Permit y r � CITY OF TIGA MASTER PERMIT
'! S ' -. COMMUNITY DEVELOPMENT Permit #: MST2011 -00072
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/27/2011
Parcel: 25111 AB07100
Jurisdiction: Tigard
Site address: 9280 SW INEZ ST
Subdivision: PENROSE TERRACE Lot: 16
Project: SMITH
Project Description: Master bedroom addition.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 1 First: 192 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 192 sf Value: $19,564.80 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 0 ,
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 0 Other Units: 1
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
• ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 1
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
asing: N
Other: N Other Description: Ecom p
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R -3 192
Owner: Contractor:
SMITH, TRAVIS J & SMITH, AMY J J & M BUILDERS INC Required Items and Reports (Conditions)
9280 SW INEZ ST PO BOX 393
TIGARD, OR 97224 BORING, OR 97009
PHONE' PHONE: 503 - 663 -1424
FAX:
Total Fees: $1,034.73
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 throu• • e. 1.� 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1..800 C;-)C'
.332.2344.
•
_ n Issued By: / !' - ' Permittee Signature: / ka4
Call 50. .6 IA by 7:00 a.m. for the next available inspection date. .
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application ' ' • '
r -,
Residential ` FOR OFFICE USE ONLY
f � r
e
City of Tigard \ Date/B: ['S Permit No.: . 1
• - ° 13125 SW Hall Blvd., Tigard, OR 9 Q�\ Plan Review
Phone: 503.718.2439 Fax: 503.598.9 61-� Date/B : ►/� Other Permit:
T t G A RD Inspection Line: 503.639.4175 Q� N r`so RR Date Ready : t1� bait. ® See Page 2 for
Internet: www.tigard -or.gov (A\ 40\ V , Notified/Method: " 0 / / irt�� i (� Supplemental Information
� C � V x.11, ALL , 1 w / 47'. r rl' �vf Sry 7l
TYPE OF WORK \. REQUIRED DATA: 1 - AND 2- FAMILY DWELLING
❑ New construction ❑ Demdfition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
[ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
[] and 2- family dwelling ❑ Commercial /industrial Valuation: $ ;C+ SIB G;�
❑ Accessory building ❑ Multi- family Number of bedrooms: l a '"
❑ Master builder ❑ Other: Number of bathrooms:
• - JOB SITE INFORMATION AND LOCATION • Total number of floors:
Job site address: CI 2 ef Su.) =v�Z Sine L e. New dwelling area: i 40 square feet
City/State /ZIP: -\--; , , r ek ) 0 yQ GI '4. 7-2, .. Garage /carport area: -_ square feet
Suite/bldg. /apt. no.: .-- Project name: Covered porch area: square feet
Cross street/directions to job site: t( 3 t =vt4.Z S'}'. Deck area: square feet
Other structure area: square feet
A 1 REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: ?V t
+. V _ .41 i eiI k 11 DOrjleOet 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.
L Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: Tr ex u ■ S Aw•y S b-" rk Type of construction:
Address: 4 1 2 g 0 s = v ea. 5 -,- r• t e.,4 Oc cupancy groups:
City/State /ZIP: -T-; g a tr a t ' 0 2 11- Z Z y Existing:
Phone: (5o3 ) c i. d — Al. 10 Fax: ( 503) ( +D - Al- 8 1 New:
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
. (Please refer to fee schedule)
Business name:
Structural plan review fee (or deposit):
Contact name: /
tY Vp FLS plan review fee (if applicable):
Address:
N S
City/State /ZIP: (t) J
Total fees due upon application:
Amount received:
Phone: ( ) Fax: : ( ) YI /� tJI f}A
r
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail:
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted PhotoVoltaic Solar Panel System.
Business name: J 3 tw1 kke,y S AC Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: PC) Q fyX 3_1_3 Solar Installation Specialty Code checklist.
