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Permit (33) CITY OF TIGARD MASTER PERMIT 'S' COMMUNITY DEVELOPMENTIN Permit#: MST201800152 T EGAR o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/11/2018 Parcel: 1 S 135AB03303 Jurisdiction: Tigard Site address: 9225 SW OAK ST Subdivision: ASHBROOK FARM Lot: 9 Project: RADANOVIC Project Description: Converting den to(1)additional bedroom and adding(1)additional bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $14,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: Y Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add9 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 7 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 0 Owner: Contractor: RADANOVIC,SRDAN OWNER Required Items and Reports(Conditions) 9225 SW OAK ST DR DAN RADANOVIC TIGARD,OR 97223 9225 SW OAK TIGARD,OR 97223 PHONE: PHONE: 503-913-1303 FAX: Total Fees: $753.54 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 not started within 180 days of issuance, or if work is suspended for more the 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 952-001-0'• -- - • ..in a copy of the Toleys or direct questions to OUNC by calling 503.2 .1987 or 1.80 2.2344. IMP Issued By: — �'�, /.�/i�� t „� P�TmftteeSigiLature: i 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Fr t Residential 1 FOR oI Iw I: Csl:ONl.l Cl of Tigard !!iew �/ �qe� qPermit Na.: .�-r�r! l� aF 71 ✓ j i' 9 0 iO-tOl13125 SW Hall Blvd.,Tigard,OR 97223 j s Phone: 503.718.2439 Fax: 503.598.1960 e/By. /7j 1 l Other Permit: TI G A K D Inspection Line: 503.639.4175 rY Of to Ready/By: Juris. See Page 2 for Internet: www.tigard-or.gov U1 TDlRle( DWI dMethod: SupplementalInformatlon R,) E�13&l�l Al 6 (40 TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. pi1-and 2-family dwelling 0 Commercial/industrial Valuation: $1 hvi vr/;> ❑Accessory building ❑Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION-5�AND LOCATION Total number of floors: Job site address: ck2oC.r7 5 04K New dwelling area: square feet City/State/ZIP: Tfe it-/ .b 1 0 g, 7 7024 3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: , tfi O/2l &7t0011/ 4 Covered porch area: square feet Cross street/directions to job site: Deck area: square feet �/1)- 577 4 PALL b 1 V b. Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Q J .W 12a+Itk o Wt Valuation: $ '`il `,�e S Existing building area: square feet rkin � 3 kvvy / l 1v . New building area: square feet PROPERTY OWNER 0 TENANT Number of stories: Name: ...5R.Dem V RA. '- ov jh G Type of construction: Address: (7,9„:26 51A/04K JI Occupancy groups: City/State/ZIP: T/GA Rb l 0/2, t 70. 3 Existing: Phone: 3) 3 it)— /&Q3 Fax:( ) — New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Y't-v : S "y"� Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: - Total fees due upon application: . '' - City/State/ZIP: �� ,.� Amount received: Phone:( ) Fax::( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: �a dsa lnp VS C�7kl ' �r� Commercial and residential prescriptive installation of ONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: Submit two(2)sets of roof plan with connection details r71,64,./t.-/— and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: ..___,...,______ .' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ] RADA AP\( G Date: 512,3* *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling Folz OFFICE t sl: ONLv 4 City of Tigard d Received 74 g Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 1IGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW' les yo N/,1 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 • 0 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 ❑ 3 Verification of approved plat/lot. 0 0 0 4 Fire district approval required. Name of district: , 0 0 0 5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0 6 Sewer permit. 0 0 ❑ 7 Water district approval. 0 0 ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0 building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 ❑ 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0 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 beams,headers,joists,sub- 0 0 0 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 slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 ❑ 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 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ 0 0 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 0 0 ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 0 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 0 ❑ 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 ❑ 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 ❑ 0 0 architect licensed in Ore.on and shall be shown to be a..licable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ 0 ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 ❑ 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 ❑ 0 including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard .:ECEIVEDate/Bv y Permit No.:fp? ..4! t:-)-, ' III III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review li Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T I C,A R D Inspection Line: 503.639.4175 A ppxt fy 2.o'�?, Date Ready/By: I$ See Page 2 for MA.Internet: www.tigard-or.gov , S� Notified/Method: Supplemental Information TYPE'rOr WOriuCOMMERCIAL FEE* SCHEDULE— USE CHECI LIST ��{{� � � Mechanical permit fees*are based on