Permit C I TY O F T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00366
L _.�l� DEVELOPMENT SERVICES DATE ISSUED: 8/22/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12070 SW 119TH AVE PARCEL: 1S134CD-03100
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT: 057 JURISDICTION: TIG
REMARKS: Addition of 384sf.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 384 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 35,481.60
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 384 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 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:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 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:
EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 2.00 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 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: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 894.39
U, LYNN YI + ANG, CHOUNG LIN This permit is subject to the regulations contained in the
PHOU, Municipal Code, State of OR. Specialty Codes and
12070 S S , OR 97223 119TH H all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Crawl Drain /Backwater Framing Insp Plumb Final
Foundation lnsp PLM /Underfloor Exterior Sheathing Ins Final inspection
Post/Beam Structural Mechanical Insp Rain drain lnsp
Post/Beam Mechanica', Plumb Top Out Electrical Final
Underfloor insulation Electrical Rough In Mechanical Final r
1 I
Issued By • J Permittee Signature : t`
Call (5A) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
07/16/2003 09:52 FAX 5035981960 CITY OF TIGARD a 002
Building Permit Application -FOR OFFICE VSE ONLY
Received
I V E ® Budding
•
Date/By: � - I � -03 05 Permit l - 00 , Z:6 D3 - o�
City of Tigard EC Planning Approval Other
Date/By. • Permit No.:
13125 SW Hall Blvd. Plan Review ,
Tigard, Oregon 97223 JUL 18 2003 Date /By. 7 _a S - 03 Permit No,:
Phone: .503-639-4171 ( / bod +� Post-Review land Use
Internet: www.Ci.ti d � 19 L) • ' I ) f Contact Case No:
$� Contact June,: See Page 2 for
24 - hour Inspection Re KtDialg3JIWWIV -DS Name/Method: 7167_ Supplemental Information
n
h X
CW 3 w y^: . - „.r. , • � _ � , '; dL i7ta ' �Yx "' :r.,k;.'^•'•rp �- - _ ,:� _ � �
.ter
..•E.: ;,.. -: :; .l c _. _.:![ oi.....: , �. n._ i p. ..��i - .�:.�: .q . '.:� id .:[:: gl• ii.;t:,�g`.
.. �,_:
.. ,,!, �.,
n. •. . . ..�. ;e�a'.���Q'aV \�:i�.�. -1'i l�.:. i4.- •. ._ L i, _ . ' '�I+:� i.��i� I �� -��:'��� �li;�'.',:`:;�x:.,.
D emolition ,, r:: ;I, i • '• •�y • 1J < �
New construction ❑ _ •.. a � :- _�. ,. .... ._ +�` _ - ,. �'F � � =; � � :. �. !, • :.:- , .:.:';:.':.::'r :itll: "-I,� . •> :.. _. .... ..Ire' :.. • ._ : °' p�! !'I: I:li!I1.l•; , c:! : IiE4 4 ::
0 Addition/alteration/replacement ❑ Other:
1, ,:y. "=% .i':F.•, m•cATEaiiORylocCO N'''fRUC'UON i,, r -.:: •`t E::i' •:'' '• Note: Permit fees° are based on the total value of the work performed. Indicate
1 & 2- Family dwelling fl Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application. Vv
Accessoryuilding ❑ Multi- Family
Master Builder ❑ Other:' Valuation $.3 5- . 0
' iV.''.r•.: •:< i; ..01& tittfl 'ORM I'i 'dt1XANON.Li Ili; .:i. No. of bedrooms: No. of baths: -
Job site address: 12o"1c7 &a \ \`1•' k m\6/ Total numbs of floors g ,L " New d we ll ing area (sq. ft.) , ,
Suite #: BEd -/A t. #: Oaf area (sq. ft) ' .
Project Name: L. i vr d t' 4 l 6- Covered porch area (eq. ft)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. R.)
,�� \ I �_
L Y ' ` \c1� � I(;( VI 1 �"''In ' , / �.1h
N� :' N;i;l . 3.1. . :K'[ an ,y' .i` F �i kr
''i : tFfi'�'i"` ifjii'ii: l:-
yi.i;, i . :; : ; ,,. I: • i Wo r X7 0' • • • B It 1 ;;; � ` ! .. ! .411
"i:! �'�Il "I c..:;,04. . �;j° ..`•�1 ( • . !ia'� :•p.:�k
• Subdivision: l_ ,�CLt:vl \.e'b c'\s 47"B' I Lot #: .. !:ir , '•:I .: al '„i;t Fr „. ....k r. i,l.,, „ x...,�.,hl.•, IFIr:R a:. -i`:; ?
Tax map/parcel #: i S .3 tl CO U 310C) Note: Permit fees* are based on the total value of the work performed. Indicate
_ ._-• :, :•• : - - : , ",!, •- • . :�, —,,,.. the value (rounded to the nearest dollar) of all equipment, materials, labor,
'i: :�t: .emu : :.. , . r ::DIE. o r rQ NjD111Y011ti: 2€ ` > a I
.. 4 .
