 3 No.ci baths: yZ._. Job site a dres : Ibg/ S J{K: AX)j>j6/of- _ Total number of floors............. 2.1 New dwelling area(sq.fl Suite#: 2 - t t g �A Lj _ Garage/carport area(sq. ft.).. Project Name: Covered porch area(sq.ft.)...... Cross street/Directions to j b site Deck area(sq.fl.).......................:f-r>? .... r^ 32L Z /'/ Other structure arca(sq.ft.). .......................... G,011/ 1/ SFC �j IgA1 — REQUIRED DATA: v� I COMMERCIAL-USE CHECKLIST Subdivision: jVA Vey Pt Lot#: -- Tax map/parcel #: Ej Q� v Note: Permit fees*are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value(rounded to the nearest dollar)of b1i-Auipment,materials,labor, — overhead and profit for the work indicated on this application. Valuation......................................................... $_ —— — Existing building area(sq.ft.)... ..................... New building area(sq.ft.)............................... _ Number of stories............................................ PROPE111TY_OWNER Z[71 TENANT Type or construction....................................... _a—ni �IJJ�_ ��. ;-� ' Z�.( �1� Occupancy group(s): New: Address: /E lD -y It A A X12 Cit /State/Zi 7Z2 hone: l/p ax: 503 ✓ "d 3 6 NOTICE: All contractors and subcontractors are required to be APPLICANT CON ACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the usiness Name: ^ mitis. _ jurisdiction where work is being performed. If the applicant is exempt Contact Name: FL-1 1�h,: from licensing,the following reason applies: Address: U ,S 'y _ ,e4Z je -- - - Cit /State/ZiAd. Ir le ci2 -- — Phone: j - F61W'' a.x: 4 >3 E' d ---___O6 e�A L l0 A�I Cli BUILDING PERMIT FEES" Please refer to fee schedule. CONTRACTOR ----- - — Business Name: :I S ` �s due upon application.............................. $_ Address: 13 N 70 5 4/ A City/State/Zip: _/ a VV1R o� Amount received............................................. Phone: C' _e O tf Fax: 11;7 Jam' 74 Date received __ —_ _ CCB Lic. Authorized 2 ;� Nonce: This pernill application evplrev If a permit Is not obtained r'ithin Signature: Date: C 190 days after It has been accepted as complete. __J /I/ -liQ _� d✓ _ *Fee methodologN vel hv'rrl-Voiinh nail:ling Induoo Servire Boo rd. (Please print name) is\Dsts\Permit roms\BldgPermitApp.doc 01/03 One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City(!f Tigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall BIN d, l'i'vard.OR 97223 UOther: Phone: (503) 639-4171 -- Fax: (503) 598-1960 THE FOLLOWING t ' PLAN REVIEW Yes No NIA 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat lot. L 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. _ V 7 Water district approval. 8 Solis report.Must carry original applicable stamp and signature on file or witn application. 9 Erosion control U plan U permit required. Include drainage-way protr,aion,silt fence design and location of catch-basin protection,e!c. 10 3 Complete sets of 116gible plans.Must be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must M incirporated into the plans or on a separate full'-size V sheet attached to the plans with cross references betweer plan location and details. Plan review cannot be completed if copyright violations exist. I I Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;properly comer elevations(if there is more than a 4-R.elevation dil ferential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wellslseptic systems;utility locations;direction indicator;lot _arca;building coverage at=percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation pian.Show dimensions,anchor bolts,any 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, V furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor trams,headers,joists,sub-floor, wall construction,roof construction. More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof(lope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, the:mal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. V Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Well bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations,for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing,Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rehar. For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over ?feet long and/or any beam joist carrying a non-unifonr 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 appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to he applicable to the prolco under review. 