the value of the work ❑New construction Addition/alterat#1 acement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition El Other: mechanical materials,equipment,labor,overhead,and profit. �< Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* CITY 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total :,..? Heating/cooling: ,:. CIB SITE INFORMATION AND LOCATION C 2 2 0 A - l Air conditioning 46.75 Job site address: 5 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: `T/ &j.4z D 0 g_ C -4 2,2 3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump f 61.06 Suite/bldg./apt.no.: Project name: �e� , t ` L� /g Duct work 23.32 Cross street/directions to job site: /�' p Hydronic hot water system 23.32 q Residential boiler(radiator or 7 L. 4 d c_ hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 M !'D scRIPTI a 1' c _ ` t ` #- `vGas fireplace/insert 33.39 ' n "` ` ""' Flue vent for water heater or gas cA`V(1 �1 s C b - J - p fireplace 23.32 /' t 1, 4��JI t Log (gas) 23.32 ' � ( {,ii.l� Wood/pellet stove 33.39 ` e ) ek4-.eti`01'" Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 i PROPI::RTSkb ' . L x '' ANT:, Other: 23.32 R Environmental exhaust and ventilation: Name: R 1) PA PAAiev2 Range hood/other kitchen eq�2 L S S& 0,4.k.. /; / Clothes 33.39 Address: �T� Clothes dryer exhaust 1 33.39 City/State/ZIP: l D O_ '.�.22. 3 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) J 23.32 Phone:(C615 ) 91'3—1363 Fax:( ) Attic/crawlspace fans 23.32 ,12n .3 Z:„, ':,'APPLICANT , Cli; 'CO..: :iitR$ON + Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue ,. .w CONT8ACTOitr 't '1:1.4'.:144 : ,iClothes dryer(gas) Business name: eftte L� Other: MECHANICAL PERMIT EEO Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: SttR j). ( 't i N -p)-/JoviZ Date: „:5)2,,3 fiF I:\Building\Permits\MEC_PermitApp_040113.doc 440-46617T(11/02/COM/WEB) I Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Fee: Total Valuation:� Permit $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application tIVEI FOR OFFICE USF ONE) ipgCity of Tigard �"" Received * , .1 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : �� = Plan Review Phone: 503.718.2439MBII Related Permit#: MAY 2 3 201 Date/B : Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Juris: H See Page 2 for 1 I GA R D Inspection Line: 503.639.4175 Intern Notified/Method: P Supplemental Information TYPE OF Wit. C PLAN REVIEW 0 New construction Addltiori/alter .�� l�n��V�3��N Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural 0 0 Accessory building amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fireum . p p 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived q0 Addition of new motor load of system. /���Job#: Job site address: 5i4) 0/4/K 5I , IOOHP or more. ❑"A","E","I-2","I-3", ty 654 `n c�a�3 ❑Six or more residential units. occupancy. City/State/ZIP: /J 0 Recreational vehicle parks. / 0 Health-care facilities. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 0/9-1•1\ L 6`V FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION���� OFF,WORK Limited energy,residential \� &t4---' 1 C4 4 �/IY oct1 (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 pe PROPERTY OWNER 0 TENANTServices or feeders installation,alteration,and/or relocation Name: 6RDA-ni A Dow°V)C- 200 amps or less 100.70 2 Address: oV c5IA) ©A ,57 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 7/ ,41kb, 9, , 9--7 ? 7,4,2 3 601 amps to 1,000 amps 301.04 2 Phone:(50) ci/3— /303 Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/orEmail: Da dQylV VJ i c wai c ` CO relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,r nt,or exchange, according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 . 2 Owner signature: �p9crDate: ./Z3//g 401 amps to 599 amps 168.54 2 0 APPLICANT 0 CONTACT PERSON` Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 1 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder no included) Phone:( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lie.: Suprv.Lic.: specifically listed(%A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): J State surcharge(12%of permit fee): Authorized signature: �� 7�-�- 4,,,,z___ TOTAL PERMIT FEE: DA- ^A_DM Nw G S/2 J if This permit application expires if a permit is not obtained within 180 Print name:JC' /}�\ r i Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: WORK ONLY: IEE SCIiEDULE., i- Description Qty. I Each 1 Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr ,specifically listed(A hr min) CO ER .v _W;ORK Y. ._ ELE3TRICAL PE Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 RECEIVED Property Owner Statement MAY 23 2018 Regarding Construction Responsibilitiepuar,FTIGARD Oregon Law requires residential construction permit applicants who are not lice Construction Contractors Board to sign the following statement before a building �1Is�® issued. (ORS 701.325 (2)) This statement is required for residential building,electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 3e. CAA/ e ', -,(Jvvim Print Name of Permit Applicant -E/2 3 1�I Signature of Permit Applicant Date Permit#: 4; mit $ 2 S7`C � 1 Address �s (/� U • Issued by: „. Date: •:��+•• This Copy for Permit Offices City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9225 SW OAK ST, TIGARD, OR, 97223 Record Type: Record ID: Residential - Master Permit MST2018-00152 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor