Permit 6 I' i ��� m �� I Imo MASTER PERMIT
, PERMIT #: MST2007 -00172
COMMUNITY DEVELOPMENT DATE ISSUED: 10/24/2007
TIGARDi 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
'' PARCEL: 2S103BD -07600
SITE ADDRESS: 12621 SW 115TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S GLEN LOT: 032 JURISDICTION: TIG
PROJECT: BOECK
Project Description: 2nd story addition. 255 SF
BUILDING
REISSUE: CUSTOM STORIES: . 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 255 sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 255 sf 24,222.45 REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER:
•
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
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: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 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 # 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
BOECK, MARK G + CATHERINE L JON NEWTON CONSTRUCTION laws. All work will be done in accordance with approved plans. This
12621 SW 115TH AVE 18036 SW SANDRA LANE permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 BEAVERTON, OR 97006 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: 503 - 913 - 8950 Contact #: PRI 503 703 - 7906 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503 -615 -8553
Reg #: LIC 81687
TOTAL FEES: $ 961.27
REQUIRED ITEMS AND REPORTS
/ .
Issued By . _ , .,,t- ,��_ ,/! / Permittee Signature : � :/
Call 503.639.4175 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.
Buildin licatl n.
.=ra u e ,S TS, t ' r • 1 y 7ieidi li ate , s ' ,
Resid`entlfli E. r'+ ` p ea -„,., 7 :; , , w x F i , t. FOR OFFICEAUSE ONLYi ,i a "` O'``r=
w. v 'NM...� 5.�i' 4 w1�!!'� , . �;� '�;�'t ° g� ''.i,'P'. .Wl4d1�1 'iP9t:?k� ..5 Awa 1�dfi �._ . � "F �a�`�.
Ar +r? ksr Received? ,�/ 7 -D,,-- 41a City of Tasd 7 Date/By: 7 Fj 7 /j /5 Pennit No.� .
III
13125 S HaN rd, I ' / 7223 Plan Revie
e - Pho 3.639.4171 ax: 503.p$•1 Date/B : zI. • 1 1 Other Permit:
sk,
ui`d Jd; d-
T 1 G A R D; InspelcpOn the 503.639 4l 75 s , Date Ready /By: 1�ri ® See Page 2 for
Mr *� t. :;gym lntemet4+wvww tigard -or gov ,r. � ,. Notified/Method: / Supplemental Information
TYPE OF WORK REQUIRED 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
ya Additio lteration/replacement ❑ Other: equipment, materials, labor, overhead arid the r fit for the
CATEGORY OF CONSTRUCTION work indicated on this application.) •
.. and 2- family dwelling ['Commercial/industrial Valuation: $
1:1 Accessory building ❑ Multi- family Number of bedrooms: /
❑ Master builder ❑ Other: Number of bathrooms: ( /
JOB SITE INFORMATION 'AND LOCATION • Total number of floors:
1 New dwelling area: 7 ,/� square Job site address: <`i 1 t g G�C� q
City /State /ZIP: 77( ei ,,, trc 9- 7 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 75 6 Covered porch area: square feet
Cross street/directions to job site: /1 (i -�i \ Deck area: square feet
t Other structure area: square feet
REQUIRED DATA: COMMERCL&L -USE CHECKLIST
Subdivision: 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.
Z AiD SCr�1 i (rf U.Y Valuation: $
Existing building area: square feet
New building area: square feet
ki PROPERTY OWNER ❑ TENANT Number of stories:
Name: At A e ,( P l wy e Lr Type of construction:
Address: lo/6 I Occupancy grdups:
City /State /ZIP: I Existing:
Phone: (/13 ) 1 I3 - Z3< Fax: ( ) New:
k , APPLICANT ❑' CONTACT PERSON
' NOTICE
Business name: i N, „.., All contractors and subcontractors are required to be
Contact name: 1—(51,& licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 '7( .1/.) L ' j,c1 ( jurisdiction in which work is being performed. If the
/ZIP: l�is� � applicant is exempt from licensing, the following reasons
City/State/ZIP: ' 7 apply:
/
Phone: ( ) 7 63 — 7 c I 0-6 Fax:: (S& ) (d l r - O
E-mail: Or ) C N s1 S L C ' Ae_
CONTRACTOR -y
��(r �it'7 77 F
Business name: � - id- PERMIT FEES*
Address: (Please refer lo fee schedule)
Structural plan review fee (or deposit): / - D 11
v
City /State /ZIP: mi l' , /
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: -f L 7 / Val' (i� 7 Total fees due upon application:
” Amount received: "71,0(7.-
Authorized signature: 7)--)Z7(j This permit application expires if a permit is not obtained
� within 180 days after it has been accepted as complete.
Print name: t_. V l Z JT_eit -, Date: '9.- 'f - 0 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\ Building \Permits \BUP -RES PermitApp.doc 02/23/07 440 4613T(11 /02 /COM/WEB)
Building Permit Application Checklist ,
One- and Two- Family Dwelling ,,
I. : ' W OR U SE O Lv' ` y "Ki r '
� 101 • Received : li ' -
1 1r Ci ty of Ti ? Permit No.:
1 / ti r, • DateBy:
e 131 SW Hall Blvd., Tigardf OK.97223; '' Associated permits.
C Phone: 503.639.4171 Fax: 503.5981960
- . 24- Hour Inspection Line: 503 639.4175 ❑ Electrical El Plumbing 12 Mechanical
TIG
€ Internet: www.tigard - or.gov ❑ Other
f t1 4ii ' ftjtic OWINaTtf gNk R�E UIR fatji P XN; REVIEWA ,Z ° A es '' N6 /A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
21 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 • Verificition'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 Erosjep ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
a n protection, - etc: • -- 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
t 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 Toad.
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 be applicable to the .roject under review. -
71,04 i F„ k ,� n .5 i , rrl d�' t .#„ ? , 9 ' ^ �'aj , r
1 , +h*�`' j, n v 1 .0 r , s "ois : g . n x , t I s � , , ;
i t A• , UR=IS D IC 0 ' ' SPrC S�',,0 Sri l � : - ; .T ,, � ` :ii: � :._, .' ,.� - . �.t.� fiWV: _,s, . : 1Ai_ ,: .?_
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.