21 Five(5)site plans are required for Item I I above. Site plans must be H-1/2" x I I"or I I" x 17". 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lim.s or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street'free List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 41()4614(6MK OM) i Jul 17 03 11 : 23p Viktor Dratkov 5036907923 p. 1 FROM : EDUAPD FAX NO. S03R90-91r- J,.I. 16 2003 04:2EIPM =11 Mechanical �' tiriit Ail cation artt;�ed Ia�h.Ma; aKMtns Avwo•dCity of Tigard JUL 200, ram 1lgQQ3 t�oa 1 noticing IJ1?S SW Iloll 131-.of Datr/Dy _.-_- ___ I ►wwwrgu. • lrii aimw Otho Tigard,On:Run 97223 Y OF T!UAR( v u1Nu.: Phone iOYAJ351.41/I Car. �1010*11mavlsl - Inlemet: www ei tigaid ur ua Dr1e'c' II cu.tib. 24-hour Jrnpccfion ReyucaC $03.639.4175 t:onr�ct --1 T��i S«fin„e!for NorrrlAeeebo0 -- i. lemennl hM�rrycUon. Fw0 �- -� r-- tMM—WRCIAL — i kleehonipal pcmdt fee •are li b.d on the total value a c wnraNcw COnitlleton 'mtormed• Indict�(Ile vslcc(tuwdw the ecetMdollar)of A liAdditiurValteratioc/�lacmrnt l� A )c G h YYQF CQ>t51RUC17 �;.' tnat_'tmrcal materials,equipment,lobar,overhead W profit 1 &1-Fafra 'dwc(lin CUfamtf`ii/Industlja( Salus: f Sre Pate 2 for Fee SruedulC --- - #Ac0 esS� $uildJr�- i Mlrlti-Family - >�F'y1I►ENTIA4SZ1Ti SYI $CtF r!' :'-'0, - _— -_ Master Builder Oihcr. �._ c4i°o” z Fte{e�l I TeW -- --_ :.JQI1SITi RM31TIgN►an (1(A710N'' � _-_- Igcatig/roony_ _ _ �_ �I ; Furnace• odd•enatreottd:uo_nrrt,��_ `I�_OJ lob site a dr 60; c Gas Itrml puny a D0 suite#: a t Pio m(Namc: tr• flet wxk _t watn em Cross streeVDlmOb' s toj stc nxuar - - -� C C / c��, �,t� to rediuyt or h roni:srsu�_ _ 1400 w f K s Ix -ii, icri oud,iiuf clemlej i•t ay.in•duc%sus rnde tee. 14 00 tea S G✓ . N0V V;-S G ftti vlty e%" r o allow �� 1 0 Subdsviewn 1 Lot/j•so R air oast 7 .a u- 11.15 Tax rtia�f/�arr cl a. tcl hcatct -------._. ^'"'++ff''It _ .. tis futp'h - -- -- Flue-.c; {agtar .s dniatal - 10110 ,-- ---- WuaYPellet mow_ 1c.00 -- — — aFr,m. ,nR mW„ io o -- 1 Odler - -.- 10100 _ -Name: V N _ Ca '5' ,1 / _ -' nw.:rn.ew+E,ue:na' =TT Addrosr: a e1 �'K ouge hood/other kitcheaequipme ---Clolim dryer-hwu 10.001IStatC/Zi . �C.Ve--►F' C;j: S egT3uct ulutuat Pbone: ax: ,SOj_ 9 (� (bethroe•ns,toilet eomQartemu, L C0"Aa.24 ri,. . . Vulit",toownj 6.10 -� Artiderawl (lrtls 10.00 Addic3s: '7 • . rena3 . 1cich ,ddkccIty.!r"'Ame/b e o ( Ot, Phom; Eax: e1q;71 7Putruct,eu •• Gas Baum E-ma11 wdasuapcndedualt haurr a s;:..;;r'?_r_ """�cnyta,tr.�blt - WataheRter !e Business N7-77-7t, • r-. r _ - - -— - D B •' City/5tate/Ltp: f�C.L�✓ ��Q��-- acth.s stye, Bas) _— •• _ - - CC$i,ac div Fax: b' D L obit, s. _ _. _ Aalhot'20 «_a.call_ ver rm. -- _ Suowe l_ _s syQsuarr. r r Z'/7--- , Mlnomnnl Pr tmth For$iS r' So S_ Plan ttniew FL-25%of?e►mit Fie S (Piraac punt"I—) �u- ore !�.ofPetmOt FM - __ T(YJAL ITa M'FFS S - rislite: l'hif psrtair aMiltahen eephaa N a pcndl b Det ebtaleeA.•lahle •Fee rOrhtNelep srr by lrr�wtary nandiaa Ie 1uarry 3trtitt beard Igo data after It has haea aacyled u t1aonlete. *silt pose rtgeired for^111"0 Ax uah.). 1 ttttetP I nmtatt/etetrPutApp doe 01003 r FOR OFFICE I ISE ON I N Plumbing Permit Application Recer.ed Plnr»ping Date/By: Pemut_No.: Planning Approval Scwcr City of Tigard JUL 2,z 20'L Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review other Tigard,Oregon 97223 C• T1' L) Date/By: _ Permit No.: Phone: 503-639-4171 Fax: 503�49!