�� overhead and profit for the work indicated on this application. f ,
t� x.1sr7 , \N4 1 e -- (29 ( 0 Valuation $
Existing building area (sq. ft.) .
A iM New building"area (sq. ft.)
SFZ- a -d "9 ' Number of stories
ga ttiegi i V A.1 gli Mniffitt `'„i{ ii♦igli;i llidl4ilt:iAllbu. Type of construction
_ Name: t.'3 \ Occupancy group(s): Existing:
New:
Address: 12.o ?° Get _o ■ Lei - .
• a
City/State/Zip: ��Cl AZ) &Z rl 1 123 NOTICE: All contractors and subcontractors are required to be
Phone: o3 -b t1Cj - 119 l Fax: licensed with the Oregon Construction Contractors Board under .
in.:::: provisions of ORS 701 and maybe required to be licensed in the ,. �f '
Business Name: '�, 1�\ () '" C(`• jurisdiction where work is being performed. If the applicant is exempt ��ll
Contact Name: •i\"A.)iS- --- 1. �C .c,�17 from licensing, the following reason applies:
Address: 2' l) t,A1`_/ (g#4.-e =
City /State/Zij 2T C7 2 C)
Phone: 5O3 -Cici -60 I . Fax5c 3 -- 24+4 -6103 _e.•!. F(91:�:'F;i �, ,i j ;;i.;r:•'r. 4, -li! --d9..; ....� ....
r 1 11
E l h UQ! _ 1 i, r 1' � "$ • ��ikl'�a':" 1 11 ' r' �
� "
..
E-mail: � C �cn� , i� C - i. = .. , �,:_:; iii ' i• r' . ' J. r �: •. : .q < ,:; G
d' 1 1 G 6 3 �' e E;:: °�l:.� �!:,. k� of , o Ifec{ ati e`d x ; �;M��'; I � - -.
,; _ mt J; S:,. ; v �. fil • u : ! 0. " : ' v.,, ` . ,Jd,, , t q::::iC'.. . h,,,,:: „ .,.. •. . ._ . l I '7
or
:t, :l S,= r.Clsl.l t'I':: iji�Y"ij' 1?�J.n,. "I } ' : �.:: ;::, ` c.' fWL
Business Name: CA93 — Fees due upon application $ _ •
•
Address:
City/State /Zip Amount received $
Phone: Fax: Date received
•
CCB Lic. #:
Authorized Notice: This permit application expires if a permit is not obtained within
Signature , ._, . - � . _ en Date: ISO days after It has be accepted as complete.
L /�1J15 ' I V •Fee methodology set by Trl -County Building industry Service Board.
(Please print name)
i : \Dsts\Permit Forms'i3ldgPermitApp.doc 01/03 ) a31.
•
07/16/2003 09:53 FAX 5035981960 CITY OF TIGARD l 006
Building Fixtures
e e . a FOR OFFICE. l L OtiLY
Plumbin Permit A n Received Plumbing
I 1 /� , Da / : Permit No. ( 2t)O�i -OD3Jj
V Planning Approval Sewer
City off' Tigard pater _ Permit No.:
13125 SW Hall Blvd. JUL Plan Review Other
Tigard, Oregon 97223 a 003 Data/By - Permit No.:
Phone: 503-639-4171 Fax: 503 598- 19doITV i Post Land Use
Da Case No.:
Internet www.ci.tigard.or.us 3U!LD , �' ,. . -j I ' ,` 0 Contact Juris.: ' ® See Page 2 for
24 -hour Inspection Request: 503- 639.4175 - . N Name/Method: - Supplemental Information.
gji," ;a';',o.m4 o,_1 �.!. . 5 vr7 i ._ _ ° %~ fight �i�j,' k' f :7 ., ' .Ealrk7� -J- atED l(fof',�j1 AiriIIaNiliji ° ' c ti-OV t '
' Description Qty. Fee(ea.) I I Total }J
❑ New construction �
:.:• i a:7 i k .: • '; .li5 i .: fa , ■ ,ii 0,:..._. i ' "�:, : :, s : i IF n/r .lacement "
El
Addition/alteratio • :; I � � : F - ' - , � ': = � e: ��" � ':� �x ; k�k;
:,:,, ,� . r. ._. .° E s e 4 Y (U AI':' } }. ' f:' ! '' _ bath 249.20
ar.' :.i SFR (1)
F1 1 & 2 - Famil dwellin l • Commercial/Industrial SFR (2) bath 350.00
IN • ccessory Building ❑ Multi -Famil SFR (3) bath 399.00
L■ Master. Builder ❑ Other: Each additional bath/kitchen 45.00
_ tmi . :.j �+ori ti iY�lkle - �_ a, V QI!I :.;: s . . :4 Fire sprinkler - � R.: 1 2 x .
Job site address -rte i 2 ? O S L.,) t t q t y AAA Y �� t 's_• :_: �r k `: ] !si ` Eli 5�; .
