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Permit
, ., ,, , , ,. A CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00357 i DEVELOPMENT SERVICES DATE ISSUED: 12/14/2004 I ,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13320 SW KINGSTON PL PARCEL: 2S104DA -18200 SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5 BLOCK: LOT: 008 JURISDICTION: TIG REMARKS: Convert garage to storage. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SEA FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: VALUE: 1,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: . CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: oo SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: loo 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: $ 165.91 This permit is subject to the regulations contained in the SHIDFAR, BENAZ OWNER Tigard Municipal Code, State of OR. Specialty Codes 13320 SW KINGSTON PL. and all other applicable laws. All workwill 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. Phone: 503 - 516 - 6546 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: rules are set forth in OAR 952 -001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Framing lnsp Shear Wall lnsp Gyp Board Insp Bolts in concrete final r Building Final Issued By /C:r2d. / Permittee Signature t s.- Uri -------) 7 Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day 1 3 3 Px3 gW K AApio. p / Building Permit • I i I �n VE d FOR OFFICE USE ONLY . A � Received � , Permit No.: V S te , ,es --O D City of Tigard g � 2 d o�� 13125 SW Hall Blvd., Tigard, OR 97 Plan Review Phone: 503.639.4171 Fax: 503 9 �cUf . I I (AI O Alli, o1 „°'i , Date /By. Date/By 't ruJ Ao lt a✓�' �� Other Permit: . 9 . } Inspection Line: 503.639.4175 t�, ■ Date Read •/By: ® See Attached Checidist for Internet: www.ci.tigard.or.us BUILDING DIVISION „ Notified/Method: Supplemental Information ... TYPE OF WORK •. " D: - REQUIRED DATA: 1- AN2- 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 ,` IlkAddition/alteration/replacement 0 Other: equipment, materials, labor, overhead, and the profit for the ” _ , CATEGORY OF CONSTRUCTION_ - work indicated on this application. p cry 0 t- and 2- family dwelling ❑ Commercial /industrial Valuation: $ MOO ''.----- ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: ".. m ; " , JOB SITE ""'INFORMATION AND _LOCATION Total number of floors: `,-_.) Job site address: , 933 0 (5/0 k I n * - pi- New dwelling area: square feet City /State /ZIP: T 1 S a Y4 cs '11 Z Z 3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet (� Cross street /directions to job site: \ n Deck area: square feet (,- -0AessctR -V l v[A.O Yet.t Other structure area: square feet REQUIRED DATA COMMERCIAL -USE CHECKLIST'.` Subdivision: 43' 10 0 f\ ''.611/415.) Lot no. : 8 Permit fees* are based on the value of the work performed. Tax map /parcel no.: a S I �{ DA I 2 equipment, the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK • " a work indicated on this application. 'j) Valuation: $ � � �� ' Existing building area square feet New building area: square feet :. , :PROPERTY OWNER, ❑ TENANT Number of stories: Name: , .E) P�h - CCZ, d J � h ■ "d Type of construction: 'V Address: ) ', , 1 St,O. \ )r/ 1' Occupancy groups: City /State /ZIP: T \ e (d / bt- G l 272-- 3 Existing: Phone: ((J ) 14) _ LD G t4U Fax: (()) 579 — I ,_ (0 / New: . ❑ -APPLICANT - ` „❑ CONTACT .PERSON` - NOTICE. Business name: All contractors and subcontractors are required to be Contact name: (,i)yl Qom✓ licensed with the Oregon Construction Contractors Board y, � under ORS 701 and may be required to be licensed in the Address: 133 t9-0 S jam) K 1 C k J ,, j p . jurisdiction in which work is being performed. If the City /St. te/ZIP: I /� applicant is exempt from licensing, the following reasons apply: jj _ t%` LZ �j Phone: (�O) 5 I Co — ( 5 U Fax: : ( ) 7 •-- /.L. (a / Iii 1 602 . 50 E- 4n . (03 CONTRACTOR . $ - O D Business name: 0/4) BUILDING PERMI FEES*. Address: Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB-Iic.: Date received: Authorized signature: Alb ■ P This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits\BUP- PermitApp.doc 12/03 ' 440 -4613T(I1/02/COM/WEB) • One- and Two - Family Dwelling � _ , , • Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received " ' Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 /G,ie Op1, 1%:: 24- Hour Inspection Line: 503.639.4175 � I ❑ Electrical'i ❑ Plumbing 0 Mechanical Internet: www.ci.tigard.or.us ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ 0 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district rpproyal required. Name of district: . 