Permit �'F`' q CITY O TI \ MASTER PERMIT •
DATE ISSUED 7/ 21/200 001
COMMUNITY DEVELOPMENT
DATE ISSUED: 7/21/2008
•
•TIGARM 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
•
PARCEL: 2 S 103 D B -00900
SITE ADDRESS: 13355 SW 110TH AVE ZONING: R - 4.5
SUBDIVISION: MIRA PARK LOT: 005 JURISDICTION: TIG
PROJECT: CLARK
Project Description: deck replacement
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sl BASEMENT: sf LEFT: SMOKE DETECTORS:
. TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sl 5,526.32 REAR:
PLUMBING .
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN GRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
3
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
l
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC/FDR: 601 - 1000 amp: 601•amps- 1000v: MINOR LABEL:
Id 1000. amp /volt :
• PLAN REVIEW SECTION
Reconnect only:
> =4 RE5 UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: CIO
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL .
ESIDENTIAL B. COMMERCIAL 1
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: 0
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
•
CLARK, SCOTT E + TRACY N OWNER laws. AD work will be done in accordance with approved plans. This
13355 SW 110TH AVE permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
• •
through 952- 001 -0080. You may obtain copies of these rules or direct
Phone: Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #: -
TOTAL FEES: $ 239.30
REQUIRED ITEMS AND REPORTS
. -\
•
Issued By . h `i // � _` Permittee Signature : a!,
CaII 50 . - . 75 by 7:00 a.m. for an inspection that business day.
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.
f` MASTER PERMIT
Il
gip CITY OF TIGARD
PERMIT #: MST2008 -00107
�i.
COMMUNITY DEVELOPMENT DATE ISSUED: 7/21/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103DB - 00900
SITE ADDRESS: 13355 SW 110TH AVE ZONING: R -4.5
SUBDIVISION: MIRA PARK LOT: 005 JURISDICTION: TIG
PROJECT: CLARK
Project Description: deck replacement
BUILDING
REISSUE: O �L STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: At, HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 5,526.32 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp/yob :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC/FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
CLARK, SCOTT E + TRACY N OWNER laws. All work will be done in accordance with approved plans. This
13355 SW 110TH AVE permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 -001 -0010
through 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 239.30
REQUIRED ITEMS AND REPORTS
Issued By `, / �Lj � _ Permittee Signature : v,
Call 50 !* -- 75 by 7:00 a.m. for an inspection that business day.
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 ZIO MIU Cos4
,�i,r k �_,�,����u,���,�,
ECEVEI Received
, , City o Tigard n . / Permit No.:
Ytw ^+ � •J g Date/By: Il O8 k OaelOg )0 7
° ° 13125 SW Hall Blvd., Tigard, OR 9 722 }O Plan Review
LL - 3 200 • � IL
Permit:
_ - 503.598'1960 Date/B : . i • w „..,
' I G Ins Phone: 503.639.4171 Fax: ection Line: 503.639.4175 Date Ready /By: 1 ® See Page 2 for
yT;IG g g CI OF TIGARD Q ;�%/ i Supplemental
Vi1>al�IttllR4tk+y�u4M”. Internet: www.ti ard - or. ov Notif ethod: age 2 for
TYPE OF WORK • QUIRED DATA: 1- AND 2-FAMILY DWELLING
❑ New construction ❑ 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
R l- and 2- family dwelling ❑ Commercial /industrial Valuation: $ (4900
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: V.'73.1.5-,5" s k) \ \ O A V1 r e New dwelling area: square feet
City /State /ZIP: \ c itz% Zp 0 2 :„10 9 7 0 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: c , a N • 1 j-) G g Covered porch area: square feet
Cross street/directions to job site: 7A rzK Deck area: square feet
Other structure area: square feet
/04 ,C(0" { I S ( -el ( (v) - 5)1 X S i) REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: '�j � /Arc 1(✓1 et U+ R ck i» Lot no.: Permit fees* are based on the value of the work performed.
�! / — Indicate the value (rounded to the nearest dollar) of all
'i'ax ma p p arcel no.: � , ' " / h., (. t [,w ` �/ t 3 f . equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
' Vaivation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: C...o C \ C>r�
`('' Type of construction:
Address: {{ • .. 1 t Occupancy groups:
City /State /ZIP: 'c GA -> (3R c R'7a 3 Existing:
Phone: (5,3 ) 0411 I:7 / Fax: ( ) New: '
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
J
Address: , A jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt fro ceasing; the following reasons
apply: I Q
Phone: ( ) Fax::( ) O
E -mail: Q
' CONTRACTOR
Business name: A S I 1/111 BUILDING PERMIT FEES*
Address:
C V V , \ n \r tl V i f - (Please refer w fee schedule
tl Y ✓ Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application: p
Amount received: 4r 0 • 70
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri -County Building Industry
Service Board.
L: \Building\Permits \BUP -RES PermitApp.doc 02/23/07 440-4613T(1 1 /02/COM/WEB)
Building Permit Application Checklist '
One- and Two- Family Dwelling «try t FOR oF E` s Uo ` NV, . '�` -'
P K�" Receive
> �;` Ci o f Ti Permit No.:
r a 13125 SW Hall Blv d., Tigard, OR 97223 Date/By:
Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
,, nri..i s+ ❑ Electrical ❑ Plumbing ❑ Mechanical
24 Hour Inspection Line: 503.639.4175
rT 1 G It'D_
to.47 4i. :0nr ; Internet: www.tigard- or.gov ❑ Other:
,4, 4 41-ii FiSIH O WING ITEMS N RE!REQ , UItittaoR PLNNIRE, � t M ", ri a - � ' , N/A .
I 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. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
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 ❑ ❑ ❑
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 ❑ ❑ ❑ .
