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C11Y CSF T I GARD r.1 r.P m I T -4. . . . . . . .
Dnl'E ISF:ZUED:
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171
F,+.Jpr)I V I S I or,j. . . . 1-:Cf2!Jr
7. . . . . . . . . . . .
Converting gage to living spam
--------------I-----------------—------------------------------
rvc�Jr,
1 71. �TOPIEZ.......: I FLOOR BASEMENT— ; 0 sf Rr'-:7
CLASS OF WORK—ALT HEIGHT........: I FIRST,....- 0 sf GARAGE.....: sf LEFT..........: SMO* DETECTRI
TYPE OF "'K... : r FLOOR LOAD....: 4P Srr-x,,". ? sf FRONT..... ... 0 PAPRING SPACE'.
'YrrL OF CONST.:SN DWELLING UNITS: 0 FINBS1W. 11 sf RIGHT.........: 0
XCUPATKY Gm.!R3 DDR.M: 0 FiPI'M: 0 1? s f VALLE..1: 550? REAR..........: 0
-------------------------------------- —----------------- PLU0MING ----------------------11------------------------
91N-5......... t WATER C;-C'TT'— 0 WASHIM MCN..; Z LAXrY 'PPYS,: q RAIN GRAIN ft: 0
LAVATORIES.... 0 DImXRS.'. 1 FLOOR 1)110N.. ? SMP LINE ft. It SF RAIN DRAINS: ?
!/Smps— I SOW[ DISI..: 8 WATER HEATERS, I WAIEF LINE ft: F KVFLW PREVNTRt e --- -----
--------------------- MECHANICAL
FURN f lm� 0
TYPF' BOV,ICMP ! 3HP. I VONT FANSS, 0 CLOTHES DRYERS:
TURN )=A*, 2 UNIT HEATZRS..,. e HOODS.,......... 0 U'HER UNITS...:
I
MA)" 'Nr!, 9TU it Z ENT,S......... ; 21 WOODECTOVES.—, A GAS OUTLETS... 0
"CSIDENTIAL UNIT-- -.-SERVICE/FEEDER-.- ---TX SRVC/FEEXRS--- —000 CIRCUITS--- -----MISCELLANEJLr,---- --ADO'L INSPECTIONS-
7, Sr OF 0 0 - '10 gap..: 0 0 - 2*1 0 W/SVC J')i FDF.,: I FX/IRRIGATIX 0 PER INSPECTION.- 0
11 201 - 410 alp.. . 0 2f: - 4" 0 1st W/o S"^'FTF" I SIGN/00 LIN LT: 0 PER ;4OUR......
01
Q, ;tll! asp—: t 401 -- GN A EA qnL'L BF CIR: 2 S1m/;AT— 2 IN PLANT.....,
-T: 2 be! Im alp.. 2 !'T!fa;p5DZL RI e
4OR LAD -
1e004 ajp/Vslt.: 0 PLAN SECTIM'
Reconnect only.: 0 -4 RES tIN SK"FOR)C"25 A.: 600 V N00&11 CLC AqEA,SK
---—------ -1---*74L —77RICTSED ENERGY
7 --------
3 K—
'nr%ITIAL------------ --
----- ---------
�
10 t STEFEO.- VACM110 SYSTEM,- Au" —Epro''. FIRE ALI Pp.m.....
'„LOQ 7l-ARM.. : OTH: 411K............. -INDSCAPE/IPPIG, POO'ECT"'E j:
;RSTKXNTATION., KINCAL.. 1.1. 741 ;
7 am.1 10SE CALLS.... TOTAL # T`"D`wv:
TOTAL tTt_:I M1 7 1
WR
-7 5W I-111mo WAY
-4—
Reg III,. : WF
:t i5sjed subject to the regulations contained in the Tigard '0.niripal Code, State of Ore. 7;,ecialty C:dFs and all
1,Cai-Ij laws. All WV � will be y,:7f in amrd_ cc Nith app;—,t! plans, Thii peroit -pii-i i week i�^ not started b
j j
issuance, or if work is susperded f,:, iz--i than 180 days.
-- --------—
haricall Irsp Gyp hard Irsp
ctv-6:F." Eltct-i�ai rinei
�,trirai P.-,qh h'Chdnicall Final
Erosion
t
L
Plan Ch,>ak# `-
CIT`Y OF TIGARD Residential Building Permit Application Recd Ry f.; t'7-
13125 StN HALL BLVD. New Construction Additions or Alterations Dace Rec'd�L_ ' - ` V _
TIGARD, OR 97223,, Single Family Detached or Attached Dat--to P E 7 61 (61
(503) 639-4171 Date to DST -Z 3-'
Frith or Type Permit# vT < Z ">
Incomplete or illegible applications will not be accepted Called
f - Name of Subdivision Lot# Name
Job nn " ( ��,� i �+ Architect Mailing 4ddiess
Address I Site Address
7 171,., �t U �� �� L � GtylState Zip Phone
Name
Name
j owner Mailing Address
72-7o � w Engineer Mailing Address
City/State ziipPhone
ZZ-1, (s-'>%) City/State — Zip Phone
Narne
Genera! ) Desrnbe wo,k new O addition O alteration>♦ repair O
Contractor Mailing Address to b,done ___
Additional Description of Work:
City/State Zip P�one
Oregon Const Cont. Board L c# Exp Dar.
Attach Copy of Pro,
Current GOT Business Tax or Metro# Fxp. Date Valu; il0n
Licenses NEW CONSTRUCTION ONLY
Name
Mechanical - Sq.Ft. House. — Sq.Ft Garage:
Sub- Mailing Address`1
'intraCtor U( � w y Ci l r' Corner Lot Yes No Flag Lot Yes No
�dylState Zip Pnone (check one) (check one) —
( 4�Ir I GS t - ;Z( !, 7 Restricted Audio/Stereo T Burg,a
Oregon Const.Cont.Board Lic.# Exp. Ljte v Energy System Alarm
Attach Copy of ;0' 'T c- 6- -!? - -----�— --
Current .COT Business Tax or Metro# Exp at Installation Garage Door HVAC
Licenses �- _ — Opener Systems
Name (check all that Other-
Plumbing
ther
Plumbing �1A _ apply) - - - ---
Sub- Matli Address — —` - Will the electrical subcontractor wire for all Yes No
Contractor — restricted energy installations?
City/State zip Phone Has the Subdivision Plat recorded NIA Yes No
Oregon Const.Cont.Boa'd Lic# Exp Date Reissue of MST# Solar Compliance
Attach Copy of I (Calculation Attached)
Current Plumbing Lie.# Exp Date I hereby acknowledge that I have read this apphc.on,that tha
Licenses information given is correct. that I am the owner or authorized agent of
COT Business Tax or Metro# Exp Date the owner, and that plans submitted are in compliance with Oregon
State laws.
Name _ Signa re of bwnerl4ient
II
Electrical �L�.L7C lL Contact Person Name I Phone
Sub- � Mailing Address
Contr?ptor ' ;? L. ELL A I _ FOR OFFICE USE ONLY:
i r City/State Zip Phone at# — hlaprTL#.
1
Oregon Const.Cont. Board l.r# Exp. Da,e i ,'• (", �-• - � � �
4ttach Copy of Setbacks one; Soler:
Current Electrical Lia ilf ! Ex Date 11
Licenses 7�1• � & (d I y'
C T usiness Tax cr Metro# Exp. Date Engineering Approval Planninq Approval: TIF:
dsts\m3tapp dor
r -
Pc,,rmit # Account Description A U12 Aait-P-d, Bal. Due
MST. Permit (BUILD) -V —
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT) __ t� u
State Tax (TAX) 0
Bldg: 1W
7
Plumb. —
Mech.- / Z
ELC/ELR: y
Plan Check
MST. (BUPPLN) -
Plumb: (PLMPLN)
Mech (MECPLN)
CDC Review (LANDUS) _�—
_ Sewer Connection (SWUSP)
Sewer Inspection (SWINSP)
Park; nev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (cRPRMT)
Erosion Planck/UGA (ERPLAN`
Erosio-, Planck/CUT (EROSN)
Fire Life Safety (FLS)
TOTALS.
WslsVrstapp doc
Rev 71!16
Permit #:
Address:
issued Date:
Statement: Information Notice to Property owners
About Construction Responsibilities
Note: Oregon Lair, ORS 701.055(41, requires residential construction permit appli-
cams tirho are not registered ivith the Construction Contractors Board to sign the
/r►llowing slutrnt:nt hc�Ji�rc�a huilclira��permit can he isst,ec/. 7his stateme nt is required
jbr residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not suh►rtit thin svatement. This statement frill he filed with the permit.
Fill in the appropriate blanks and initial boxes i and 2.and either box 3A or 313:
'XQ - 1 own. reside in, or will reside in the completed structure.
( I understand that i must register as a construction contractor if the structure is sold or offered for sale
before or c,pc►n completion.
F 3A. My general contractor is
(Name) Contractor regis. #
i will instruct my general contractor that all subcontractors who work on the stf acture must be
registered with the Construction Contractors Board,
OR
. 1 will he my own general contractor.
If 1 hire subcontractors, I will hir,!only subc: ntractors registered with the Construction Contractors
Board. 11*1 change my mind and hire a general contractor, I will contract with a contractor \\ho is
registered with the CCB and will immediately notify the office issuing this building permit ofthe
name of the contractor.
i herci►s certif`� ;hat the above information is correct and that I ha%, read and do understand the Information
Notice to i'r•ol►er;} t)ssners about ('olist r•rrction Responsibilities on the re%erse side cf this form.
-P6
(Signature ot'permit applicant) Mato
t
(1171ite cohi'to issuing agency pervnit file.
pink ropy to applicant)
Inforrnation Notice to Property Owners
About Construction Responsibilities
No1c'. 1,11i\ /►ricuvm►tiuu Notice lo!'►peri) (hr►nv'S Ubou►('(m.c►ruchem Respor►sibilities
ww, devchy,"d h)'the ('o N.y1►•u(•lirr►t('u►►(►'(W101"y /3ot"'d ill c►c cm-,hiptc'c• it i►h ORS "0/,05515).
if S(-II,ire vCti y it-,\,1111 01111 t:iintm of It,c(inst im ,r Ill'l\ norm:or make lr ,rh I,Imml Ir11pro%ernent to an strucitlrc.
Volt can Prevent ntiklIN I,roblenl,b� hculg a\\are of the ii,llo\\ino responsibilities and areas of concern.
EMPLOYER RESPONSIBiLITIES:
Kpm hire persons not registered \\Ith !hc ( onstrnl.tlon ( ontractors Board to (it) labor in constructing (,r a,�;isting iu the
cmistrlretinn(,r 1111Prowenlcnt ol'a re,identia{arul:Ulrc.}ou will, in host ins►ance�•be rtrlcd to he an enll�loyer and the pcl,Ple
ion hire\\ill he cmploVees. :1s the cmpll>Ver. \'('u rnua oomph \witII the fi',Iluwio;ti
Oregon's withholding tax Lrw: A�;m cntpi„\1-r.\(,u nr nst\vithhof(t incunu te\( s Gori ernp!o)ee wrtRes;tt the Cinlc crul+I( \1-i ,
arc Paid. 1'ou \\ill he liable fi,r the i 'x prtVment, Owen it \'on drn't VICtualtV\\ithhold the tax from vour cniploNc'c•,, for11101C, orc
ill For trial on.cal! the Oregon Dept.o, Revenue,It 9-1 -801)1.
Unernplo}ment insurance tax: As an emplo'ver. 1( u arl•IL(Iuire(I It,pa) it ta\ for kill enlplo\ntelII in,;uram. 'pur4,u es,,II the
vl'age,of all empl„\re,. for more inforutrtti(:m,call the Oregon I:rnploNment Department at 378-+52.4.
Workcrc'cl)rnperisation insurance: A5:In crnr,lo)1-r,woo ore subjcrt to the(.)ref un SS'(,rl.crs'(:ompen;ation Lil\\.:ind must
Uhtaltl ctI 'c!)iilpcnsiliioll illsilrance I„1'\our cmPl(,\Ceti. If)(,it Fall loolitaiit \workers'.'(t•ilpcilsilllfnl rl,tirllaIwce \(\II Inav
he-,uhict.t i''pcna{tie'sand\\ill he liable furalI i.);)lilt cots if(,ne of\ourenlplowcc,i',injured-i the job fur tit,ire in Forn(ittiorl,
call IIID `,Vuurkerti'('ornpensa(ion Division at the 1)cpa1'ment or('nnsunler and ittlsiness tierwice�at 1)4'7888.
11-S,Internal Revenne Service: Al Ill cn,plM er,V( i mw,t\\ithlrold federal income tax from empio\ccs'\\ages. You\\ill be
liable li\r the Ia\pa)ntcui e\en il)tnl h(in'1 ill;ttlalk v,ithhold the tax. for marc inf(nrlrlt It'll.Al the Internal Revenue:Servlce
at 1-800-829-1040
OTHER RESPONSIBIL.ITii:S AND AREAS OF CONCERN:
0 idecoin pliance: sthepel•':tllholderl'orthi;pr(dict•(.\.Ili are re:porisiblc'lur'rt."W \trlclan\ Iallllfct(}r!�'ClC(+de YC(llnit'�`1CIU`
that Illi\ he brought 10 vmrr rattentioll 1hC(rI1L'.11 Itl5pl•CliolIN
Liahilit% and properh'damage insurance: conum\om 111,11lai -c iIl vlll!o .1-r it volt hi e adeyuaic incur:ince cu\erazr tin
aceidems and omv sion.s st eh is t'allulfi i('t+,,Paint „\cr IIIWN,\\utcr(laIIlaYL Irom pipe plim tol e',. fire.or\\ork that must he
m-doirc
Ti mv to Nil per\ise villpluvi't`s: NlAe',Illi' \,'11 ha\e`.tllfl(:It'lil time I!'�tlflei'\kc.%mIr elllplo\cc.,
l'•spertis(•� ti1<,L( .urc•.,'rrho\cthl'(•1)l,erir.rl� 1(.I;r,\t,tn ,\\nLenrr;rl::'t,nlr;rcr,,l' Iuc,,(,nlil,ul(.'the\\l'r4t 'ir.'uc'!I ul:unifini(h
Irides. alld I,,nntif'w inlilding o1,1161k at 1111-appropriate lirttec 4n rhe\ cern pertc,rm the re(Ithred intpectim ,
If :• I' il,t�t"!tlihllt`Citl({Ul�ill'll`•, \\t lil'of l9ll iIIe( on'ti llttwn(
(� '8i 46,1 I the C3onrd i-4 It!,atc(1 at till �umul��r51 NVtiuitl +tit 1. in tiaiOnt
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i
CITYOFTIFARDBUILDING p'ERMI"C
GiY 1WID F-'ERMIT #. . . . . . . . BUP91--0 :79
COMMUNITY DEVELOPMENT DEPARTMENT anooN
13126 SW fwl Bed. P.O.Bou 23397,Tfp M,Orew Wr223(403)6*417� DATE ISSUED: 11/06/91
SITE F41.iDRES 7. . . : 07270 SW HERMOSO WY PARCEL: RS I OI PB -0160
SUBDIVISION. . . . : HE RMO SO PARK ZONING: R-•,3.
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 14
REISSUE% FLOOR AREAS-----__-_-__-_. EXTERIOR WALL CONSTRUCTION-
CLASS OF' WORE;. :ALT FIRST. . . . : S f N: S: E:: W:
TYPE OF USE. . . 'SF SECOND. . . : c PROTECT OPENINGS?--_--__...
TYPE Of` CONST. .51\1 TH I RD. . . . : s f N: S.- E: W:
OCCUPANCY (.iRP. :R�; TOTAL--.--.__. -• 0 s f ROOF CONST: F I RE FR r'?
OL:C:UPANCY LOAD: BASE:ME:'NT. : Sf AREA SEP. HATE=D:
STOR. : 1.11'. : ft GARAGE. . . : sf OCCU .r-.EP. RATED:
BSIhT? : ME.Z T? : PLOD SETBACKS-- RF_•'GU I
FLOOR LOAD. . . . : ps f LEFT: ft RGHT: ft F I R SPKL: SMOI', DE-l". .
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM: HNDICP ,C:
BEDRMS: E;A'rHS) IMP SURFACE: PRO CORR: PARK IMG:
VALUE. $ : 5000
Remar-ks : Constri.rct nevi 6 : 12' trr_rSs roof over, existing 1 : 12 r-oof.
Owner. . ____._._.____-- -_...._.___.__._._.____.__.__._.______.__.--____ _____._____..____._...__..__._ FEES
LAN I Z. type amol-Ent by date rec.pt
7:'70 SW HE:RMOSO WAY PRNT $ 50. 50 JI_H 11/06/91 -
F'LCK $ 32. 83 JLH 11/06/91
-
TIGARD OR 97222 5PCT f E. 53 JLH 11/06/91 -
Phane #:
Contr-actor,: __.._..__--__-___-.---___.-___-____
DUCT: CONSTRUCTION CO
230b SW 92ND AVE
P'ORT'LAND OR 97210 _._._.____.---•--___._._____.____.__.
Pti o n p #- 6 38-4'718 $ 85. 86 TOTAL
Rey #. . : 63608
--- ---- REQUIRED INSPECTIONS
-- ---This permit is issued subject to the regulations contained in the Framing Insp W_W
Tigard Municipal Code, State of Ore. Specialty Codes and al i other F i rra I Inspection
applicable laws. All work 011 be done in accordance with
apprpved plans, This permit will expire if work is rot startedW.._-
within 18@ da,s of issuance, or if worth is suspended for more
than 180 days.
Permittee Siynatr.we :
I s 3,_led By :
Call for-, xnsper_tion 639-41751
I
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Oro
� y� Y�•��..'.v�" R i'rr C /y a'c F"_4,s'
APPROWD FOR CONSTRUCTION
(CITY OF 'TIGARDCt—
PEF'wiI SITE
BY D�ATE
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