>49�liEa L'' �� Date/ a iew Case N .: Date/B _ Case No.: Internet: www.ci.tlgard.or.us Contact J iii: See Page 2 for 24-hour Inspection Request: 503-639-4175 Meme/Method: :1 (iu Sarnletenial Information. TYPE OF WORKFEE*SCHEDULE(fors ectal information use checklist) New construction _ Demolition DesCrilltl0n t1h'. Fcc(ca.) Total Addition/alteration/replacement ❑Other_ New 1-&2-family dwellings includes 100 ft.for each ulllih•connection _ CATEGORY OF CONSTRUCTION SFR I bath _ 249.20 1 &2-Family dwelling_ . Commercial/Industrial SFR 2 bath _ 350.00 Accessory Building L Multi-Famiq� SFR(3)bath 399.00 Master Builder ❑Other: _ Each additional bath/kitchen _ 45.00 JOB SITE tNEORMATI/ON,4nd LOCATWN! Firesprinkler-sq. R.: Pa c2 _ Job site address: / /!a5 4�)/�lix�yj i r� L-w� Site Utilities Suite#: Catch basin/area drain 16.60 ---I Dr well/leach line/trench drain 16.60 Project Name_ _ Fooling drain no. linear ft.) _ Page 2 Cross street/Directions t .�b`site: Manufactured home utilities 110.0 _ CL��,rj p Jii3�/L� �y2� Manholes T6.6 wW Me Rain drain connector 16.60 San itar sewer no. linear ft. Page Subdivision: (� {') 1 Lot#: !,1 Storm sewer no.linear fl. Pa e 2 Water serviceno. linear fl. Page 2 Absor tion valve I G.GO Tax ma / arcel #: 0_ _ Fixture or Item DESCRIPTION OF WOR _ Backflow reventer Pae 2 Backwater valve -- 16.60 _ �---� -a- Clothes washer 16.60 -- - - -- --- Dishwasher 16.60 Drinking fountain 16.60 MXROPERY,Y OWNER +IT TENANT Ejectors/sump 16.60 Name: V�/I�' - C�-/L �l _ 4'L Expansion tank 16.60 Address: r ? Fixture/sewer ca 16.60 City/State/Zip:/State/Zi � ( �'�� Floor drain/floor sink/hub - 16.60 Garbage disposal 16.60 Phone: OV 3 7MY -6?!0 ax: -79 -C 36-.2- Hose bib 16.60 CANT CONTACT PERSON Ice maker 16.60 Name: IJEY��r �P�L _ i Interco tor/ rease trap 16.60 Address: Medical gas-value: $ Page 2 7 � Primer 16.60 Cit /State/Zl Roof drain(commercial) 16.60 Phone: �4AFax: Sink/basin/lavat2g 16.60 E-mail: Tub/shower/shower pan 16.60 _ CONTRACTOR Urinal _ 16.60 Business Name: Water closet 16.60 - Water heater _ 16.60 Address: s Other: City/State/Zip: -} , _ Other: 1~a_: r Plumbing Permit Fees* Phonez CCB Lic. #: .#: - Subtotal Plumb. Lic $ -`.- Minimum Permit Fee 572.50 5 Authorized Residential Backflow Minimum Fee$36.25 Signature. = Date:- Plan Review 25%of Permit Fee 5 State Surcharge(8%of Permit Fee) $ -- 1 (Please print name- F TOTAL PERMIT FEE $ Notice: This permit application expires If a permit is nmt obtainedµithin All new commercial buildings require 2 sets of pians with isometric or 190 days after it has been accepted as complete. riser diagram for pian review. *Fte methodology set by Tri-County ltnilding indasin service Hoard. 0[)sts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: _ Residential Fire Suppression Systems: Site Utilities _ Qty. Fee(ca) Total Square Footage: Permit Fee: ` Footing drain- I"Iow 55.00 0 to 2,000 $115.00 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer-I st 100' 55.00 7,201 and gnater $309.00 _ Sewer-each additional 100' 46.40 J Water Service-Ist 100' 55.00 Medical Gas S stems' Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain- I st 100' 55.00 $1.00 to$5,000.00 Minimum fee$71.50 Storm&Rain Drain-each additional 100' 46.40 $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 Fixture or stern Qty. Fee(ea) Total including$10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.0:and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27.55 1 and includinit$25,000.00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for each additional$100.00 or fraction thereof,to Inspection of existing plumbing or and including$50,000.00. specially requested ins ections-per hour _ 72.50 $50,001.00 and up s 142.00 for the first$50,000,00 and$1.20 for Subtotal: each additional$190.00 or fraction thereof. Fixture Work: Are