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
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- ❑ ❑ ❑
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. ❑ ❑ ❑
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- ❑ ❑ ❑
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 rebar. 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 10 feet long and/or any beam/joist carrying a non - uniform 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 Ore_on and shall be shown to be a, , licable to the ,ro'ect under review.
Y` ` j . a , t µ i � r yt y r i hr� ,. i r M.0 s f
, ,*,r .. �UR I S DIC 4 I t I ONAL fS I * GCI C;ICSb ", ; r-. , . '1 1. ,
r � p _ F . r, ,t ,.. -x . - , . . .. <, ,4.. .. :n°:R „. r )i,T. i:.
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. . . ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be 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 and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
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- RES- PermitApp.doc 03/21/06 440- 4613T(1 I /02/COM/WEB)
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
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 and complete the following statement:
l own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
!� will be performing work on property I own, a residence that 1 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 contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify t . t the informatio checked and
completed above is correct and accurate.
CZIAV CLA f(r_ ....• imor
Print name of permit applicant Signature of permit applicant
3 LX o
Date
Permit #: W to 'o S' 7
This form is supplied to building 4 0o4w. oc
permit offices by the Oregon Address: / 5,555 �w /1 &
Construction Contractors Board, : ;
as required by ORS 701.055 (6)
Issued by: Date:
This copy to issuing permit office
;ail 02 08 02:25p Scott Clark 503 - 624 -7274 p.l
1
:-
1
C1eanWater S ervices D `r 1 -: 1 li
Our c<vnuuiln:cnl i• cic;Ir. n CWS File Number
_ g��IS 1tielQiai>re- Screening l
Site Assessment 1. �I �� I
Jurisdiction: Washington County BY
Property Information: (example 1S234AB01400) Owner Informati n:
Taxlot ID(s): 7 5 103 p -> oe c C n Name: _C. 1N G`,(x.Vk
Company: p� Q
Address: \3 2 1 5 J W `\ V ' v
Site Address: l - , j City State Zip: –r - (7 P -D ( R Q7
City State Zip: `( II ) (, C t -7.=a..3 Phone'Fax: `1 — /
Nearest Cross Street: '? {) �1 1` E -mail:
Development Activity: Check all that apply Applicant Information:
Addition to Single Family Residence (rooms, deck, garage) ❑ Name:
Lot Line Adjustment ❑ Minor Land Partition ❑
Company:
Residential Condominium ❑ Commercial Condominium ❑ Address:
Residential Subdivision ❑ Commercial Subdivision ❑
City State Zip:
Single Lot Commercial ❑ Multi Lot Commercial ❑
Phone /Fax: /
Other Z.. 1r; V, 2 :.K
E -mail:
Will the project involve any off-site work: YES ❑ NO Unknown Location and description of off -site work:
Additional comments or information that may be needed to understand your project:
This application does NOT replace the need for Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development
Permits, DEQ 1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and /or Department of
the Army COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site 1 certify
that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this information is true. complete. and accurate.
Print/Type N.me: `1 li ti _ _ [ Print/Type Title:
Signature:
lg. Date:
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT
PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on
adjacent properties, a Natural Resources Assessment Report may also be required.
❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or
within 200' of the site. This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and
protect water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider
letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and
completed under applicable local, State, and federal law.
Based on review of the submitted materials and best available information the above referenced project will not significantly
impact the existing or potentially sensitive area(s) found near the site. This Sensitive Area Pre - Screening Site Assessment
does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently
discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section
3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
p ; This Service Provider Letter is not valid unless / CWS approved site plan(s) are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE
ASSESSMENT OR S 'VICE PRO IDER LETTER IS REQUIRED.
Reviewed By: i
■ Date: ff ZG6
2550 SW Hillsboro Highwa • Hillsboro, Oregon 9712
Phone: (503) 681.5100 • ax. (503) 681 -4439 • www cicanwaterserxiccs nrp •
Revised. May 8, 2007 [ * 3
CITY OF TIGARD -
OW
BUILDING DIVISION • PERMIT MS1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7121 200E1.00107
Phone: (503) 639 -4171 ! 2'i0`2UGf3
Inspection Requests (24 Hrs.): (503) 639 -4175 .. '�I I ..
INSPECTION WORKSHEET FOR DATE: 10113120U TIME 7:(l0Alvf PAGE: 12
SITE ADDRESS: 1336.: Sv 110TH AVE CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT # OOa TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Check replacement
OWNER: CLARK, SCOTT E + TRACY N, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message A M
Or i
276 Framing 076624 -01 503 -624 -7274 't`
Corrections /Comments /Instructions:
W a-h. — \G '. J
y
JOG +e : Cam. Jr "tor )Gr, i 1 4A--f) (7 , ^u-1 wIle 4
'rp i
❑ PASS .PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 7.5 Date: / 3a - 7 ' Phone #: (503) 718- 25.23
CITY OF TIGARD
BUILDING DIVISION - - PERMIT #: MST 2008.00107
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/21/200t
Phone: (503) 639- 4171 r,,
Inspection Requests (24 Hrs.): (503) 639 -4175 ..,�J!
INSPECTION WORKSHEET FOR DATE: 9/10/2008 TIME: 7:00AM PAGE: 6
SITE ADDRESS: 13356 SW 110TH AVE CLASS OF WORK:
SUBDIVISION: MIRA PARIS LOT #: 005 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Deck replacement
OWNER: CLARK,. scan E + TRACY N, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/10/2008 Pour Time: 12:00
Code # Inspection Description Confirm # Contact # Message
20gi Footing 075326-01 503 -624 -7274 N
Corrections /Comments /Instructions:
SS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
l l FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 73 --S Date: /U Se630 F Phone #: (503) 718- 21l .23