/A Catch basin/area drain 16.60
Suite #: I $1 P t #: Drywell/leach line/trench drain 16.60
Proved dame: Mu t _ - U "t" Footing drain (no. linear ft.) Page 2 ;
Cross street/Directions to job site: ,` � Manufactured home utilities 110.00
L /v N - t1? `� VT � - �j tt l SP Manholes 16.60
y Rain drain connector / 16.60
Sanitary sewer (no. linear RI •--/- Page 2 ,
Subdivision :l. GPo V j fvi- No, 3 I Lot #: ii.. o Storm sewer (no. linear ft) Page 2
I O C7
Water service no. linear ft. P le 2
Tax lrla. .arcel #: l i • U CD • c'�` ��..•'_•.
y, . J ,�� ": � 1'' Nii„h, a,r �l • `tt �r '� � `r+riw�awH'.7:�
' 'i. l :” ..:;k4:h II 1 3 17 C :r.1rl aii36 :: ; ,l. Absorption valve 16.60
■ I ' ■ . ! 6 ` a.4 ' Backflow preventer Page 2
' Backwater valve 16.60
t .l 1 ti.- t) `� ■ �% Clothes washer 16.60
Dishwasher 16.60 ,
Drinking fountain 16.60
a
E! _ -, '°i Y r , :c r:2E�T -J " "-:0_ Ejectors/sump 16.60 4 ,
Name: R. l Ly A; u `Y i Expansion tank 16.60
Address: i cy j S lk.: 1 IS 44) Aty' Fixture/sewer cap 16.60 '
Floor drain /floor sink/hub 16.60
Ci /State/Zi • : _ ► LtiZ Q 7 22 Garbage disposal 16.60
Phone: 5C S -.6 49 - 1lci Fax: Hose bib 16.60 ;
1 . ' _: . 1 t ' _ ' •' Ice maker 16.60
Name: W CD .elp 0 ,16-, Interceptor/grease trap 16.60 ,
Address: S- .i 7r 0-A % 1 g- Z
Primer Medical gas - value: S Page age 2
f • • d r t) 2 1 Roof drain (cotttrnercisl) t 16.60
Phone: -- '5 - . Fax: 2) 2tl _6 (03 Sink/basin/lavatory / 16.60
E -mail: Tub/shower /shower pan / 16.60
't b ;; :. h r£ ` - 1 f_� 4'u; r J 4 1: i4_ inV, Urinal 16.60
� " �"� Water closet / 16.60
Business - .. ' : is 7E ►t∎_ +� L 1 Water heater 16.60
Address: ' 2t ��mitmm other:
-- Ci /Sta : � a 1►`, ti
Other:
1 1 -6 03 i:22011
Phone % subtotal $
CCB Lic. 7lli._ b• Lic. #: Minimum Permit Fee 572.50 S
Authorized W R /1C Date: Residential Backflow Minimum Fee S36.25 7.? S a •
Signature: 4... 1,!:1Gf+4 Plan Review (25% of Permit Fee) s
. ;AU tS ` .,(4 IZ)) C • RI P b :)Q.p' State Surcharge (8% of Permit Fee) S S W
(Please print name) TOTAL PERMIT FEE $ .
Notice: This permit appltotioa expires if a permit is net obtained within All new motnserdal buildings require 2 aft of plans with isometric or
180 days after It has been accepted as complete. riser diagram for plan review.
*Fee ttreebodology set by Tri- County Building Industry Servtes Board.
i:IDsts\Permit Fonnv\PhnPetmitApp.doc 01/03
07/16/2003 09:53 FAX 5035981960 CITY OF TIGARD a 004
•
Electrical Permit Application , V FOR OFFICE 1.'SF ONLY Receives Electrical
p /By: Permit xo.:i -Tc.9t_ ";`3- 'X)' IC' 9
City of Tigard JUL 1 2i i .1 pare wg Approval Sign
No.:
13125 SW Hall Blvd. CITY(,)! Post- Review Land Use
Date/By: I1 Plan Review Other
Tigard, Oregon 97223 n • ` ' HHU Date/By Permit No.:
(��4{,/'
Phone: 503-639-4171 Fax: 503 -598 -1 6U L (' • ION Case No.:
I n t e r n e t - , www.ci.tigard.or.us AI I C o n t a c t brie.: ® Ste Pane 2 for •
24 -hour Inspection Request: 503 - 639 -4175 Name/Method: Supplemental Information.
.._, , �,, ;.:,:•. -.,,, 4...:Yu!�: � av �._ _ .. � ... � . ._ ,•,.,.. %u_.. `.'.;'' �' I�d's>''�h lC ? ?� , lyl�fs:�� °': ":
:` �:� ..,
��:��.: ... .
... ',(�.�..? n: T�pl'' ��11�1�0�. �. 1 ...... .........'�t�..:�'i�rrli�''r4�: �.; Ir[,7�i1��'� � y es I�IIAt >Ap.
