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Permit CITY OF TIGARD MASTER PERMIT 44000 DEVELOPMENT SERVI PERMITS#... .... : i7ST97- ►275 ..4.61 13125 SW Hall Blvd., Tigard, PARCEL: 15135DB -04800 SITE ADDRESS...:11465 SW 92ND AVE SUBDIVISION °DOGWOOD RIDGE ZONING: R -4.5 BLOCK LOT .............:8 JURISDICTION: TIG Remarks: Interior remodel of kitchen, bathroom, and master suite PATH I - -- - - - - -- ---- -- - - -- ----- ---- -- - BUILDING --------------- REISSUE: STORIES : 1 FLOOR AREAS -- BASEMENT...: 0 sf REQUIRED SETBACKS - -- REQUIRED--- - CLASS OF WORK. :ALT HEIGHT : 0 FIRST • 0 sf GARAGE • 0 sf LEFT • 0 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT : 0 PARKING SPACES: 0 TYPE OF CONST.:5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT : 0 OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL - - - -: 0 sf VALUE..$: 2m0 REAR • 0 --- - - - - -- PLUMBING - - - --___________ _____ ___ __________ ____ __________ _ ____ ____ SINKS • 1 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0 LAVATORIES • 4 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 1 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 — ----------------------------------------------- MECHANICAL - - - - - -- ----- FUEL TYPES- -- - - -- FURN ( 100K ..: 0 BOIL /CMP ( 3HP: 0 VENT FANS : 1 CLOTHES DRYERS: 0 GAS FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 1 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 0 WOODSTOVES • 0 GAS OUTLETS...: @ --- ___-- _---- ______ - -- _-- ____ —_ —_— ELECTRICAL -- - - - - -- - - - - - -- -- RESIDENTIAL UNIT - -- - -- SERVICE /FEEDER - -- - -TEMP SRVC /FEEDERS -- -- BRANCH CIRCUITS - -. — MISCELLANEOUS - -- - -ADD'L INSPECTIONS - 1m SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp,.: 0 W /SVC OR FDR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 4A amp..: 0 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: 0 PER HOUR • 0 LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 1 SIGNAL /PANEL...: 0 IN PLANT • 0 MANF HM /SVC /FDR: 0 601 - 1A0 amp.: 0 601 +amps -1000 v: 0 MINOR LABEL -10: 0 l" amp /volt.: 0 ----------------------------------- PLAN REVIEW SECTION ----------------------- Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR) =225 A.: ) 600 V NOMINAL: CIS AREA /SPC OCC: - ---------- - - ---- ---------- - - - - -- ELECTRICAL - RESTRICTED ENERGY --- - ------------- --- — A. SF RESIDENTIAL------------- - - - - -- B. COMMERCIAL - ------- ------ ---------------------- -- ---- _ ------ --- ---- -------- --- AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM..: 0TH: .. BOILER HVAC LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK • INSTRUMENTATION: MEDICAL OTHR: .. HVAC DATA /TELE COMM.: NURSE CALLS • TOTAL # SYSTEMS: 0 Owner: — ------------- - --- -- Contractor: ----------------------------- TOTAL FEES:$ 403.81 ROXANN STRONG SAS BUILDING & LANDSCAPING This permit is subject to the regulations contained in the 11465 SW 92ND AVE 9740 SW TIGARD ST Tigard Municipal Code, State of Ore. Specialty Codes and all TIGARD OR 97223 TIGARD OR 97223 other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is Phone #: 684 -8111 Phone #: 639 -3908 not started within 180 days of issuance, or if the work is Reg #..: 000565 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- A10 through OAR 952- 'v%1- 04 :0. You may obtain copies of these rules or direct questions to OUNC by calling (503)246 -1987. ----------------------------------- -- --- - -- REQUIRED INSPECTIONS -------- - - - - -- ----------- - - - - -- -- Footing Insp Mechanical Insp Shear Wall Insp Mechanical Final Foundation Insp Plumb Top Out Low Voltage Plumb Final Post /Beam Struct Electrical Servi Insulation Insp Building Final Crawl Drain Electrical Rough Gyp Board Insp PLM /Underfl or aminq Insp Electrical Final Issued : 1 t -4 Per Si gnat�_ire:►,V., iL.. �� ,► � �ei �� � +++ ++ +.1- -1 --1- r- - -i I ++ +-F-I--t-i-i- l-- 1-- I- i- i- i--Fi--I--1--h-F-I--h-h-F-i--1- i--I--h-I-^hi-^I - t•i- 1-i--M-F-h+++ +-I-+++ I+++ ++++ Call 639 -4175 by 6:00 p.m. for an inspection needed the next busine way • Plan Che - 1-12- 'Ti OF TIGARD - Residential Buildi Permit Application Ret:d By . ;r,,. ,;;145 S.W.HALL BLVD. New Construction Additions or Alterations Date Recd ' ':sARD, OR 97223 • Single Family Detached or Attached (Duplex) Date to P.E. 1 ;03- 6394171 Date to DST 7 -41" ff 7 _ 03- 684-7297 Permit # 6 b Print or Type Called - 7 / PAyi V Incomplete or illegible applications will not be accepted Na of Protect _ Name Job 6t�a t I ►�`rerloY Pizni a�� Architect Mailing Address Address A d ss V 0 --- 1 City /State Zip ' Phone, �1ame �, J R i7 X Pk h Y\ g,- 1t3yYN b n me • Owner Mnding Addre � , N �I I E 1 . • 0 ziot- -4t En meer g Mailin Address 't O s 'G�(_ 'Lyi State Zi �ir1 Ph e g 1V2j <� (' f'e .� l 1 1 k ` a D° a e l �� p 7 U ��/ (I I _DO /State Zi p. Phone c:-. - OR General ` c S O ' �) D escribe work New Add ition O Alteration Repair O Contrac actin ss to be done: rb vontra 9 � � COT! OVA\f 0[ PCOCIA, 'C__ ' Additional Description of Work: it _c�,ty /S`tate Zit/ Phone -1.,tri 1e. t� D ° Rem ode` b C K1 i l ►eta 0 o - 9 b'3c) - )9 t.* j �, �n Ir,, S gyp, /_ 1, , ce Ot ro,orv \ + W %LTC/ - - O �b onst Cont. Board Licit Exp Date _ �. tv 0 I e'r Sl�,l +`� Ke r,h5sC f ( 1 Attach Copy of V , - A r 5 �l �' i v o . Q Current COT Business Tax or Metro # E Da a PROJECT = ` Licenses ') 1 SZ ('., 11,E („ - 1.-I ??I Dar VALUATION $ TO) 000 Name cri Mechanical �tJX fldlT�a� NEW CONSTRUCTION ONLY: - M alin Address S q. Ft House: Sq. Ft Garage Sub- Mailing C ontractor -}}6 S -• - - • Corner Lot YES NO Flag Lot YES NO CD City/State Zip Cone (check one) (check one) • Restricted Audio /Stereo Bur I Ore n Co s Cant. Board Licit Exp. ate gar Attach Copy of Energy System . Alarm Z Current COT Business Tax or Metro # Exp. Dat ' Installation Garage Door HVAC Licenses `1 ,i ° - - ) Opener Systems r 9 Na e i ( � (check all that Other. Plumbing V. c & rv\ (O43) apply) Sub- - Mailing Add Will the electrical subcontractor wire for all YES NO C Contractor L restricted energy installations? c - City/State Zip (Phone Has the Subdivision Plat recorded? N/A YES N Cregon Const. Cont. Board Lic.# I Exp. Date Reissue of MST: Solar Compliance ttach Copy of (Calculation Attached) Current Plumping Lic. x Exp. Date I hearby acknowledge that I have read this application, that the Licenses COT Business Tax or Metro # [ Exp. Date information given is correct, that I am the owner or authorized • agent of the owner, and that plans submitted are in compliance Cr., Name L-00 be �Vi lA with Oregon State laws. �- Electrical q Si t `r of Gvl/rterlA ent (...„ o, Date Ikr s" ti cc i I I,1 Re -it' u t ATE i hC S I h (, � ,t,l (O Ilwt 1 - (3fft. Sub- Mailing Address �_ C,o tact P rson N rr3e ' Phone # t/ _ Contractor t), L O S� L rN`k 41'I Q I D) 11 1 i't+.-IC R.a g L G; to Zip l Ph one p FOR OFFICE USE ONLY: �tiy`� �}.