1:\ Building \Permits\BUP- RES- PermitApp. doc 03/21/06 440- 4613T(11 /02 /COM/WEB)
. PI,umbin2 Permit Application r,- A r
• ( - y t , ,„,, f 1 ! r� "'» s'�'"� 4 Pr t .: u `,,,:,. v,,,, t 4£ �.,,,, r, r
Building Fixtures ;.9 *`` . n (
� '' ' FOR OFFICE kUSE ONLY I V O ��,tr�. j 1 r r
-“•:=3 3 r6*: .,. vi u, ; "x. ws - ') ; '` - CC :: `.,..Xt, Vt ,=- ,;';'�- ?4+it,k ,r RB�'r. ` t- Ck4 3 * .t u^�Li , i
a City Of Tigard Received`:: Permit N -y
"'' . ate/By: te/By. - t'LS/ ooU)-00/ 1
13125 SW Hall Blvd., Tigard, OR 97223 ` ''.� 0 r. P�
Phone: 503.639.4171 Fax: 503.598.11960 ' 20 elan R e view Other Permit No.:
Ua
Inspection Line: 503.639.4175 r ' 3 U,!-'
�
TIGr / Dap y l u ris" HI Page t Brad e 2 for
p Y /B
r,, -: "', ,-� Internet: www.ti g ard -or. g ov r ;� T om, L ti. Nofified%Method: Supplemental Information
. TYPE OF WORK. ` ° t %, r. "�i x � z FEE* SCHEDULE •
r a.
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 4 249.20
a and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LO�ATION Site utilities
Job site address: O j L, 7_ 1 c l� ( / S f Catch basin or area drain 16.60
City /State /ZIP: -/ G1) /77-1_ ! Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name:
7 ! c ,_,_ C i` Footing drain (no. linear ft.: _) Page 2
Cross street/directions to job site: kj At, , ,rye may Manufactured home utilities 110.00
N �`� "/ ' 7 u l � Manholes 16.60
- 7 t h 4. i, "F/y1eL s" X f G 7 C ( 7-01-4-, Rain drain connector 16.60
/,l C.C./ L 7) L s'A t (-6.1 L ! 5 / Sanitary sewer (no. linear ft.: ) Page 2
e .__C (. 1) £'/K Storm sewer (no. linear ft.: _ Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
D 51' 5 /J-DD fl; Backwater valve 16.60 .
Clothes washer 16.60
Dishwasher 16.60
at OWNER ❑ TENANT
Drinking fountain 16.60
�l / Ejectors /sump 16.60
Name: /1 At � / j4 I6� �?'c '\
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Z1P7 6G?1 ) Q Floor drain/floor sink/hub 16.60
Phone: (7/s) 3!) cU Fax: ( ) Garbage disposal 16.60
• , 'LAPPLICANT ❑ "CONTACT PERSON Hose bib 16.60
/� i Ice maker 16.60
Business name: ✓ ` Sim' �/t,_, -N� Interceptor /grease trap 16.60
`T v ~ V 1 , 1
Contact name: , C-w Medical gas (value: $ ) Page 2
Address: / 23 L. 5j..j ,64 ( a),z___ Primer 16.60
City /State /ZIP: 'J ("/ 44-A4_, 44-A4_, Roof drain (commercial) 16.60
Phone: ) o7-- �( Fax:: (slit) c - M'
Tub/shower/shower asi lavato 16.60
Tub /shower /shower pan 16.60
E -mail: \ L - ...J (4'1 5 4e y.".- C 41 • #
(, .< Urinal IIII 16.60
CONTRACTOR Water closet 16.60
Business name: �3 ---- `5 - PL cfl/t,�i / ,ks Water heater 16.60
Address: J .1 y_ Other:
(� c v� ` Subtotal
City /State /ZIP: O'>17 LO i7 (/
/ Minimum permit fee: $72.50
Phone: (�{ ) •') 7 13 0 O Fax: ( ) -1 , vX Residential backflow minimum permit fee: $36.25 1
Plan review (25% of permit fee)
CCB Lic.: ],/��f / / gy a' Oy Plumbing Lic. no.: A - / / vf
State surcharge (8% of permit fee) 5 .vO
Authorized signature:
TOTAL PERMIT FEE
Print name: ` m Date: 1 - / - .) / This permit application expires if a permit is not obtained within
J Y 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information `•
Fee Schedule: s Residential Fire Suppression Systems:
Qty. F ee (ea) . Total
Site Utilities Squalre Footage: - 'Permit Fee:
Footing drain - ls' 100' 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 - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm &Rain Drain - 1st 100' 55.00 Valuation:- Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
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 • . Fixture or Item. Qty. Fee (ea)` Total. additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: . . Plan Review for Plumbing Installations:
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) WorkPerformed greater, except systems designed and stamped by licensed •
Fixture Type: 'Replace engineer.
. Previous Capped Added . Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric,or Riser Diagram
Eye Wash El Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
- 3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter , plumbing permit can be issued.
Washer - Clothes
Water Extractor . •
• Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM - PermitApp.doc 12/27/06
' r/" f.
i s � „sa ' E � �'� v �S , tis t t -. +� ��# r IF I , r ir 1'+, , 4 . re " � m � n ( i ,i 1! ° l { i� a4 ti»
Electrical Permit Application Q .. ! V.. , t.' 0� r _ , FOR OFFICE ONLY t i •
it i.t sI :7 -, �'r�v ^ �,�. O� i . �YY1 .Gri}A9 4 K 1. WT t :: ::,";2!;/
v... ��.'i� .t 1 �, 3i : r; t 1 A r
iN "19 1 n0/ 7 �
City of Tigard Received
2��� Date/By:. Permit No 424 . V
itt1 n 13125 SW Hall Blvd., Tigard,'OR 97223 r .r 0
J t � Plan Revew
i1 ; 2 +' Phone: 503.639.4171 Fax: 503.598.1960 ; • y. Other Permit:
T I G -t i i D Inspection Line: 503.639 ' ' . J j - . 'Daie'Ready /By: _furls: ® See Page 2 for
ri Internet:. www.tigard- or.gov ..4 ct /Method: Supplemental Information
TYPE 'O WORK _1 "._ - PLAN REVIEW
❑ New construction IShQddition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
` CATEGORY OF CONSTRUCTION :, exceeds 10,000 amps at 150 volts or ❑ Floating buildings. • less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
)EP•- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB. SITE INFORMATION AND LOCATION ✓ ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
/ 100HP or more. occupancy:
Job no.: Job site address: /� b Z( J l ❑ Six or more residential units. ❑ Recreational vehicle parks.