• New construction ❑ Demolition ' 0 Service over 225 amps- M Health -care facility
cotrunercial ❑ Hazardous location
is Addition /alteration/replactm Ci) _ Other: 0 Service over 320 amps- rating of ❑ Building over 10,000 square feet,
-4 7•+ r ! "r'.: - ` �'`i . !`i•° family dwellings four or more residential units in
:a= �Ii��d ;�2:. � -emu •;+>�ti��F�iGbRY •. ..- '�c�ri:�a- =: . _:•. ;,��..... t & 2 farm y ge
a-t& 2- Family dwelling ❑ Cornrnercial/Industrial 0 System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps OT more
❑ Accessory Building, ❑ Multi- Family ❑ occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
- o , �,E, IgatiLl t Flt AI : ;... Submit _ sets of plans with any of the above.
1141.a' � r' The above are not a .licablc to tem.. re. construction service.
Job site address: Ca C lam` , 1 . 9i k ":r•.-� �2.a.,�� .. :.... ,�w-4 - .1 4
:_ —..1 :. vs �' t• ; :!.
• 7L' � CI:'i::v1e4 °: .err ?i'ji:f�? ,.j' Q,�:r�i: iad� '`- rite =,.:.� d�r =�Air,�, . a,�
Suite #: _ I Bldg,/ Number of lnspectio n per permit allowed ,
_ Project Name: ,, Al c\ l }fat-- Descriptioa Qty Fee (ea.) Taal I i
New residential- single or molls- family per
Cross street/Directions to ob site: dwelling unit. Includes attached garage.
(, - �v Server Indeded: •
Ly ill w# 1 t 1000 sq. R or less 145.15 4
Each additional S00 so. 10. or portion thereof _ 33.40 1
Limited energy, residential 75.00 2
Subdivision: t_O J '' 3 I Lot #: 1 l 00 Limited energy, non residential 75.00 . 2
Tax map/parcel #: i S 1''"t4 C ■ C l C O Each manufactured home or modular dwelling
Iliii.LNiTITOT itti: ', 1 r ''! a , ,0 ,i!e; •'.. W.. ti aw: , w.. i. selvi" and/or feeder 90 -90 2
( Services or feeders - Installation,
,,,J4o , t 2 \ - S •..4- alteration or re/o at(on:
r^ � �� (11 � 7A0 amps or less 06.85 2
L-> Q C'c l — 201 amps to 400 amps 106.85 , 2
401 amps to 600 amps 160.60 2
j P:%:u 601 amps to 1000 amps 240.60 2
GI !'�uk` '! �; : t Over 1000 amps or volts 454, 65 , 2
Name: \r / ,N)!-) 41 Reconnect one 66.85 2
Address: 1 Z1-' 7 0 S LL' l i e - Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip: \ _ 1 Lib) Z Ll 7 2 7.- _ 200 amps or Ices 66.85 1
Phone:, ^ `> , f t 4 - 1 \ fl I Fax: 201 amps to 400 amps 100.30 2
_ _ 401 to 600 amps 133.75 2
'r t; 7Z: f :1 /l : ti :. .,,ty F.(In .,
I1 ; C . .. ` '. '� � lr E _
�, is .� _:e- J >.'.: °: S•�iSacP..n;� ) .. Branch circuits -new, alteration, or
Name'^ gk (l IV erteaalon per panel:
r A. Pee for branch circuits with purchase of •
Address: L1 1/4 • , service or feeder fag each branch circuit 6.65 2
City /State/Zip: `q ` (∎ 2_ ) 217 B. Fee for branch circuits without purchasabf
service or feeder fee, first branch circuit l 46.85 2
Phone: S u 3 - •_ ' ' - 60 I I Fax: L 3 -2.1 Li '6103 _ Each additional branch circuit 7,. 6.65 2
E-mail: ., e vt r \ 1 6 L C C .6.1A �T , 11 t - ' Misc.(Scrvicc or feeder not included):
„; .. _Bash pump or irigatiWt circle _ 53.40 2
!*R. * " ; "r a '> t ; � �jT�'V�. -oi; .N' :t• . r., • _ ;_ Each sign or outline l' tm 53.40 2
J ob No: • 7 ID • Signal circuit(s) or a limited energy panel,
alteration, or extension • • Page 2 2
Business Name: , ' Description:
Address: -
Each additional inspection over the allowable in an of the above_:
City /State/Zip: _ Per inspection per hour (min. 1 hour) 6250
Phone:
— Fax: i nvestigation fee:
CCB Lic. #: Lic. #: - : ''` 'c: * ' :t r rcaL^+t ii T.. y _ - j..s TT .. ti iftt'iil.' 1i.i.., l'
Supervising electrician subtotal S
signature required: Plat Review (25% of Permit Fee) S
•
Print:Name: Lic. #: State Surcharge (8% of Permit Fee) • $ ,_
TOTAL PERMIT FEE S 'lir
Authorized ' i Notice: This permit application expires If a permit is not obtained within
Signature: ' /L 1 . _ C-......-fw.... D ate: 7 -1 t L' 7� 180 da after It bas been accepted u complete.
'Thi "Fee methodology sct.by Tri -County Building Industry Service Board.
A.D.1 \S_ i t \cam. 1
(Please print name)
i:\Dsts\Permit Forms \ElcPcrndtApp.doc 01/03
07/16/2003 09:53 FAX 5035981960 CITY OF TIGARD E1005
. FOR OFFICE USE ONLY
Mechanical Permit App tie_ C 1,� Mechanical •
' VE
rr)gy: Permit No.: t iw ,f ,100) -- Or)�. (-;`,/ . arming Approval Building
C of Tigard DacdBy; PermitNo.:
13125 .SW Hall Blvd. J 8 2 00 3 Plan Review Other
Tigard, Oregon 97223 Date/13g:. Permit No.:
Phone: 503 - 639 - 4171 Fax: 503 C+ • Post- Review Land Use
.. , i G ARD Datetsy: Case No.:
Internet: www.ci.tigard.or.us '.. _: i� ISIOvContact Juris.: er SeePage 2 for
24 -hour Inspection Request: 503- 639 -4175 // '" Name/Method: $opplemental Information.
a p .,.. sue' ..,„:.;,,g,;5;,.. : - ,; q{ - a i �9., �i m .., -� ;t�.: �
«: � � i;S�.- .:�� i:;.. i .. t' . `` � r'� - "� 1;r.Ltai�'F.� �`�"I�`@!P471� -lt6
. ❑ New construction D Demolition ' Mechanical permit fees* are based On total value of the work
rE Addition/alteration/re • lacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
, . i %)" } "..:: , mechanical materials, equipment, labor, overhead and profit.
•r;.... fir. • Gi 5 1r ?iPJG CI'FI :u .� ? i :FS ;;aY
1 & 2- Family dwelling [] Commercial/lndustrial value: S See Page 2 for Fee Schedule
011
AccessoryBuild ng ❑ Multi - Family F ee( eas ' '` �ti ,i, �? JG1 ` �� - { -ice ti• e Tota '
Description Qty )
❑ Master Builder ❑ Other: ..• : Heatthgg ,Coorkiiti::•; :ii:. ::Mi
, t >Zl :;it__'1' _ ;ir,2! ,e•e \ rtoa.S.itE121Fk ?. Furnace - add - air conditioning** 14.00
Job site address: i 2 0 - 1C% 5i,i) i ■ Cl I O" Gas heat pump 14.00
Suite #: I Bl ./A t. #: Duct work • L- - 14.00
Project Name: 4 '(/UU X l & Residential hot water system 14.00
Residential boiler
Cross street/Directions to job site: • (for radiator or hydronic system 14.00
1...\i 0k) 052) —\ C I \lir-- Unit heaters (fuel, not electric)
l (in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: WAN) 4E144' NO, ; I Lot #:3 /00 Repair units • I 12.15 '`
:.,
. Other Ftiel°IAii liiiiiiii _. •. t 4 { : .
Tax ma • • • el #: t S t 3 4C. ∎ • 3 l 00 Water heater 10.00
* .L '7 ' ,- c, _,Di "ir�i:..,6is t ` � = � " "r! Gas fireplace 10 - 00
,R ck ' � b� 4'Jik'1 Flue vent (water heater /gas fireplace) 10.00
• Q J A-- taS Log lighter (gas) 10.00
4 , Wood/Pellet stove 10.00
V t - pew T .1 Wood fireplace/insert 10.00
.
0,1\ Chimney/liner/flue/vent 10.00
C _;: i Other: ` 7- 1 1 .7 10
,." -; ;FIT. _i -_� . •r'k 'r °:f, e;: , ;t:
Name: No NI Nit, \ .:�. : :...: .. := Eov? ruiimeittint irtiiteitlioviiiiialitii'oa''•F7 >::;. >=:.4
^t Range hood /other kitchen equipment 10.00
Address: \ 20 CU, l lq� Y. Clothes dryer exhaust 10.00 •
City/State/Zip:1'0 1> C),-,.4 Single duct exhaust
Phone: *363 - 64q -II C t I Fax (bathrooms, toilet compartments, / 6.80
• ' 1 -i x;- • - x Gmi ?', ,; L� 1 !. zi if ‘l p 0647 7) I;s .:"..?••;:-.:1 utility rooms)
Nae: a 9-A �' fe 11U Attic/crawl space fans 10.00
Other: 10.00
Address: 23`{ t AJ bet 1 7 _
.., . ;.,::.: :.: pitrie;�-: �
5 : 6 . ti , . > ;.� ;..
City/State/Zip: (j2 C - 211 "(S5.40 for first 4. 51.00 each additional)
Phone: of -- 814 - 6 \, 1 . F ax: aa 204 - 6I03 Furnace, etc. +•
Gas heat pump "'"
E -mail: Wall/suspended/unit heater ""
. ° = c° .: tii w ra'�I :!ii!i. r i• Water heater . ".
Business Name: g.) Fireplace " **
- ,
Address: BBQ ••
City /State/Zip: Clothes dryer (gas) 's
Phone: Fax: Other. "•
CCB Li Total:
MeehailailiTeriiiit:BeedX �•i ;: .:
Authorized
Signature: e- NO � -J3 Subtotal: S
Minimum Permit Fee $72.50 $
(• ._ C 'f o o) P eT > Plan Review Fees25% of Permit Fee) S
(Please print name) State Surcharge ( 8% of Pe Fee) $
TOTAL PERMIT FEE 5
Notice: This permit application expires if a permit 1s not obtained within "Fee m set by Trl- County Building Industry Service Board.
180 days after it has been accepted as complete. " "Site plan required for exterior A/C units.
is \Dos \Permit Form s\McePcrmitApp.doc 01/03
•
08/18/03 12:12 FAX 5038463525 CLEAN WATER SERVICES 0 001
` S Fil. Number 331 S
CleanWater Services Sensitive Area Pre - Screening Site Assessment
Our commitment is clear.
8 A 3 Date
Jurisdiction /arc�
Map & Tax Lot /5/ 3 03100 Owner
Site Address
Contact
/i'eyy;s B% fril «yd
Proposed Activity Add; r ioLl r-o Sic'? _ Address
Phone 5 $l? -6/7/
Official use only below this line
Y N NA Y N NA
Sensitive Area Composite Map Stormwater Infrastructure map;
I I Map# 2 i II 1 QS;tt 43/7
,� Locally adopted studies or maps I Other .our .1 104,-e I EN Specify Specify dw5 9:/e 32.97
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 03 -11:
I Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
I Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
/3-Gscd or rem ;e.# o l C W5 Pe 3219 and .a,/ / v,Goro
porgy l,,/l 3 e•,sil.vr 4. r.4.5 c/o AI ," a /7Dr(2r r0 PX .sr wir4+ti zoo
a 1 rye 5; re.
Reviewed By: G�.! Date: 5/ /5 /o 3
Returned to Applicant
Mail X Fax Counter
Date by 703 By ' '-
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124
Phone: (503) 846 -8621 • Fax: (503) 846 -3525 • www.cleanwaterservices.org
. Permit #: H Tge,05 -- C6 ?j �p 14-
Address: l ?-07() u0 (( 19-0 E__
Issued by: Date: 5/ lo 3
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:
f il 1. I own, reside in, or will reside in the completed structure.
51 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
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 v
,'K, 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
rr
wners about Construction Responsibilities on the reverse side of this form.
V CCV).,u
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant) ,
, . .
Information Notice to Property Owners
About Construction Responsibilities
Note: This Information Notice to Nopertv Owners about Com1retiox Responsibilities
was developed /x' the Construction Contractors Board /x accordance with ORS 70/.05j(j).
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 RESPONSIBILITIES:
}[you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement ofa residential structure, you will, in most instances, be ruled to be an employer and the people
you hire ill be employees. As the employer, ou must comply with the t'ollowing:
Oregon'swithliolding tax law: /suo employer, you must withhold incometaxes from employee wages atthetimc 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
inhrmation. call the Oregon Dept. of Revenue at 945-8091
Unemployment 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 Department ut37D'3524.
Workers' compensation insurance: As an cinplove r,vou are subject to the Oregon Workers' Compensation Law, and must
obtain workers compensation insurance for your employees. I fyou t'ai Ito obtain workers' compensation insurance, you may
hcou6iccttopcna|dosandv@bcUoblohuraUdoimccouJooeof>oorenup|oycosiyi jorcdootbcjob.Furmoroin[onnorion,
call the Workers' Compensation Division at the Department ofConsumer 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 forthe tax payment even ifyou didn't actuallywithhold the tax. For more information, call the Internal Revenue Service
at 1-800-829'1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: A, the permit holder for this project, youur responsible forresolving any failureto meet code requirements
that may' he brought to 'our attention through inspections.
Liabilit and property damage insurance: Contact your insurance agent to see i fvou have adequate insurance coverage for
accidents and omissions such as falling tools, paint ovcrspray, water damage age from pipe punctures, fire, or work that must he
re-done.
•
Time to s 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 ofrough-in and finish
trades;and to notify building officials at the appropriate times so they can perform the required inspections.
|f you have additional questions, write or call the Construction Contractors Board (PO Box |4\40, Salem, O8V7]09'505Z.
50}/378'4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-ovumm4
1194
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line? (q1` 639 -4175 MST (f - 00 k7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested _ - (3-- 3__ PM BUP
Location ( 0 d I r< c f- Suite MEC
Contact Person d-ra —Nk- f ' Ph (L ) '3 /6 - 6D_ n� PLM
Contractor Ph ( k) ) f0 q q — ((q / SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain s0 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing '
Firewall Yr "�' � �M I�► 3 1�+ \� j 0 ei
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
hi 0,
PART FAIL
^�
PLUMBING V v N `( .,1
1 �\�''�( , 11'
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
r:
SS - PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
I_N1—' PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
4 Fi r io m
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE LI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA n
Approach/Sidewalk D ' 05' Inspector \ ^ ,� c y.V ∎ c o Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 - 0e36 , 4
INSPECTION DIVISION - Business Line: (503) 639 -4171
BUP
Received Date Requested / /— 3 AM PM BUP
Location 7 ) / Suite MEC
Contact Person 1 Ph ( ) 1 1 — 9YSa PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Fra
u atio
rywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
.4 1371.1 PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /r —
Approach/Sidewalk Date Inspector / Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 - 603
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested l —3 / AM PM BUP
Location / a 0 70 Suite MEC
Contact Person Ph ( ) r 'f 8 - 7 rr �a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation -
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framin ,06) Gc/e ,Id 1�4fl A,r.
sulation
rywa ailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART
PLUMBING :: d � ' ��
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA l /7
Approach/Sidewalk Dat L �' ��� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 oso� G p
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /U .a 9 AM PM BUP
Location fa - 7 o 1/ '7 Suite MEC
Contact Person Ph ( ) f g 9 V�GZ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Ft und a in n Access: / t! ELC
g / Z /�.4 t �c�a�- 71) j ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
In
Insu ation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P T FAIL
PL MBIN
cam
Unde Slab
ough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ja1;1t«7A
ervice
'Rou
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at Ci II, 13125 SW Hall Blvd.
PASS PART FAIL
'� -% %able to inspect — no access
SITE El Please call for reinspection RE: ,, p
Fire Supply Line
ADA Date 10 /2 q /6 3 l
Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 '0, dy ,3 - Oso 361,
INSPECTION DIVISION Business Line: (503) 639 -4171
:1 •
//
Received Date Requested ( AM PM BUP
Location 7 2-0 70 //9 Suite MEC
Contact Person Ph ( ) 99 9' ' - PLM
Contractor Ph ( ) SWR
ILDI Tenant/Owner ELC
ELC
Foundation Access:
Ftg Drain / S 7-� /�.Th **set-. ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
aming
Ins -.n
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other
P;
SS ART FAIL
< PL�II�I
Post & Beam
Und- Slab
ugh -In
- ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: f
Fin �
T FAIL
ECHANICA ■
Po s Beam
- ough-
Smoke Dampers
• RT FAIL
TRIC
• uqh -I
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
•AS PART FAIL
SITE ❑ Please call for reinspection RE: ri Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date /73d/C.)3
U Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 c 3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested l4 — 2 -3 1 AM PM BUP
Location /0-070 / / `? ° - Suite _
Contact Person Ph ( ) q fo 2.736 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
(:)"
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL --
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 6 -36 , 4=.
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /U Z� AM PM BUP
Location / 4? 76 /1 47 Suite MEC
Contact Person Ph ( ) ` 1 r 1 C) — 7cpci ? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING --
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour T 3 �O ea(e) BUILDING Inspection Li 4It • 39 -4175
INSPECTION DIVISION Business Lin . 03) 639 -4171
c BUP
Received Date Requested Z / PM BUP
`Z
Location ! 2_ 0 70 i i 9 Suite MEC
Contact Person I -ervrl Ph ( ±) 5 90 ' 7 30 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ft • Sr..
Access:
-wl II rai f 1 Y� ELR
� Inspection Notes: - 584 Z � SIT
•ost & Be-..
Shear Anchors i) 6%"1". \ j Ext Sheath/Shear
Int S_heath/Shear
teamin _ OP AM ,.- • 4)
I • T
Drywall Nailing
Firewall ' PO 1 "C p t
Fire Sprinkler
Fire Alarm 42,..AL`" 0 \ , ',
Susp'd Ceiling
Roof - , , ■
Other: _,,L.,,, M �`.
Final ig t �r 6 ` 1e- i1i / c l/�o+n- tom — '
PASS i
7 PLUMBI ` = W C i �� my_ ��
ost & Bea e i � � _ ,
Un•er - • /
'ough -In , 5
► ' . - : rvice _ �_ �a ._ -
Sanitary Sewer 3 c , r � -� ) f i SS
Rain Drains , � , •
Catch Basin / Ma of : (« ` � �_ v e _ A a 14---.,
Storm Drain 1
Shower Pan fM�
Other:
Final 1 i /f vj n
! ` lM�n, yj ti_ �'l/tJ` -� -- D �-1( C-
PASS PART -� �, 1
9 (P 7 Smoke Da rs 1..."_..- i� a � AL ■ '
Final ..1 r _ ∎� / . -
- kJ 0 d .(--'l/`s_r
PASS PAR FAIL
ELECTR L f L i 5 5 L`--t. S 1 -e-X C
Se � - A
Rou -In
✓ (/ \� ✓ �
UG/Slab b
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line ff`` t
ADA Date I V 21 6 Inspector Ext
pproach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST - CO 3�
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested (� �V AM PM BUP
Location77 c 3C-e.1 /(9 /�. Suite MEC
Contact Person Ph ( ) ?/8 5 a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: ; �
Crawl Drain
-%% ELR
Crl Dr t!�
Slab Inspe• Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL 4/
PLUMBING
Post & Beam
Under Slab
i
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
1,
ADA
Approach/Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lin k ) 639 -4175 CO 3 �-oo a69-40 INSPECTION DIVISION Business Lin.. x),539 -4171
_ 5 BUP
Received Date Requested q 6 -- AM /��/ PM BUP
Location / w 76 1 i q '` 4.0 Suite MEC
Contact Person /00P1 ". ii?.f , Ph ( ) 5VO — .s2 736 PLM
Contract r Ph ( ) SWR
UILDI Tenant/Owner ELC
Footing .