4 City/State/ZIP: S oy cat �l-D0�{ Permit Fee (includes plan review
$180.00
i and administrative fees):
k P� , -i 24 Fax: (5 )64,3 -1
y State surcharge (12% of permit fee): $21.60
CCB lic.: et, , l t 1
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
/ rawS within 180 days after it has been accepted as complete.
I Print name: I r.GwiS S Vt" l'+11\- i I Date: %-t-2.4......11 I * Fee methodology set by Tri-County Building Industry
Electrical Permit Application _
* "; FOR OFFICE USN ONLY
'
City of Tigard Received
4 � �
- DateB : Permit No.. / • (1 oo e2
97223 ° 13125 SW Hall Blvd., Tigard, OR 9722
Phone: 503.718.2439 Fax: 503.598. . t ° ex,. 11" . ; Other Permit:
T l G A R D Inspection Line: 503.639.4175 r f �Q;. ` `: *- Read /By: tuns: Ed See Page 2 for s Internet: www.tigard- or.gov . G 4� Z �� 1 `otified/Method: Supplemental Information
TYPE OF WORK A'Vv, PLAN REVIEW
❑ New construction ErAddition/alteration/repla&� " Please check all that apply (submit 2 sets of plans w /items checked below):
o" ❑ 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
12i- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
El Multi - family El Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
Job no.: Job site address: I Zis .) 0 5 T S1-• c 1 o es. c
❑ Six o or r m more a residential units. ❑ R eceational vehicle parks.
City /State /ZIP: - 1 — S & 012_ �- 2 2 ( �I a ❑ Health za d fcation ❑ Supply voltage for more than
❑ Hazardous locati 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Q 1 3 vil 4... --1---ircZ 5+,,t,,,,,fi' Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Mow> iwv I iCtaJ Nu'1�bcv Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
—/ 200 amps or less 100.70 2
B PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
® (� 401 amps to 600 amps 200.34 2
Name:TA V 1 S • My J (Mi + 601 amps to 1,000 amps 301.04 2
Address: —L Z $0 s L4j .NLGL 5+-LCi....1— Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 1 13 44✓41 Olt t i 7^ 7 I{ relocation
Phone: (50 3) ( 4 . 0 _ Q-„, go Fax: (503 ) G — of i-g 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
('�, Branch circuits - new, alteration, or extension, per panel
Owner signature : — 7 — ge w$' Date: 4 12111 A. Fee for branch circuits with
LK APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit ( 56.18 51 ` 2
•
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 0 60111/4)E(1 , ) panel, alteration, or extension. Page 2 _ 2
f Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: r 1 e
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): (, 7 I
TOTAL PERMIT FEE:
Authorized signature: )_--
This permit application expires if a permit is not obtain d within `180
days after it has been accepted as complete.
Print name: I Date:
Mechanical Permit Applicatio FOR OFFICE.USE ONLY
I City of Tigard \ Received Permit No
" 13125 SW Hall Blvd.. Tigard. Q}A'? -r2 Date /By. �S��.Q(��(xJ�
a '� Plan Review
"- Phone: 503,718.2439 Fax.) s 5 1.1060 e .,,
Date /By Other Permit
Inspection Line 503 r lV+ INC) TIGARD �� Date Ready /Bv Ions El See Page 2 for
ll! Internet. www.tigard - or._ v � �� t�` ?4' 4f P Notified /Method: Supplemental Information
TYPE O . SI VO P ` Mechanical permit fees* are based on the value of the work
❑ New construction ddition /t j r; /replacement performed. Indicate the value (rounded to the nearest dollar) of all
•
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
CATEGORY OF CONSTRUCTION
,�,/ - RESIDENTIAL, EQUIPMENT / SYSTEMS FEES* -
l� 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea Total
JOB SITE INFORMATION AND LOCATION Heating /cooling:
Air conditioning
lob Site address: ta S S yA4 5 f ru' (requires site plan showing placement) 46 75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: r i 9 Ars 0 `2 a■1-Z2. 4 Furnace 100.000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street /directions to job site: c 3 •� A__ ---r1..e2 sr , work / 23.32 ? Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric).
in -wall, in -duct. suspended, etc. 46.75
1‘4+ ` A I eQ Jb v ko°et Lot no.: Flue /vent for any of above 23 32
Subdivision:
V I cu) IV ail J O Other: 23 32
Tax map /parcel no.: Other fuel appliances:
lit DESCRIPTION OF WORK . '� .. ' Water heater 23.32
9 __ ((�� n Gas fireplace 33.39
AAEI's -Flo r, Ci�'-� 0 t W /41- .. ' 'V0 h1/4. Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER 1 ' ❑ "tTENANT��- -" , Chimney /liner /Flue /vent 23.32
�. Other. 23.32
Name: ( v . Ow 1 S )hJ S i' Environmental exhaust and ventilation:
Address: Ct _ 0 S Z v,.e-t_ S . f ._# Range hood /other kitchen
W equipment 33.39
City /State /ZIP: 7-, Are 0 ( 1 - 2- E/ Clothes dryer exhaust 33.39
J / Single -duct exhaust (bathrooms,
Phone: (5o' ) ( -7-0 - q l Fax: (Sol ) ( 4, _ell-$' I toilet compartments, utility rooms) 23.32
— x•APPLICANT' - _. ❑,CONTACT ;PERSON, Attic /crawlspacefans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: 514.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail:
(E Range
. CONTRACTOR Barbecue
Business name: y �� Clothes dryer (gas)
T 3 o.,1d ev =KG . Other:
Address: 9 -
C i 0 �( 3 9 3 ,, ,;.g MECHANTGAL P,ER FEEi„ `, <,•;"
City /State /ZIP: 13 0y.i v‘ii a g, 4► - OOI Subtotal
Minimum permit fee ($90.00) 4U ,a)
Phone: ( S 0 3 ) (, 6 3 - i u 2 4 Fax: (to 3) ` L 3 _ 14 2 1 ] Plan review (25% of permit fee)
CCB lie.: I ( 21 S � State surcharge (12% of permit fee) 0
TOTAL PERMIT FEE P.
■ Authorized signature:
This permit application expires if a permit is not obtained within ISO
//llaJS days after it has been accepted as complete.
Print name: I hdWl S S v.,..l •}k Date: l.' - 1�. ,rl
} * Fee methodology set by Tri- County Building Industry Service Board
I - \Bmlding \Perinits \MEC- PermitApp doe 09/09/10 440 -4617T (II /02 /COMSEB)
0 L• II IN ilii
•
I I MAY 24.2011 .
•
C Clean Water Services File Number
C1eanWate� b �' o ® z 3 3�
•
Sensitive Area Pre - Screening Site Assessment •
1. Jurisdiction: Tigard
2. Property Information (example 1 S234AB01400) 3. Owner Information •
Tax lot ID(s): R0499829 Name: TRAVIS AMY SMITH
. Company:
• Address: 9280 SW INEZ STREET • .
Site Address: 9280 SW INEZ STREET City, State, Zip: TIGARD, OR 97224 • •
City, State, Zip: TIGARD, OR 97224 Phone /Fax: 503.929.1877 / 503.670.9781
Nearest Cross Street: 93RD &INEZ E-m TRAVIS @GOSMITHMORTGAGE:COM
4. Development Activity (check all that apply) 5. Applicant Information •
Addition to Single Family Residence (rooms, deck, garage) Name: TRAVIS AMY SMITH
❑ Lot Line Adjustment ❑ Minor Land Partition Company:
Li Residential Condominium Li Commercial Condominium 9280 SW INEZ STR
• • Address:
❑ Residential Subdivision ❑ Commercial Subdivision TIGARD, OR 97224
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip:
Other Phone /Fax:
503.929.1877 / 503.670.9781 •
E-m TRAVIS @GOSMITHMORTGAGE.COM
6. Will the project involve any off -site work? ❑ Yes El No ❑ Unknown
•
Location and description of off -site work N/A
7. Additional comments or Information that may be needed to understand your project
• SMALL ADDITION TO THE MASTER BEDROOM .
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ
1200.0 Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army
COE. All required permits and approvals must be obtained and completed under applicable local, state, and federal law,
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify .
that I am familiar with the information contained in this document, and to the best of my knowledge and belief, this' information is true, complete, and accurate.
Print/Type Name TRAVIS AMY SMIT , . Print/Type Title PROPERTY OWNERS .
Signature ••ds' .W.Afi Date May 24, 2011
FOR DISTRICT USE ONLY .
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER, If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report
may also be required. • •
t.1 Based on review of the submitted materials and best available Information Sensitive areas do not appear to exist on site or within 200' of the site. This
Sensitive Area Pre- Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently
discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Seotion 3.02.1. All required permits and
approvals must be obtained and completed under applicable local, State, and federal law.
❑ Based on review of the submitted materials and best available Information the above referenced project will not significantly Impact the existing or potentially
sensitive area(s) found near the site, This Sensitive Area Pre - Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order
07 -20, Section 3.02.1, All required permits and approvals must be obtained and completed under applicable local, state and federal law.
❑ This Service Provider Letter Is not valid unless CWS approved site plan(s) are attached. . .
.. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2): NO SITE ASSESSMENT OR
SERVICE PROVID y ETTER IS REQ 1-.6D. � —
Reviewed by OF , ;.-/ > Date 2- ; 0
2550 SW Hillsboro Highway • Hillsboro, Oregon 97123. • Phone: (503) 681 -5100 • Fax: (503 - 4439 • www.cleanwaterservices.org
• . •
..
_ ____ _ _
7 .. " Building Division
, . .
Development Code Provision Review
TIGARD Residential Projects
Building Permit No: ilS7 27) / / )o7) -
CWS Service Provider Letter Received: Yes ❑ No Ei/ /A ❑
Routed Plans:
Original Plan Submittal Date: 5/0 4177
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (V) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact I� 1'115 A dat 503 -718- Z 1 /tZor kris i7-e- @tigard- or.gov)
Land Use Case No '1'A (97 i) Name P- MroSe. Trrr'ace.
Zoning g - q..5
111.
Front .i Rear 15 Side S Street Side / S Garage 2:
C"Maximum Building Height . �S D Actual Building Height i 2
CKVisual Clearance
E �'
L1� Sensitive Lands Type: NO me
Notes:
Original Plan: Approved Er
Not Approved ❑ Date: ' h hi
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope: 4-
Notes:
Original Plan: Approved Not Approved ❑ Date: S S
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
•
Cit Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov)
E f /Street Trees
E3 Protected Trees
Notes:
Original Plan: Approved IJ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ► 1 o •
•
Date Routed to Building: i
Page 2 of 2
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.
I Ng BUILDING DIVISION
TIGARD TRANSMITTAL LETTER
a
TO: 1 DATE RECEIVED:
2
DEPT: BUILDING 'EC:?,MIVED
MAY 1 22011
(FROM: CITY OF TIGARD
Ya�i s "�' BUILDING DIVISION
OMPANY: n Jr✓
PHONE: o —G3 C
RE: f0 ec�e) / tJ Q l! �Y > 7 2 "
ite dress) _ (Permit/Case Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
•
REMARKS: I f�,„, aeLQQA `I- ra�.
•
FOR oyncr USE ONLY
Routed to Permit Technicia Date: : Date ( �, Initials•
Fees Due: ❑ Yes [ No Fee Description: Amount Due:
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\ Forms \TransmittalLetter- Revisions.doc 4/4/07
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Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9280 SW INEZ ST, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
05/24/2013 00:00
MST2011-00072
PASS - C of O
Violation Summary:
Inspector Contractor