,� ^ 0 Health-care facilities.
❑ Hazardous locations. ❑ Supply voltage for more than
l
City/State /ZIP: G f ��i� l - Z l 600 volts nominal.
Suite/bldg. /apt. no.: Project name: '> o _C. /C ❑ Service or feeder 600 amps or more.
FEE ' SCIIEDULE,
Cross street/directions to job site: � � .. ( ( Description 1 Qty. 1 Fee. 1 Total 1 *
� /J New residential single- or multi- family dwelling unit.
L,e� 1 t '- / c.(' L_ f 4( j C /(/ C -t /7iJL i_ Includes attached garage.
Subdivision: //■ ( -t:- 741 Lot no.: 1,000 sq. ft. or less .. 145.15 4
Ea. add'.l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/� (// _ 0 �, Limited , multi - family
G ',' a"CA c t UL� residential energy (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or t -e! .'cation
200 amps or less 80.30 2
i PROPERTY'OWNER. ❑ TENANT 201 amps to 400 amps 106.85 2
Name: ,,Z f( y f L' _/ t . , , < 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: rj,. 1) S i Over 1,000 amps or volts 454.65 2
City/State /ZIP: J Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ,563 ) 1( 3 - Z� SU Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. , 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT . ❑` CONTACT PERSON above service or feeder fee, 6.65 2
44,.u.,-- • hrcircuit
17
Business name: 1w� j---/L7 C-..
B. Fee for branch ci rcuits
without service or feeder fee,
Contact name:
T/t first branch circuit 46.85 2
Address: 1 7 to J �-rC ; : A LAti C Each add'I branch circuit t 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: V < � Each manufactured or modular 90.90 2
�/ ( y dwelling, service and/or feeder
Phone: (<1/3 ) • o•3— -7 9 2 Fax: : (In ) (D 1 ¶ - G $ Reconnect only 66.85 2
E -mail: 1 t 6,z(L.,17 { g ei„,... r, A.)_.-7 Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal,circuit(s) or limited -
n ycL; 4 $ � energy panel, alteration, or
Address: • extension. Describe: Page 2 2
City/State /ZIP: - t L L'2 ' Each additional inspection over allowable in any of the above
Per v)) L3' 6Z3� ( ) � / � /o Investigation i ti ion 62.50
Phone: (
S S� Fax: Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: • Suprv. Lic.: 1../4/ V..5 Industrial plant per hour 73.75
'ELECTRICAL PERMIT FEES'. '
Suprv. Electrician signature, required: Subtotal:
Print name: n, {-( Date: Plan review (25% of permit fee):
ILI �f t^ l,+�l I • State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit'application expires if a permit is not obtained. within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T( I I /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page - 2 - 'Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL -WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ 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.doc 03/23/06
1s i µ F 1 ,..e� 1 '� YZe t r { .4h�S-, k k ,:,, - r -
Mechanical Permit A li t 7 ) e FOR OFFICE USE ONEYs� ` `�'
pP $ L .zwN ,� , , .",: lt,t ::ate* 4.1,; .,- a� ,,'t �f a.� i,. t .∎ .
a , Y9. { 1!. yFl.ty.
71 City of Tigard l . ..-. �; -:✓� R 1,,." Date/By: ivved Permit No(� 7
° 13125 SW Hall Blvd., Tigard, OR 97223 /! ✓1�D7 ADO/
, . 0 Plan Review Other Permit:
t,, P hone: 503.639.4171 Fax: 503.598.1960 C y.: Date /By:
T I G AR tj Inspection Line: 503.639.4175 `� ��� O ' 2UU Date Ready /By: Juris: B
and - or. ov _ S Se Page l Information
for
Internet: www.ti
g g � , � '4 tified/Method: Supplemental
Ci i t 1/4__)': i 1: .
' TYPE O yVS R K , , (_ j '.0 i ' ' ° a l -r � �` COMMERCIAL FEE* .SCHEDULE - USE CHECKLIST
❑ New construction Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
ts--I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total
' JOB SITE INFORMATION AND. :CATION Heating/cooling
Job site address: 1Z ('Z ( 'j _) ( (S. Air conditioning or heat pump
Y ' ' (requires site plan showing placement) 14.00
City /State /ZIP: ` 6. // r 5 - 21 S, Furnace 100,000 BTU (ducts /vents) 14.00
G' � Furnace 100,000+ BTU (ducts /vents) 17.90
'J
Suite/bldg. /apt. no.: Project name: 6 -af ( <
Gas heat pump 14.00
Cross street/directions to job site: ,� h r �f' --2- t I t( - = ej Duct work 10.00
Hydronic hot water system 14.00
�Ci( 1.1..%O 1; U f -1 C: ,47 / �d ci`" €s'< Residential boiler (radiator or
y ( hydronic) 14.00
/A). S) ( U 1,r5'C i f /il/ / r ,
Unit heaters (fuel -type, not electric),
. in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances •
DESCRIPTION OF WORK Water heater 10.00
L / Gas fireplace 10.00
Zw P 2 5 cPvZ J- / 4 1 f ( Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
EJ PROPERTY. OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other 10.00
Name: , L. (4- (.7 £ L K Environmental exhaust and ventilation
Range hood /other kitchen
Address: ) /( r 5-tl r/' equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ) 1 23-3 <0 Fax: ( ) toilet compartments, utility rooms) 6.80
' ❑ APPLICANT ❑ CONTACT PERSON . Attic /crawlspace fans 10.00
/— Other: 10.00
Business name:
l� , U "` >✓` �„„... ' ' Fuel piping
Contact name: ...-------fll- $5.40 for first four; $1.00 for each additional
Address: f S S''� tin Furnace, etc.