yon capping,moving or replacing existing fixtures? If "yes please indicate work performed by fixture. Fpilure to accurately report fixtures could result in increased sewer fees*. Quantity b Fixture Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Filstinit Capped ---- -- - -Baptistry/Font Bath -Tub/Shower -jacuzzi/Whirlpool _ ('or Wash -Fsch Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher -Commercial -Domestic Drinking FountainLye Wash - ----- ---- Floor Drain/sink -2" -4" Car Wash Drain - - Garbage -Domestic *Note: If the fixture work under this permit results in an Disposal -Commercial _ increase of sewer EDI Is,a sewer permit will he issued and -Industrial _ fees assessed for the sewer increase must he paid before the Ice Mach./Refri .[rains _ _ plumbing permit can he issued. Oil Separator Gas Station Rec.Vehicle Dump Station _ Shower -Gang -Stall _ Sink -Bar/l.avatory _ -Bradley -Commercial -Service Swimming Pool Filter Washer-Clothes _ Water[extractor Water Closet-Toilet Urinal _ Other Fixtures: i:tDsts\Permit Forma\PlmPertnitAppPg2.doc 01103 C!'e Y OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 ---�- �- BLIP Received Date Requested_T_ 6- AM--_ PM ___ _ BLIP Location —_ 3/ �� Suite _ MEC Contact Person ___ j,� ____ __ Ph ( —) 3/� �'� yam_ PLM Contractor Ph SWR BUILDING Tenant/Owner -____ _ ELC Footing ELC Foundation Access: Fig Drain ELR Crawl Drain Slab Inspection Notes: SIT Post 6 Beam Shear Anchors -- Ext Sheath/Shear _ Int Sheath/Shear Framing j.4 5 o— Vv.lac '14C r.pa-4".• c t'�cc cbt. Insulation Drywall Nailing — — Firewall t/��L..'(-� \ 1. T/i I�i 1V\i1 JAAA 4- Fire Sprinkler L � W Fire Alarmt_4 l.: •- r b. Susp'd Ceiling - Roof Other: Final PASS PART FAIL_ PLUMBING Post&Beam Under Slab Rough-In Water Service -- - Sanitary Sewer Rain Drains -- Catch Basin!Manhole Storm Drain - ---- — Shower Pan Other: mg�,� -- - A 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 ❑ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: -__- _- Ej Uneble to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dote -` - InsRectof lib f (� __ _Ext. Other: Final DO NOT (REMOVE this Inspection record from the job site. PASS PART FAIL FP'O" : 6DUrWr FAX NO. 03 90771b Jul. 17 7M1 M7:19Rr' P1 Ejectrical Pere pppoiwd LlrCltical tJ r_ 2003 Planning/tM7121 City of Tigard ^ Nte _ PoWt 'o 13125 sw 11"IJ Bl'd .,ITh �E TIGAHD �/ r;tu�M„:•w - - - Other r:o.. Tigard,Oregon 97223 Fail-if hl view —_ �_-- t u>t — -.-- Phone: 503-6.19-4171 Hex StJ3�39�-;9t�0 IM:e a ---•- alae lila; 1Jerrim www,cl,t..ard.or.uR untacl, lur+s.- Set rare E fnr 24-hpu2 IAspet:LOII lZs�tteet SrJ3-EA9-4I'3 I NtnWNx�nd� ��.v f Su pkrgt�l lut[4rm►•t!e _ F.�OV P1-04 IXW(PItyttR i� J ilult�Qpby)" rr. New omstnietiorl _ _ �LJIOiit'0Q Serv(eemc.723 wr..rA- - Htel,tr.ur+Car-•ihq comm:0110 L:.l Hnardovt Inatkvl I p.ddititm/itlteraV,otv'r lacemeal T Other: []berAve o�eT 930ampt-rating or Q Wtill dihn war 1C,f)OC syryrr y M 4' n_. 1' RY or R1� raN i 1&2 firmly dwclnnP fn„r or mere"Aidelitial,nils n 1 !-Feb3ti) dwellm l ommercilUlrtdt�e>r!al syttcnt over ,olta nutttinal atic iutrca ---�- -- Buildine d•-W tht*e tterita ❑'eb krt,atxt anmc,3t rror Acoes�ollBuildingMulti-kJMPV Ocnipont lord o,w 799/now ❑Menufiof,md -c mint nr RV jWk jA$04tar Hider Other. igroWighung P'lo, ❑Other. .h,rws-�/x t nr nx y 9oDnR, u s<ts of pleat with env of tit eMrl. 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' ��.r�-- — I %,AS r- '- i ;4I tm k i00 eat X10.30 Fbtme: SZ e1VaiA5011:r, ---� .... �2 prsnch tircrit• •,ev,Jteratiou,or __.. lien Par ter!: Fee to.b,u,neY h oulre wid,pwChs"o1 t1(�d_fe9S: .)-1�/2. ///J�aAr tarvico or tsda fell,tub Mach: b_05 2 Ciity/S—tn /^TZl ��(i G J J a L,•tiraner ncna s+fiTn,¢rnve-�-+� z --� . -,r`- U ecrvfcr�t reldtr rr4�t7ranchtt✓rsult 4 PI10IIe: 0 D ) T'ax: - anch aAi!ititttl Arend cim dt I S 2 1?•t718i1' u ar(",avvi a nr htalr eat b d tIeSI: ' ch [7 :1. e'73t I+ ,,� ,��'�•y Ir;-T(�K JUpt (�f Vit __.