�(p • + - 1 V � tX0 ON x}1'1 Z3 I WI. 03D gyp: Plat # M L# Cre -on Const. Cont. B Lic.# Exp Dat gtlA rli. ) 5) 3 6 -L1 top 4 c - Attach Copy of - 3 (� I -"( ' Setba ks: Zo - N Solar$ Current Eieancat Lc. Exp bate X bate �� Licenses 2, 4045 I mil Engineering pproval: Plannin :+ pproval: TIE COT Business Tax r M Jq � � r Etip. gate I p� lU 1 = REMCL.DOC (DST) 5197 Msf9 -o17$ MST. Permit (BUILD) (UBUILD) /40 — v Plumb. Permit (PLUMB) (UPLUMB) S4 `" 54 Mech. Permit (MECH) (UMECH) Zs, 25, ELC /ELR Permit (ELPRMT) (UELPMT) h/o, `° _ 5/0 State Tax (TAX) (UTAX) 1 2. / 2 BLDG: 7, o 3 • PLUMB: 1. 70 MECH: 2 ELC /ELR: - a', d v Plan Check MST: (BUPPLN) (UBUPLN) 91, �' c'I. 33 Plumb: (PLUMB) (UPLUMB) Mech: (MECPLN) (UMEPLN) CDC Review (BUILD) (CDCBLD) (UCDC) 40. '-- CDC Review (PLN) • (CDCPLN) . N/A _ . Sewer Cannon (SWUSA) (USWUSA) • } Reimbur. District ( ) ( ) Sewer Inspection (SWINSP) (USWINS) Parks Dev Charge (PKSDC) N/A Residential TIF (TIF -R)- (UTIF -R) Mass Transit TIF (TIF -MT) (UTIF -M) Water Quality (WQUAL) (UWQUAL) Water Quantity ( WQUANT) (UWQANT) Erosion Control Prmt (ERPRMT) (UERPMT) • Erosion Planck/USA (ERPLN) ( UERPLN) • Erosion Planck/COT (EROSN) (UEROSN) Fire Life Safety (FLS) (UFLS) .1Y TOTALS: 461. q 31z• I:SFREMDL.DOC (OST) 6197 Permit #: 01 S O F ,� f ,1 �}, Address: I 1 ! �5 (A) . ! J J �� �%�� : z Issued by0. Date: 41 9rn 1859 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building_ permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: a , 1. I own, reside in, or will reside in the completed structure. 1 � 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ri 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR §1P 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about _ Instruction Responsibilities on the reverse side of this form. �� ► �l►�..0 � ,�► /99 (Sign. e of pe t ap i icant) ( ate) (White c. , o issuing agency permit file, pink copy to applicant) RnVorrmaVon etkce' to GPrropc rr1y Owners • • • Abour2 Constu o ©UUU©nl ResponaNNes • Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESIPONSEMSYES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax iaw: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. U, +employment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378 -3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1- 800 - 829-1040. OTHER RESPONSOLlTILW Al 7 AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. • If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/378 - 4621). • The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own .pm4 1 /94 • CITY OF TIGARD BUILDING INSPECTION DIVISION MST q 7 " 24 -Hour Inspection Line: 639 -4175 Businesw LinC 639 -4171 BUP j i ts - 15q Date Requestted AM PM BLD Location 1/ !e9" Suite MEC Contact Person ki SW Y1q Ph (0r/ /< ( - &)1 . PLM Contractor Ph 4003 - d 7 - 1' - hD►- r��SWR 6UILbING` ��� °; Tenant/Owner ELC Retaining Wall ELR Footing f Access Foundation FPS Ftg Drain Slab Crawl Drain Inspection Notes: ail & r G SGT Post & Beam -�Or� SIT Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: ,, PART FAIL P § L MBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains _ Final PA T FAIL ECHANI Pos Beam Rough In Gas Line Smoke Dampers SS , PART FAIL ELECTRICAL :: =; Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE' = Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date /e - . /3 7 Inspector � Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.