�^ I t" Gas heat pump
City /State /ZIP: / y ,,,, Z Gj( _, q - 1 0 0 k. Wall /suspended/unit heater
/
Phone: r Water heater
( )' �') �� � t� Fax::( ) �(��
" � Fireplace
j P�JI
E-mail: J C plc C ( ,_0„../ r IV� Range
-J CONTRACTOR - . B arbecue
Business name: ,�� ( -j 4 If_ C£'_� Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES *'
City /State /ZIP: °Og,.t t57 Subtotal
Phone: �-�{/ ) -- 7 -1..q I 4 Fax: ( CV)) 6 t -. ! �� Minimum permit fee ($72.5
u } ( Plan review (25% of permit fee)
CCB lic.: 5-p&p t r/11/0 7 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized si nature: l This permit application expires if a permit is not obtained within 180
g ✓ v , days after it has been accepted as complete.
Print name: .)'` '-Jr l 4� Date: 'Lj' - 7 ._ 7 * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building\Permits \MEC- PermitApp. doc 01/19/07 440 -4617T (1 1 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
September 24, 2007
Jon Newton
Jon Newton Construction
18036 SW Sandra Ln.
Beaverton, OR 97006
RE: Second Story Addition
Project Information
Building Permit: MST2007 -00172 Construction Type: VN
Address: 18036 SW Sandra Ln. Occupancy Type: R -3
Area: 255 Sq. Ft. Stories: 2
The plan review was performed under the 2005 Oregon Residential Specialty Code. The review
of the submitted plans will be completed when the following information is provided.
1. Revise Sheet A4 including details to remove references to engineered trusses, or
revise engineering.
2. Provide a foundation plan to show foundation work to be done in accordance with
engineered design, or revise engineering.
3. Show post sizes on plan as given in the engineering.
4. The engineering provided calls for the new ridge beam to post down directly to the
existing glu lam. The plan shows the glu lam 11.5' from the rear wall, and the ridge
beam posting down at 12.5' from the rear wall. Inform engineer of discrepancies and
show any changes made by engineer on the plan.
5. Provide prescriptive bracing or engineered lateral design.
6. When responding, provide an itemized letter stating in what way each issue has been
addressed in the revision.
When submitting revised drawings or additional information, please attach a copy of the
enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of
Tigard in tracking and processing the documents.
Respectfully,
Loraine Sellers
Plans Examiner
Loraine @tigard - or.gov
Phone: 503.718.2708
Fax: 503.624.3681
CITY ' {= OF TIGARD
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
T. J. PLUMBING
9568 SE WYNDHAM
PORTLAND, OR 97266
Permit #: MST2007 -00172
Date Issued: 10/24/2007
Parcel: 2S103BD -07600
Site Address: 12621 SW 115TH AVE
Subdivision: HUNTER'S GLEN
Lot: 032
Jurisdiction: R-4.5
Zoning: TIG
Project Name: BOECK
Description: 2nd story addition. 255 SF
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work, Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624,3681.
If you have any questions please call 503718,2433.
No plumbing Inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR;
BOECK, MARK G + CATHERINE L T. J. PLUMBING
12621 SW 116TH AVE 9568 SE WYNDHAM
TIGARD, OR 97223 PORTLAND, OR 97286
Phone #: 503- 913 -6950 Phone #: 503- 772 -9300
Reg #: L.1C 81687
LIC 31698
P1.M 26- 240P13
LIC 88482
LIC 58302
AN INK SIGNATURE IS REQUIRED ON THIS FORM
•■ 4
Signature of Autho ized r u o er Name (printed)
TO - d 2882 T9L £0S NOSNHOf WOl Wd 1717:80 LO- TO -AON
!fq
ct, 31. 20074 2:26_ c BOONES FERRY ELECTRIC No. 0642 P. 1
mil► i 1 1 ma ri nA 1.P
r COMMUNITY DEVELOPMENT
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
BOONES FERRY ELECTRIC INC
PO BOX 628
WILSONVILLE, OR 97070
Permit #: MST2007 -00172
Date Issued: 10/24/2007
Parcel: 2S103BD -07600
Site Address: 12621 SW 115TH AVE
Subdivision: HUNTER'S GLEN
Lot: 032
Jurisdiction: TIG
Zoning: R -4.5
Project Name: BOECK
Description: 2nd story addition. 255 SF
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
BOECK, MARK G + CATHERINE L BOONES FERRY ELECTRIC INC
12621 SW 115TH AVE PO BOX 628
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone #: 503-913-8950 Phone #: 503 - 882.4936
Reg #: ELE 3.223C
LIC 88482
SUP 4918S
/ AN INK SIGNATURE IS REQUIRED ON THIS FORM
X 01' ‘el . ` Signat . e of S ervising Electrician Name (printed) SUP LIC #
This form is recognized by most Building Departments in the Tri- County area - for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
BUILDING DIVISION
TIGARD+ TRANSMITTAL LETTER
TO: ( ./1-Jitr - L s L DATE RECEIVED:
DEPT: BUILDING DIVISION
- L E VEJ
�
NOV 1 9 2001
�
FROM: 1- -61" ,% C17YOF flUARD
COMPANY: 01.. v 1 G�. r 6-4 / '
BUQLD NG®11�s1ON
`�
PHONE: .� t7 -290C, By:
RE: /1 / I fI nv / '► — 00 17Z-
(Site Address) (Permit/Case Number)
73 o - f-cie_
(Project name or subdivision name and 1 number)
ATTAC ED ARE THE FOLLOWING I Ef, S:
Copies: Description: C pies: Description:
Additional set(s) of plans. / Revisions:
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. G Basement and retaining walls.
Beam calculations. I Engineer's calculations.
Other (explain):
REMARK •
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: k • a . q Initials:
Fees Due: ❑ Yes KNo Fee Description: Amount Due:
Special
Instructions:
Reprint Permit (per PE): ❑ Yes lA No ❑ Done
Applicant Notified: Date: Initials:
I: \Building \Forms \Transmittal Letter- Revisions.doc 4/4/07
TRANSMISSION VERIFICATION REPORT Co /7-
TIME : 01/23/2009 13:31
NAME : TIGARD BUILDING DEPT
FAX : 5036243681
TEL .