•' ::t C W ball(PIC 7 43.40( al 'ix_nJE—— Job No: + S�y,sl rna,iL`+i M e litc-fail lnerp pr,c ei,---- l ta.or_or ettewion BustLfxeG6 Name:-�Vo�[G r�aLa•ivuoe� ---•- - - - Adrlre : C �(v¢' Wit addltlonsl ln!pnE!ao over tkt 4I14wabInd the above: G1t�S18tC/ I.J Vttok / 0R r7UU� Prl rrx9eeaQlta�W41.1 sv) _ _ .-d2.So Phone: ?o Y 6 Y 9 rim V 3't / $ Itnzsrt�ton:ae. -- CCU Lic.;«: /'('7 Y L 7 I )V{e.sit: 3 - /0 c _ Supervising els ct icllm A __.=- ` ';._.�.VectFtcaf sinre uhad. je! pitm Reviow ZS�4 0!tnn(t Fce) --- Print N, �e R�'��'. �0��;�i �Lic. �[L»� St_nre StMULM4 of Pczmit ----- _ _ TOTAL PRRMIT PTB i AUtbatuedNotice: This Otnnit am"talfei t ru W di nii el+tein,rl wir ,n Srt�tumrrr. _ _ ___ Q'+rt•—.��2�/� g0 da.•.ager Il MaDeea atx�url w wmPl�t,e. 'rte iiiwbodrsl B elle by TeKesary 11a1t tedra„Ser kr Hear d --- lea trdw - j,\r"rP>trm,rnrrm167ePartattApp.doe OM te ;EOVTLEE09 9E:60 ?07./90/80 c April 27, 2-004 T�' CITY OF TIGARD Pevzner Construction FILE COPY OREGON 13470 SW Tapadera Street Beaverton, OR 97223 RE: REVISION TO APPROVED PLANS Pro_j_ect_information Building, i'crmit: MST2003-00374 Construction 'Type: VN Address: 13165 SW Hoodvista Lane Occupancy Type: R-3 Area: 3,839 Sq Ft Stories: 2 This letter is to follow up an inspection at the project listed above. i. At final inspection it was noted that a room was added under the stair. The room was not on the approved plans. Submit 2 copies of revised plans to the Cite of Tigard, Building Division, indicating desired changes.Upon approval and issuance of the revised drawings, you may recall another final inspection. 2. The size of the room exceeds the area allowed to be unsprinkled according to NFPA 13-D, Chapter 4-6. Since the room did not exist at the time of the rough sprinkler inspection, it was not listed as a correction at that time. Submit 2 copies of revised sprinkler plars to the City of Tigard, Building Division. Upon approval and issuance of'the revisc,9 drawings., you may recall another final inspection. FYI It is helpful to submit revised drawings when field changes are desired/made to the approve) plans. When submitting revised drawings or additional information, please attach a copy of the enclosed City of Tigard, better of Transmittal. The letter of transmittal assists the City of Tigard in tracking and lime ing the documents. Resl.ectti lk / /f 1Lnior ria aloe Plans I'miminer(503-718-2436) 13125 SW Hall Blvd., Tigard, OR 97223(503)639-4171 TDD (503)684-2772 --- — CITY CSF TIIGARD 24-Hour BUILDING It;:;pection Line: (503) 639-4175 — Da 3 INSPECTION DIVISION Business Lime: (503)639-4171 Received _ Da a Requested_ dap UP� �_ PM _ BUP Location I---- _-_ _ _Sui,e_ MEC Contact Person Ph (._ _) 3_��_TZ'y -�_ PLM Contractor Ph (__. ) _ SWR �pFb_ — Tenant/Owner -- --- -- -- ---- - -- ELC - ----- --- -- Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain _ Slab Inspection Notes: SIT - Post&Beam ----------- - - - -- Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing --------- -- ------ -_-__ Firewall eS e -- - --- I Susp'd eiling Roof Oth --- - in SS PART FAIL -- P BIiVG - ---- - Post&Beam �— Under Slab Rough-In Water Service - Sanitary Sewer � __.- - ---- ------ --- Rain Drains a --- ------- — Catch Basin/Manhole Storm Drain Shower Pan Other: --- ---- - Final PASS PRT FAIL - M - - L /00 _ -- -- -- - Post eam Rough-In Gas Line S ampers - --- ----- maTT PART FAIL - TRICAL Service - Rough-In UG/Slab -- - - --- Low Voltage Fire Alarm -- - Final Reinspection fee of$_- required before next inspection. Flay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE _ Please call for reinspection RE: _ Ll Unable to inspect-no access Fire Supply Line VCj? ADA Approach/SidewalkDate Inspector - -- Ext - -- --- ----- Other:_ Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL kLAAAAAAAAAAA,L ' &AAAAOAASOAAAAAi ,0AAAAOAAAAAAA.A i ► ► i ► i � ► i p N bA U N d ► —4 � p R i 0b t, .