ELC
Foundation tl Access: in N,S ' /`.�J ELR
Crawl Drai
a Inspection N • ' -� (�,�.y SIT
Post & Be ...p-72.---
1 ntra chors
Ext Sheath/Shear may/
Int Sheath/Shear (L C 1 '� 3 ` I� /(� /
Framing U `L l�/ (,......j2
Insulation -! 1 4 I„ 22
Drywall Nailing 5� ( / _ I
Firewall 1 A �Q Lev
t) Sprinkler
Fire Alarm f - _
Susp'd Ceiling — // - . �" - -
Roof Gi ,,. - W -
Other: /I
Final - ' as� -- et-Y+� L i m 1 L%---
PA .5 • FAI Q ,
- i tnuf f1Tr aT /6 i (j vt.. � �(
Post & Bea _ /� / ,, /I S 1
Und: r Sla• �� vv d ,�
(
Rou • h -1 / '�
Wat: - rvice ' '
Sanity Sewer),.) II
Rain ! rains
Cat ' Basin / Manhole
St• Drain
S ow r Pan
"i ther:
Final
PASS P , - FAIL
zMECHANIC
Post & Beam
Rough -In c
as i�� ��
Smoke Dampers
Fina
ART FAIL
R ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE III Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
q*' Approach/Sidewalk Date I nspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 ' DC) 3
INSPECTION DIVISION - Business Line: (503) 639 -4171
G� BUP
Received Date Requested / -" 7 AM PM BUP
Location /2Z 2 0 .a 6 / q A---€7 Suite MEC
Contact Person rh iivt vc-- Ph ( ) ( 0 .— //97 PLM
Contractor Ph ( ) SWR
B . ' ► G Tenant/Owner ELC
Footi •�
ound- '• • Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors 'Wed!) �J) ien
Ext Sheath/Shear (/��C�
Int Sheath/Shear
Framing
Insulation �-
Drywall Nailing f3 �f ` ` r e ;3p
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
F'
AS PART FAIL
BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA lj �� Ins Ext
Approach/Sidewalk Date Inspector , p
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
MST — Master Permit
Inspection Description Date Passed By Notes
Grading
Footing/Setback ` / '(e /d 3 '
Foundation walls 44 l / al 11 i'
Slab
Footing drain
Waterproof basement walls
Plumbing underslab
im yawl drain A/2 7/03 (2'6 A - - v.st,t,•► / spduz_
Post/beam plumbing 1 7 '
S
Post/beam mechanical /4/Z -7/ 0 3 r40 fr
�� Underfloor insulation
U� Post/beam structural / o / 30 /o 5 774
Shear walls /anchors
Exterior sheathing / d /83 ZZA
Plumbing top -out / l l)
Gas line & test D 3 -' W (P ):
Mechanical rough -in /a/ e',3 03 4o
Electrical rough-in /v I0
Electrical service
Low voltage
Sprinkler rough -in
Backflow preventer
Roof nailing
Firewall
Framing /h /) 9//5
MFG -Home set -up
Insulation //- c' 3 - D,7 //1
Drywall nailing
.-""Rain drain
Sanitary sewer
Water service
Pump /fill septic tank
Approach/sidewalk
Street Tree Certificate
Grading final _
' ,, Mechanical final
Plumbing final
Electrical final b r,
Final inspection J a//
Special Reports ( frI2? J
SWR - Sewer Permit
Inspection Description Date Passed By Notes
Sanitary sewer
Final inspection
Inspection Record — MST (Master) Permits
iNdsts\forms\TnspRecordMST.doc 04/17/01
. r
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00366
, DEVELOPMENT SERVICES DATE ISSUED: 8/22/03
I'l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12070 SW 119TH AVE PARCEL: 1S134CD-03100
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT: 057 JURISDICTION: TIG
REMARKS: Addition of 384sf.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 384 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 35
OCCUPANCYGRP: R3 BDRM: BATH: TOTAL: 384 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 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:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 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/F DR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 2.00 SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
41. ink
1000+ amp /volt
PLAN REVIEW SECTION 1
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
r i il a g
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
V
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 894.39
This permit is subject to the regulations contained in the
PHOU, LYNN YI + ANG, CHOUNG LIN Tigard Municipal Code, State of OR. Specialty Codes and
12070 SW 119TH all other applicable laws. All work will be done in
TIGARD, OR 97223 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Crawl Drain /Backwater Framing Insp Plumb Final
Foundation Insp PLM /Underfloor Exterior Sheathing Ins F Final inspection
Post/Beam Structural Mechanical Insp Rain drain Insp
Post/Beam Mechanical Plumb Top Out Electrical Final
Underfloor insulation Electrical Rough In Mechanical Final
IP ,
Issued By : J Permittee Signature f!i'l.
Call (5 ) 639 -4175 by 7:00 p.m. for an inspection needed the next business day