SER.# : BROD4J479592
DATE,TIME 01/23 13:30
FAX NO. /NAME 5036158553
DURATION 00:01:07
PAGE(S) 04
RESULT OK
MODE STANDARD
ECM
Letter of Transmittal
r�J
City of Tigard
DATE RECEIVED
TO:
DEPT: ` - .. 54-4-
FROM:
PHONE NUMBER.: (56 V
Letter of Transmittal
City of Tigard
DATE RECEIVED 1//YZ54
TO: LTCS
DEPT: (`�"1k- D 0/0A S4'
FROM: \(//' v " 17) �
PHONE NUMBER: ( 61 -
RE: -'` 6 • 2 (021 \ \G` 41)--
j`41)- t-e
(Case number, site address, arcel number, etc.)
COMMENTS:
OP ij 4.
A 111.4 ALA:
i :dsts \ forms \LetterTransmittal.doc 07/31/01
" CITY OFT , A R D _ J MASTER PERMIT
PERMIT #: MST2007 -00172
COMMUNITY DEVELOPMENT DATE ISSUED: 10/24/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 103 B D -07600
SITE ADDRESS: 12621 SW 115TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S GLEN LOT: 032 JURISDICTION: TIG
PROJECT: BOECK
Project Description: 2nd story addition. 255 SF
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: y
•
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 255 st GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 255 sf 24,222.45 REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
*,• ELECTRICAL
RESIDENTIALUNIT 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: I _
EA ADM. 500SF: 201 • 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: Vi
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAL/PANEL: IN PLANT:
MANU HM /SVCIFDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
6
1000+ amp /volt :
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 �•
1I,
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: y'
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: `7i .
PI,i1
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: Ih.
HVAC: DATAITELE COMM: NURSE CALLS: TOTAL A 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 c3
BOECK, MARK G + CATHERINE L JON NEWTON CONSTRUCTION laws. All work will be done in accordance with approved plans. This
12621 SW 115TH AVE 18036 SW SANDRA LANE permit will expire if work is not started within 180 days of issuance. or
TIGARD. OR 97223 BEAVERTON, OR 97006 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: 503 -913 -8950 Contact #: PRI ' 503- 703 -7906 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503 -615 -8553
Reg #: LTC 81687
TOTAL FEES: $ 961.27
REQUIRED ITEMS AND REPORTS
•
•
r / / / /
Issued By . , _/ ���_, Permittee Signature : , j , . . �% ..:..e
Call 503.639.4175 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.
CITY OF TIGARD ' 11
BUILDING DIVISION / PERMIT #: IViST2007 -00172
13125 SW Hall Blvd., Tigard, OR 9722 DATE ISSUED: 10/24(:.1007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 4.A. , t�� J I 0
INSPECTION WORKSHEET FOR DATE: 1/23/2009 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: F3OECK
DESCRIPTION: 2nd story addition. 255 SF
OWNER: I3OECK, MARK G + CATHERINE L, PHONE #: 603 913.8950
CONTRACTOR: LION NEMON CONSTRUCTION PHONE #: 503.703 -7908
n� A,
Inspection Request Scheduled For: Date: 1/23/2009 Pour Time: y'■s 1L
Code # Inspection Description Confirm # Contact # Me• • ..
299 Final inspection 079976 -02 503703 -7900
Corrections /Comments /Instructions:
gi) \r&O (Lci k i — :_ a_ _ Slr L/I/Nr \/\ Rg_c_...A----i_i-v-\_c
0 ....y . V ( 6.--,"---C_SZ, — a....KJ
QA/1" 5
I VL, 6 5
/ 6.., ' ‘IP
`.1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ` �2./ Date: / 2/3M -v7
#: (503) 718- -v7 �/
p
CITY OF TIGARD - 77
BUILDING DIVISION PERMIT #: MST2007- 00172
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/24/2007
u^
Phone: (503) 639 -4171 " ual + ` :'
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' F ' ' I� It
INSPECTION WORKSHEET FOR DATE: 1/23/2009 TIME: 7.00AM PAGE: 6
SITE ADDRESS: 12621 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTERS GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: BOECK
DESCRIPTION: 2nd story addition. 255 SF
OWNER: BOECK, MARK G + CATHERINE L, PHONE #: 503-913-8950
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503- 703 -7905
ily (p , s/
Inspection Request Scheduled For: Date: /12312009 Pour Time:
Code # Inspection Description Confirm # Contact # Me W : • -
399 Plumbing final 079976 -01 503-703-7906
Corrections /Com ents/lnstructions:
A/ �
f �l S` / g CN%��
km-ke ., ;`\ ,/rr),A U
,e.0 ZINN& `11AWA-4.----
k Arv■ P) L-(2) \\/( -'' -+
C
q -( 1 2 ) 1 t ) ‘iL W
-- jk o n - +L-Q. - QV
fist_ S `-.- - e
-- i - if - ,- , A - 1/4-4 tla-7/ ,Q.,,k. _ ,
/ , ,,
z,„„)..„.
c ) , ,,,, ,, , ,, 0 / Vebe; 1/4'e-A b
* '‘D MSY r\ 11/4)& C YIA:0
, E1-1 1 A) * (67
ASS n PARTIAL APPROVAL SANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ol V Date: )/ Phone #: (503) 718- > D'Y /A
CITY OFTIGARD `
BUILDING DIVISION A/ ,O
PERMIT #: fviS7° t1t37- s3Cli7`�
13125 SW Hall Blvd., Tigard, OR 97223 7 DATE ISSUED: 101/241 t (f7 ig(i
Phone: (503) 639 -4171 i / iw�t liil it
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 102/2009 TIME: 7 PAGE: 5
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: BOECK
DESCRIPTION: 2nd story addition. 255 SF
OWNER: BOECK, MARK G + CATHERINE L, PHONE #: 603 - 913- I33r<i0
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503-703-7906
Inspection Request Scheduled For: Date: 1122J2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer ___ 503-703-7906 N
399 �, LA..1 -C i.,—�
Corrections /Comments /Instructions:
3 4,,„f2._ --be 4,,i,,j2-‘,,,,A
r . 0
0 . , /
/ 1
l Aj i l
ir
4 Rao___ ❑ PARTIAL APPROVAL 7 CANCEL pi NO ACCESS
n FAIL 1 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
\Xi . l 2 718- l"
Inspector: v Date: �� Phone #: (503) 718
p
Ins �
CITY OF TIGARD
BUILDING DIVISION #: MST2007-00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2007
Phone: (503) 639 -4171 v iutii Di l i
Ins Requests (24 Hrs.): (503) 639 -4175 ,. °`__..
INSPECTION WORKSHEET FOR DATE: 1/30f2008 TIME: 7:02AM PAGE: 41
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: BOECK
DESCRIPTION: 2nd dory addition. 255 SF
OWNER: BOECK, MARK G + CATHERINE L, PHONE #: 03- 913 -U950
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503-703-7906
Inspection Request Scheduled For: Date: 1/30/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 064188-01 503-703-7906 Y
Corrections /Comments /Instructions:
Cc7t...4—uc:v 1—,x p l t)fl C 1 o..) <1 A r`e b f't'v A-1 4- -t.- 4-.i., -c-te (V\ .0 e1 of
AN c ri o‘,i at,,A C � i . i - v1 M L I t» c,,4-0. c vt c3'" 5e��,4
Ce 2 'Fi- , -<-, ;?1 P tol-r 06-4 I I 'V IA\ --7 ci
vva- f'VSuy, 5 - 7 ic ZLi4o
- r AN,. . If „ - 3 " ec„-v u - D,-74 1z `Ca - , /■,✓ o
c--A'V L., a,. caul -ate
•
_ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
4FAIL 0 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c rO \ n i - k , . A A A . . . , . . _ Date: l 13 6 I c .Phone #: (503) 718-
CITY OF TIGARD ' .
BUILDING DIVISION PERMIT #: M sT2007 -00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10124/2007
Phone: (503) 639 -4171 / u'd glm i p I I'
Inspection Requests (24 Hrs.): (503) 639 -4175 �_'!+L --
INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7 :00AM PAGE: 17
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: SOECK.
DESCRIPTION: 2nd story addition. 255 SF
OWNER: 13OECK, MARK G + CATHERINE L, PHONE #: 503. 913439 50
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503 - 703 -7906
Inspection Request Scheduled For: Date: 11/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 059293.01 503- 539.4700 Y
Corrections/Comments/Instructions:
P I v L"..-;\"._, 10 A LiC,vv CO3►�,/ Sul , c 1 10 b 6 it \-
.
1
'�o✓ A \ -.-e / Liw4- %N1 cr L 4 6 i r✓\ ,,- k-,c, „, A or-- Co ti r 0,0 1�0 %v,
--l—, 0 ��d\ S T 7 )S 2 q Lk o P ✓a v. )1e . c ` a 06 4. cc't 1 " -P la x✓,
q i;,.1 6,-it ./ c i r S LA, ■ l co ‘,/o ee. 3 ' BI,:, \ a ,AA, S-e.w.- 0,-tri si A e,
S W c, 7, I v-0\; S hr .& ( vim, , J c .b e 1r6 f a LJ ►` i' Pic.
. n PASS Ul PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V1 I.A„-j > f S 1.-- - Date: / 1 1 710 Phone #: (503) 718 -
1°
CITY OF TIGARD 'R Otka
BUILDING DIVISION g PERMIT #: MS-I2007 -00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2007
Phone: (503) 639 -4171 / �u��Nl ilp "
Inspection Requests (24 Hrs.): (503) 639 -4175 '
INSPECTION WORKSHEET FOR DATE: 1/30/7008 TIME: 7 :02AM PAGE: 39
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: EJOECK
DESCRIPTION: 2nd si'ol' addition. 255 SF
OWNER: BOECK, MARK G + CATHERINE L, PHONE #: 503913 - 895fJ
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503 - 7037906
Inspection Request Scheduled For: Date: 1!30/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 064188 -02 503 -703 - 7906 _ Y �,,,� -
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL n CANCEL I1 NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4 tg
Inspector: Date: I Phone #: (503) 718-
CITY OF TIGARD ' 0 vo--- A
BUILDING DIVISION P to PERMIT #: MST200 7- 001172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1O/24/2007
Phone: (503) 639 -4171 / �nlpi
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7:OOAM PAGE: 27
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: 13OECK
DESCRIPTION: 2nd story addition. 255 SF
OWNER: HOECK, MARK G + CATHERINE L, PHONE #: 503. 913.8950
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503-103-7906
Inspection Request Scheduled For: Date: 11/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 059280-01 503 - 682 -4936 N
Corrections /Comments /Instructions:
•
PASS n PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONA FEES ASSESSED
A ,
Inspector: , ; 0 Date: , p Phone #: (503) 718- 20)--
.
CITY OF TIGARD - -
BUILDING DIVISION - PERMIT #: MST2007-00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2007
Phone: (503) 639 -4171 t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/30/2008 TIME: 7 :02AN( PAGE: 37
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: E3OECK
DESCRIPTION: 2nd story addition. 255 SF
OWNER: BOECK, MARK G + CATHERINE L, PHONE #: 503.91313950
CONTRACTOR: JON NEWFON CONSTRUCTION PHONE #: 503 - 703.7906
Inspection Request Scheduled For: Date: //3012008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 064188 -04 503.703 -7900 N
Corrections /Comments /Instructions:
i l'
will
►
f War
PASS j j PARTIAL APPROVAL ❑ CANCEL NO ACCESS
. - n FAIL n CALL F. • INSPECTION n ADDIT ONAL FEES ASSESSED
Inspector: �� Date: (.
Phone #: (503) 718 '
CITY OF TIGARD _r
BUILDING DIVISION PERMIT #: MST2007 -00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2007
Phone: (503) 639 -4171 end °p n��f�I�
Inspection Requests (24 Hrs.): (503) 639 -4175 =�� __..
INSPECTION WORKSHEET FOR DATE: •1/30/2008 TIME: 7:02AM PAGE: 38
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: W3OECK
DESCRIPTION: 2nd story addition. 255 SE
OWNER: k3OECK, MARK G + CATHERINE L, PHONE #: 503-91a-895o
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503-703-7906
Inspection Request Scheduled For: Date: 1/30 /2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message :COW
..
615 Mc3ch�anicai rough-in 064188-03 503-103-7906 Y �N
— °--'--- "— C L ' — '
Corrections /Comments /Instructions: .- 13
IvAc-NuT C, (( (fit= i
.4111 I
PI
— - iv - I ler MICA■
•
PASS n PARTIAL APPROVAL CANCEL ❑ NO ACCESS
FAIL 1 1 CALL FOR INSPECTION n ADDITIONAL FE S ASSESSED
■ Inspector: � IkY Date: 1 6 ,-, Phone #: (503) 718- '
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: MST2007- 06172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10124/M07
Phone: (503) 639 -4171 n "�'Ifil��im���
Inspection Requests (24 Hrs.): (503) 639 -4175 =_...
INSPECTION WORKSHEET FOR DATE: 11/13/2007 TIME: 7 :01AM PAGE: 67
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: 1;3OECK _____�
DESCRIPTION: 2nd ;story addition. 255 SF
OWNER: f3OECK, MARK G + CATHERINE L, PHONE #: 503- 9138950
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503.703 -7906
•
Inspection Request Scheduled For: Date: 11/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 059500 -01 503703 -7906 Y
Corrections /Comments /Instructions:
C'T) ----- -,--0,-/__-/„.4_,,,z, iv'v-' e 71.- n7• 0 = -7 .4.4.E
❑ PA n PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: / Date: 14-i3---,0" Phone #: (503) 718 - '2_4.4"."---
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MMIST2007 -00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2007
Phone: (503) 639 -4171 olt„O
Inspection Requests (24 Hrs.): (503) 639 -4175 °`,_.. '
INSPECTION WORKSHEET FOR DATE: /1/912007 TIME: 7 :00AM PAGE: 60
SITE ADDRESS: 12621 SW 1155TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER': GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: E ;OECK
DESCRIPTION: 2nd story addition. 255 SF
OWNER: 13OECK, MARK G + CATHERINE L, PHONE #: 503.913 -8950
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503 - 703 -7906
Inspection Request Scheduled For: Date: 11/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 059371 -01 503-703-7906 Y
. 2 £ - • "5
Corrections/Comments/Instructions:
-,--,--- ,, = . ; _ v era .6 "'
/
t/ PASS r / PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
l I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: p Date: 1/--- c — O 7 Phone #: (503) 718- 2.4-1- ,�
CITY OF TIGARD '- //t-i
BUILDING DIVISION
A , PERMIT #: MST2007-001 72
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1012412007
Phone: (503) 639-4171 t101400
Inspection Requests (24 Hrs.): (503) 639-4175 AW 'IL
INSPECTION WORKSHEET FOR DATE: 11/512O07 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 12621 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: HUNTERS GLEN LOT #: 032 TYPE OF USE:
PROJECT NAME: BOECK
DESCRIPTION: 2nd F....Ivy addition. 255 SF
OWNER: BOECK, MARK G + CATHERINE L, PHONE #: 503-913-8950
CONTRACTOR: JON NEWTON CONSTRUCTION PHONE #: 503.703-7906
Inspection Request Scheduled For: Date: 11/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
23f Shear trvalWanchors 058998-01 503403,7906 N
Corrections/Comments/Instructions:
' A
In i ii i
RMJ A
Or /' ' I 1 f
•
X PASS 1 1 PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL 0 C ■ LL FOR INSPECTION n ADDITIONAL FEES ASSESSED
.....i
A - g
Inspector: ile ( Date: t c-- 0 Phone #: (503) 718-
CITY OF TIGAR® J
BU DIVISION 1 �Y : , PERMIT #: t )t.i't.�s:
131251.SW Hall Blvd., Tigard, OR 97223 0 DATE ISSUED: it),-
Phone: (503) 639 -4171 N�pq jIl.(' ' <
Inspection Requests (24 Hrs.): (503) 639 -4175 Ailli -5'I i
N
INSPECTION WORKSHEET FOR DATE: /k' m :; TIME: 7. (114;4i4,1 PAGE: ip
SITE ADDRESS: .1 ;t:; .ri f;‘,..,, ! {° T; } A• CLASS OF WORK:
SUBDIVISION: t;l.!; ! }_::i, f ', i.f.N LOT #: G2 :. TYPE OF USE:
PROJECT NAME: rz11)I: - ':•K
DESCRIPTION: -, : 2;
OWNER: r °' "?d PHONE #: t: } 13 V ,
�Y{.��.'�:�.. Ntlrtil`4F�. �.: -' '.,��il�,i.lr. ill:. �.. �.: _ }� s q
CONTRACTOR: ,y? a } •i ;':i: t''4i :':y-.; c i �' ' i— 2d it';7I�.�N PHONE #: ' / li, r c�ilu Q/ U` �� ,
t kk/
Inspection Request Scheduled For: Date: _; : 2;:g-,_ ' Pour Time:
Code # Inspection Description Confirm # Contact # Me sa
it': l'iL m - i , fil: : :1 (.3; !-: :iit:,01 , !-;():)-7(1: 4 ,'9(G •
Corrections /Comments /Instr ctions:
AV /A q 1 / °'
t n
J& R .. 3" (.",(- & -Q 1f
LA/)" ■,....y iLx 2--) L.;A__.„Q \.,14 w\-1__
., 0
--(--k )- tom- - eiv. A 'i cl _ ( L Q --\----De›
4 ..-1._*■ D C ..\ c4 \A C--Z L '
-11r ,,,, J k-,.i 4---C C......0.A.,,A. L...ery\ C 6_,,-
');1,9. ..-k-f---\- N.k4A t \/uD k , e_ 4 r- 3 "/ -
6 .0,A, L ) 69 •
f\ CaIN '1- cei k V V Q kzA)
a
\\S 0 \ Mali '6 i'V 4 . (Al\ )(1A.,), (7c, GL.V\
, Eilivt•- ) • V
/ P ASS PARTIAL APPROVAL / CANCEL NO ACCESS
• FAIL I I CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: (! Date. / 9 Phone #: (503) 718-
CITY OF TIGARD - e. . _ - o
BUILDING DIVISION v PERMIT #: `di.:.; , ?'?I? /..W i�i
13125 SW Hall Blvd., Tigard, OR 97223 ,, DATE ISSUED: ;;! •,-,t, t;;,,;,�`
Phone: (503) 639 -4171 ii :u #4 '*i /
Inspection Requests (24 Hrs.): (503) 639 -4175 .. W :_,., . /_/
INSPECTION WORKSHEET FOR DATE: 1122/2009 TIME: ?: OW PAGE: 6
l
SITE ADDRESS: 1 ` } fs.n ,: ;vy 1 • c,,'I_': A' CLASS OF WORK:
SUBDIVISION: 1 ;l~fr.R ; i. aN LOT #: ; ):32 TYPE OF USE:
PROJECT NAME: Hc;F: :,t°,
DESCRIPTION: :1. . t % s
{ ' ��rr� > +nitilt, « ' a +e / r/
F
OWNER: F.i;- : *., mAt 1.%, tit CA f i:P,,1' L. PHONE #: f;(;;+'!:;13'.k:,'ti3 '
CONTRACTOR: .ioN i C.-:R t11 :1 , .)N PHONE #: ';i)'; i0 ::L%'iS
Inspection Request Scheduled For: Date: 1 Pour Time:
Code # Inspection Description Confirm # Contact # Message
r, :lliii :./ `, Cik'b11 & !. 1 .% 79179P6 N
Corrections /Comments /Instruc l
(\ ,ef," A.4 ,-.1-‘,---1 e • 4.---ee- D,r , ri.J" \.1 ic---0 --=‘, - CIS .
..., \\\
\, sA
/r Q1
\ ,92 1 . 1 (//)-- .
) / j /
( \
/
.6 1 I PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL 1 1 CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
NZ/2i j k-1 2 / v 1
Inspector: �O L_ Date: 1 Phone #: ( 503 ) 718-
,
CITY OF TIGARD '2 ' ; _
B UILDING DIVISION J ' . J PERMIT #: t;t:; ,'�•_, �.t {•, •
13125 SW Hall Blvd., Tigard, OR 97223 - il DATE ISSUED: - ( ; /,r4, / 7 � t � Phone: (503) 639 -4171 !°"� @ "�
'Inspection Requests (24 Hrs.): (503) 639 -4175 ,;.. L •
INSPECTION WORKSHEET FOR DATE: :rr :;./`)Q(f TIME: 7 :00frA,1 PAGE: I.
SITE ADDRESS: `i aie. 'S i:,1r.! 1 Th fi i AV CLASS OF WORK:
SUBDIVISION: i r(Ri'E i ; r LOT #: ;l : ;,x TYPE OF USE:
PROJECT NAME: ,,c3i Cv.
DESCRIPTION: 2;,j ..to :Idrtilio'i. 4,6 rr SI
OWNER: ' >;;L .X, !`PiAPt', C-: �`a`,i I,_P.C,* W � , PHONE #: t•.'• : : .
CONTRACTOR: ON N .: V' ON :14; ;1 :'13 : PHONE #: ::.0`.',"7(r3 .40C:
9
Inspection Request Scheduled For: Date: Ii �;,r r!) Pour Time: , �"�`I 160'-au- um 4
Code # Inspection Description Confirm # Contact # Me'agfr
;y
._A
. _ Flrlai l :ispe: "ire! - , ( frj_:'7ta )? e,t73- 703- '7906
Corrections /Comments /Instructions: n 11
`( , d'.. r L- try ,(" ' -2 -c-N S
.. V2 .1../.\ --e- cam.- - \ cLKA.
. C. k. S -4-- .. &...J.., --sz- --r
vv-,__9_4---.
•
l
/ 1 A „ I
frYRL
/ oil'
.!
4
, .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL 1 1 CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: V ii i V Date: / /773/10q Phone #: (503) 718 - -(1.2.-y . . . . . _
` / • ,
� ' /
` ` �
x/ �~ v`_�= �� *�`�`\`��
- ^^�, v `~ '~~
� ~
�m4�' ,9 (3
- --- - \ �-�--�-/ - ` '
`~~� � � �
' |.
!
( ("\--. . 'R ECBV ED }
•
/
/| /
- -^+-' �� >
� ^
3 CITY OF TIGARD ..
----
BUILDING DIVISION ~^^^=~~^~ 1 /
-
_ -
-, - �
__ __,
-'_- _ --_ � -_' -- - �
\
__- �'-�~�`^_,-
T ��-- -_
� �
!
(
- -_�
') ) |
/ ^
- '--~-'---' �~ �- � �y �L ( _ /
~ � �
/ / , �� -
_ �� _ __ �� A. p�`�
-- -_ - _---' ��--__-- ~ ^ .�
-_-- _ - -�- � ,�_^
I .
_ _.
---_------
'^ ��---_-__- - ~ ~_~~ `
�� �
' - -_� 1�/
< ( u�t�^``
' --- -- - - -- -_---__�__-- ------ -' �� �_
/ �
~~� ' - - - -_- --- -_ --_'
`
'\
rJ �-� --- '
' - `| - -�- c-L- / t,D^( .
[ --
'
Nr 11 � [> /�� / . ~i|� 7�(---------_
���� � x�T� /7� C]=�p� ' � '
` / ^_ • ���
_ `~
c«�--^ . • �
.. .\
/ )
-_ --__` ' ----__ '--'_ - - '--'- ___. .__ -' __ /
�
`'
` • .. � �
,
•
RECEIVED
C :re G Ain)
MAR 1
3
(, Div/ s r o-v-) CITY OF TIGARG
BUILDING DIVISION
itert L/A( 010 4-u elp
4 g 04 At /- 4- L 3T2ti C7 / dJJ
5 / Z 21 S G.) S r9 ✓ez_
c
6 4,4-74-7 - 66 r 7
Soo- X01-- .9 0-L
) "7" 5 'et-_(./v-
5 - c23 tr0
5 G/1' pc. /' `6/e-' ti
:3 " (. / N E 02o N 6-2)7< e_c_ _
M- v /57 L.>
1 -
■