� A 14- POO tO ► ti i � U °� ► C 44 24 J \, 44 !�1 ^.• 44 �.� A ► i A �' ► 'A \ CITY OF TIGARD 24-Hour BUILDING Inspection Lina: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP - -- - Received _ __. Date Requested-�A — AM ___—_ PM -- BLIP --_ —_ Location A?i _�ps � - Suite----// --- - MEC Contact Person ..----- -gbh(-�f' -� �� t� q PLM - -- --- -- Contractor .- ---- Ph 6�) �, SWR --- ——�-.-� BUILDING Tenant/Owner ___.._ _ ELC Footing ELC Foundation ACCESS: Ftg Drain ELR Crawl Drain Slab Inspection Nates SIT Post& Beam - - ---- -- .._ Shear Anchors - Ext Sheath/Shear - ------- - - ---- Int Sheath/Shear Framing �.— Insulation Drywall Nailing "�--�-�- -- ---- Firewall Fire Sprinkler --�------ — v - Fire harm ISusp'd Ceiling - -" ---- T Rout - - _---- Other: Final - PASS PART FAIL �_- 15 5�N `i -- I.t l� - �L 11` -�—��-`"�/'•� • -- -- - ----------- - ej PLUMBING ` - -�---- Post Beam -- � � t - !� �� 6 UnderrSlab - Rough-In Water Service --- Sanitary -Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain —i-- -- —` Shower Pan Other: -- Fin,l PASS PART FAIL MEC_N'.NICAL --- ------ - - -- - Post& Beam Rough-In - — - — --- - Gas Line Smoke Dampers - - --- Final PAJL PART FAIL ---�i- - ___ f-LECTFMAD Service Rough-In UG/Slab Low Voltage - - -- -- Fire Alarm Reinspection tec,of$_- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd, ASS PART FAIL SIT 1 Please call for reinspection RE:—_ _ -_-__ Unable to inspect-no access Fire Suiply Line — ADA Date -./ _� Inspo It .A7jo Ext Approach/Sidewalkt� Other - -- Final DO NOT REMOVE this Inspection record fro the . PASS PART FAIL / ES-007S Series 0070T ' No. 007M 1 DT (1'/z", 2") DOUBLE CHECK � � VALVE ASSEMBLY j Sizes: r� '/2", 1"M 1 , 1'/z"M 1 and 2"M1 bolted cover f A double Check valve assembly shall be installed at referenrcd cross-connections to prevent the backflow of polluted water into the potable water supply Only those cross-connections identified by local inspection aulhontie- 's non-health hazard shall be allowed the use of an approved double check valve assembly. Check with local authority having jurisdiction regarding vertical orientation,frequency of testing or other installation requirements. The valve shall meet the requirements of ASSE Std. 1015 and AWWA Std, C510. Approved by the Foundation for Cross- - Connection Control and Hydraulic Research at the Univerity of i Southern California. No. 007M1OT (11") FEATURES • One piece bronze body - unibody • Lightweight CHECK MODULE ASSEMBLY • Shorter end to end dimensions The 007M1QT Series features a modular design • Blare by male connections - no adapters concept which facilitates complete maintenance • Working temperature rating up to 180`F and acsembly by retaining the spring load. • Replaceable seats and seat discs • Captured stainless steel springs • No special tools required for servicing Test First cocks rhe..i, Second AVAILABLE \ Module Check Assy Module Prefix: Assy U - union connections Suffix: OT - with quarter-turn, full port, resilient seated ball _ W valves(Standard) - S - with bronze strainer - LF - without shutoffs �\ MATERIALSr Bronze body construction. Durable tight seating rubber discs, bronze ball type lest cocks. Model 007M1 acetal check seats. Series 007M10T furnished with quarter turn, full port, resilient seated, bronze ball valve shutoffs. SPECIFICATIONS IMPORTANT:INQUIRE WITH GOVERNING AUTHORITIES FOR For Double Check Valve Backflow Preventers LOCAL INSTALLATION REQUIREMENTS. A double check valve assembly shall be installed at re erenced For information on ?'e" size, send for ES-007M20T. cross-connections to prevent the backflow of polluted water into the potable water sul)ply. The bronze bodied assembly shall con- sist of two independently onsrating center stem guided check a t�.aaEA inr va[rrE TECMNOLOQY modules Each check mod, a shall include a captured spring, ,�� replaceable seat and replaceable seat disc.The check modules shall be accessed through a single r'p entry cover The assembly REGULATOR snall also include four top mountr�d ball type test cocks and two 1874 �wArI5 Industries ln'— resilient seated isolation valves. Water Products Division•Safety 6 Control Valves The assembly shall be listed or approved under the re uir 815 Chestnut Street,North Andover, MA 01845-6098 USA of ASSE Std 1015,AWWA Std C510 and C , T�V Tel.(509)688-1811 Fax:(508)794-1848 ed by the Foundation for Cross-Connection Co r raulic Wefts Industries(Canada)Inc Tel.(905)A51-8591 Fix:(905)851.8788 Research at the University of Southern California.Watts Re ulato Watts Industries(Europe)RV Fix:+31-833854192 Company Series 007M 10T AUG Walls Ocean BV Fax:.31 8338.52073 CITY OF TIGARD 13UILIDING DIVISION i September 2, 2003 T CITY OF TIGARD Wyatt Fire Protection OREGON 9095 SW Burnham Tigard, OR 97223 7 RF: RAVEN RIDGE. RESIDENTIAL. FIRE SPRINKLER SYSTEM Building Permit: BUP2003-00498 Construction Type: VN Owner Name: Pevzner Cor,struCtion Occupancy Type: R-3 Address: 13165 SW Hoodvista Lane Occupant Load: NA Area: NA Stories: 2 The plan review was performed under the State of Oregon Structural Specialty Code (OSSC) 1998 edition, and th,.- Tualatin Valley Fire & !fescue Ordinance 99-01 (TVFR99-01) 1999 edition. The submitted plans are approved sut.ject to the following. I. Separate control valve required to shut off the domestic only. NFPA 13-D, section 3- 1.1. 2. Underground mains and lead-in connections to system risers shall be flushed before a connection is made to the sprinkler piping. NFPA 13-R, section 2-1.3.1.2 3. At least one :,pare sprinkler of each tv,)e, temperature .rating, at d orifice size used in the system shall be kept on the premiss. NFPA 13-D, section A-1-5.1 4. Clearances shall be provided around all piping extending through walls, floors, platforms and foundations. Minimum clearance for pipe sizes 1 inch through 3 inches shall he not less than 1 inch. OSSC Standard 9-1, section 4-5.4.3.4 Approved Plans: I set of approved plans, bearing the City of Tigard approval stamp, shat; be maintained on the jobsite. The plans shall be availahl,� to the Building Division inspectors throughout all phases of construction. 106.4.2 OSSC When suhmitting revised dra,,�ings or additional information, please attach a copy ofthe enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of Tigard in tracking and processing the documents. i I Respecthilly % Brian Blalock. Senior Plans Examiner I 13125 SW Hall Blvd,, Tigard, OR 97223 (503)6394111 TDD (503)684-2772 --- c CITY OF TIGARD BUILDING PERMIT PERMIT#: BUP2003- 2003-00498 DEVELOPMENT SERVICES DATE ISSUED: 9/9/03 13125 SW Hall Blvd..Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S109AB-10000 SITE ADDRESS: 13165 SW HOODVISTA LN SUBDIVISION: RAVEN RIDGE ZONING: R-7 BLOCK: _ LOT: 029 JURISDICTION: TIG REISSUE: FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION CLASS OF WORK: FPS FIRST: sf N: S: E: W TYPE OF USE: SF SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: REQD SETBACKS _ REQUIRED _ FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR. PARKING: VALUE: $ 3,000.00 Remarks: Stand-alone fire sprinkler system. Owner: Contractor: PEVZNER CONSTRUCTION WYATT FIRE PROTECTION INC. 13470 SW TAPADERA ST 9095 SW BURNHAM BEAVERTON, OR 97223 TIGARD, OR 972.23 Phone: 503-888-6405 Phone: 684-2928 Reg #: LIC 64077 FEES _ REQUIRED INSPECTIONS Description Date Amount —� Sprinkler Rough-In 11411!!.!)1 I'Crnu1 I rc 9/9/03 $72 10 Sprinkler Final i AXI 8%,Slatr I a-: 9/9/03 $5.77 1 FLSj FLS 1'In k. 9/9/03 $28.84 Total $106.71 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is riot started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 0010 through OAR 352-001-0100 You may obtain a copy of these riles or dig act questions to OUNC uy calling (593) 246-6699 or 1-800-332-2341. r � Issued By: \ -- 1mlttee ---. -- Sign�fe: Call 639-4175 by 7 p.m. for an inspection the next business day Fire Protection System ` I r .J (I /-,l i/V .1 /l �Uildin , Perr�'t� Received 7oipB, g Dare PJo.: u 61x3-a0�9 g Cit O1�Tigard Planning Approval7 City g AUG 1 �r;�; i DatdB : Nn.: 13125 SW flail Blvd. Plan Review - Tigard, Oregon 97223 Datr]B : ' Permit No.: Phone: 503-639-4171 F�s�1Tp9r5�ae�v Post-Review Land use (I_ NG DIVISION Date/By: Case No. Internet: www.ci.tigard.or.tis Contact tuns.: 1 97see Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method Su Ie :9 mental Information HST,-9 OJ-(Z)5-7y _ TYPE OF WORK _ REQUIRED DATA: New construction Demolition _ I'&2 FAMILY DWELLING -- Addition/alteration/re lacement Other: _ CATEGORY OF CONSTRUCTION Note: Permit fees*are based on the total value of the work performed. Indicate _ & 2-Family dwellin []CommerciaUIndustnal the value(roundrd to the nearest dollar)of all equipment,materials,labor, overhead and prof.Valuation.._... a work indicated on this application. Accessory Building— aMulti-gamily pom�y---�— . for the. ................................ S Master Builder ❑ Other: _ JOB SITE INFORMATION and LOCATION No. bedrooms:_— No.of baths: Total number of floors... ........ ........................ — Job site address: I5 `J. AQ)lNkSi A "L New dwelling area(sq. ft. Suite #: I Bldg./.A to Garage/carpon area(sq. ft.)............................ Project Name: {ZNatA Covered porch area(sq. ft.)............................. Deck area(sq. ft.)............................................ — Cross street/Directions to job site: Other structure area(sq.ft.)............................ 'ti Wti REQ. nE?)AIiECKLISTTA: *. h �� t DIN1�VIERC ' Subdivision: Lot#:--- 'rax map/parcel #: Note: Pet rut fees*arc based on the total valu.of the work pe-'brmed. Indicate DESCRIPTION OF WORK overhead value(rounded to the nearest dollar)of ail equipment,materials,labor, overhead arl prod:for the work indicated on this application. Valuation. . ..................................................... S Existing building area(sq.ft.)......................... New building area(sq. ft.)............................... Numner of stones............................................ PROP TY OWNER TENANT } Type of construction....................................... Occupancy group(s): Existing: _ Arne: "[\JJ 1 1 Ct t U New: Address: 1?j 7 � r) --- - Citv/ Zi_State/ : C�J it 7x3"3 -— NOTICE: All contractors and subcontractors are required to be PhoTIC:r - )5g' U' Fax: I'censed with the Oregon Construction Contractors Board under APPLICANT CONTACT PERSON plgvisions of ORS 701 and may be required to be licensed in the Business Name: jun.,diction where work is being performed. If the applicant is exempt Contact Name: _ from licensing,the following reason applies: Address: r. _ __ -- -- --- -- Cit /Sta—te/Zi�, _— gjLDIuNq PERMIT UESe rPhUpC; Fax: F-nali oehedtl' ,• t ee. lytr - CONTIUCTOR - Business Name. _U I I %I-,L liurA Fees clue upon application...... ..... ...... _�__--- Address:_ J )q Amount received.... ..........................._._.. . _ ---- ('it /State/ZI : �� U Phone: v ' 11Z_ Fax: &;A- (y�, 7 nate received:— CCU Lic. #: 64,01 _--_— -- -- --- — Authorized / i� Notice: This permit application expires if a permit Is not obtained within Signature: _ Date: � � 180 day,after It has been accepted as complete. *fee methodology set by Tri-County Building Industn Service Board. (Please pnnt name) .\Dsts�Pertmt FormsiBldgPermitApp doe 01/03 CITY OF TIGARD Residential Certificate Of' Occupancy Penni No.: [ V �� `i Address: Z Owner/Contractor: Date of Final Inspection: �27 e Inspector: _ This structure has been found to be in substantial compliarce with the provisions of the Sure of Oregon Otte& Two Family D►vellin? Specialty Code and is hereby approved for occupancy. i c