0 ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ 0 ❑ 7 Water district approval. ❑ 0 ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ 0 ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ [] ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to.clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑ , prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the •ro'ect under review. JURISDICTIONAL. SPECIFICS 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, I ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\ Building \Permits\BUP- RES- PermitApp.doc 2 Electrical Permit,ApRECEIVED .. . .,.... ,.., . FOR OFFICE USEONLY . City of Tigard Received 1 Permit No Th5 .:r -6 13125 SW Hall Blvd., Tigard, OR 97223 NOV 2 Li 2004 A Date/By: 1 % ,.... / ,, 0 - 0 M Plan Review ,. Phone: 503.639.4171 Fax: 503.598.1960, 4 i ii iiiipiti I al\ Date/B : Other Permit: Inspection Line: 503.639.4175 c;ITY OF TIGA .'4.1,1,• '''- .• . 41. Date Ready/By: Jun: Ei See Page 2 for Internet: www.ci.figard.or.us BUILDING DIVIS • • ' Notified/Method: Supplemental Information MTr ..i, tArI . brikbibIZIPARKTSWIE1 .k:V:*'':::gRZtaikhlPWtPLird■'igaMWIt',: :: .'''' ' ' - ,,, - .,•.,., - _ ' New construction lAddition/alteration/replacement Please check-all that apply: 0 OService over 225 amps, cornm'l 0 Hazardous location Demolition 0 Other: OService over 320 as amps - rating EBuildng over 10,000 sq. ft., 7 .t11l' Tr rAlfAir l" ''V' l P IK TC'.KEZNW : Vr*Zgflirff61q r k l r'X lr MV I , :n.-rrr;.- , :e!:.::' - ;nil. , , . ' ,;',4, 7 ' '4,4:Zit;41 of 1- and 2-family dwellings 4 or more new residential b' 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure DBuilding over three stories [Weeders, 400 amps or more 0 Multi rj Master builder 0 Other: [' MgrAigki5007”4 ' .. _=,: .„ Occupant load over 99 persons DManufactured structures or ' 1 . 4n4..rc,*IP'L*7i*ialtte - ,„,',,,,'„ilz.e4,;„.::.,..•:....1:' , 21, , , .:4,,,,,opos t , , g:a ,E plan RV park Job no.: Job site address: / 33,10 sto .Kine:ii,M pi . oHealth-care facility [1Other: Submit 2 sets of plans with any of the above. City/State/ZIP: T S a yr ! Or 9 7 2 t The above are not applicable to temporary construction service. fttiiMEMWET*7.tKftH Suite/bldg./apt. no.: - Project name: t 7 :' Description Qty. Fee. Total *` Cross street/directions to job site: New residential single- or multi-family dwelling unit. Includes attached garage. L G e + bit-LO n i-t--t 1,000 sq. ft. or less 145.15 4 Subdivision: j3 loon 6 -1-in, Lot no.: ./, F Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map/parcel no 2. S 1 (.4 .1) ft - 1 12-00 „_ ,..,,. Limited energy, non-residential 75.00 2 Ilg Each manufactured or modular dwelling, service and/or feeder 90,90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 Ma,: Y-'„, ,:•1 w w-i-wizmIterAwArz 201 amps to 400 amps 106.85 2 A.Wir."'Aqvg!0.$4.......;‘ilinit.:A 401 amps to 600 amps 160.60 2 Name: (F3 a 2_ ( 511 , t_ ' J JO v . 1 601 amps to 1,000 amps 240.60 2 Address: / 33 a 0 6 (A) lel 1 /Obi Pl- Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: T) CI t(61 (). q 7 2,2, I Temporary services or feeders installation, alteration, and/or .._ J relocation Phone: (sk5 Is- ( - (0 5 (fi Fax: (51) 5 ) 79 -)4. ic ) 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, leasr , r"change, cor . ORS 447, 449, 670, and 701. i 1 I s _ 1 0 4 Branch 401 narreth circuits i t r o c 6 O _ new, amps 133.75 2 ? Owner signature: hl Date: , alteration, or extension, per panel W '' op wrwita A. Fee for branch circuits with " '"'''''''' t "' service OT feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: E o Ae i" without service or feeder fee, / 46.85 2 each branch circuit Address: ) 3 0 s 1,6 )K ,,,- 4 Each add'l branch circuit / 6.65 2 City/State/ZIP: -r - i OK (11 2.. 3 Miscellaneous .(service or feeder not included) Pump or irrigation circle 53.40 2 Phone: S/15 )6 ( _ 4/ s L Fax: : iZO 5 ) - „S - 7' _ fj_c„/ Sign or outline lighting 53.40 . 2 E ' --) Signal circuit(s) or limited- 47.4M1W-MtnigA gargq.*:1-WWPWA:MatinV:MagiZikAR energy Panel alteration or extension. Describe: Page 2 2 Business name: Otchu-r Each additional inspection over allowable in any of the above Address: Per inspection 62.50 City/State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 Iiii! - WW1440ICRISOWErtg l ilMaM CCB Lie.: Electrical Lie.: &wry. Lie.: Subtotal 5 S° Suprv. Electrician signature, required: Plan review (25% of permit fee) - - - - -- - State surcharge (8% of permit fee) 2./ . .04 Print name: Date: TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board ** Number of inspections per permit allowed. i: \Building\Pertnits\ELC-PermitApp doc 12/03 440-4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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: Fee for each commercial system $75.00 (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\Pennits\ELC- PermitApp.doc 04/03 I . Permit #: (U}S i c94004 -- 00 357 0 K ��'�� Address: / A1657 PA . � Issued by: ` / /1/ /V 9 Date: 11 1 8 . 5 9 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: 1. I own, reside in, or will reside in the completed structure. --l-p 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. n 3A. My general contractor is I I (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 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 Owne .. 1 o , t Co esponsibilities on the re verse side of this form. ' (--(-----/ / .// 3 (Signature of permit applicant) - (Date) (White copy to issuing agency permit file, pink copy to applicant) 1 • l[nlovmallon Nonce RI) Property Owneps ArQ© ConWrucNon glespone 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 ne.v. 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. 14 RESPONSOBEUITfiES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ef 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 wqbholle.ling tax caws As an employer, you roust withhold income taxes from employee wages at the time employees are paid. You will be liable fot 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. UneutpP.oymeEt frilSalraGCC taz „' As ?fl employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For mere infcrmation, call the Oregon Employment Division at the Department. of Human Resources at 378-3524. Wo:rken' corroperpsaton iTailleZEICC: As an emp!oy you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensatio.: Insurance for your employees. If you fail to obtain workers compensation insurance, you may be subject to penalties and w;l1be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensadc.n Division at the Department of Consumer and Business Services at 945-7888. U.S. 1 ne Sezcios..-: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even f you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. CINHIR MESPONSPMUMES AND AREAS OF CONCERN: Cede compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirernents that may be brought to your attention through inspections. Liability and proli damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents 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 yArhave 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 • Igilf 05 -07 -1900 11:20AM FROM 2 503 3572350 TO 5035981960 P.01 01/19/2005 14:20 FAX 5035981960 CITY OF TIGARD (1001 CITY OF TIGARD 13125 S,W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE -ewNER- Electrical Signature Form Permit #: MST2004- 00357 Date Issued: 12(1412004 Parcel: 2S1040A- 18200 Site Address: 13320 SW KINGSTON PL Subdivision: QUAIL HOLLOW - SOUTH Block: Lot: 008 Jurisdiction: TIG Zoning: R.4.5 Remarks: Convert garage to storage. Your company has been Indicated as the electrical contractor for the permit indicated 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 to the address above, ATTN: Building Division. No electrical Inspections Will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: SHIDFAR, BENAZ - A ?1d � ►e iC) ; rIC _ 13320 SW KINGSTON PL. X __ TIGARD, OR 97223 Phone #: 503 - 518 -846 xL=- ,...... Phone #: x S .-.57-350 Reg #: AN INK SIGNATURE IS REQUIRED ON THIS FORM X 4 . ALP. 4 Signature of Supervising Electrician - s, please call 503.718.2433, TOTAL P.01 CITY OF TIGARD 24 -Hour BUILDING ,. Inspection Line: (503) 639 -4175 6& INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received • Date Requested AM PM BUP Location / 3 3 pc_ Suite MEC Contact Person Ph ( .) PLM Contractor Ph ( ) SWR BUILDING Tenant/OvI �X � ,el. ELC Footing (� , 7 r (,c I` f2)ELC Foundation Access: Ftg Drain ELR Crawl Drain • Slab Inspection Notes: = — O - SIT Post & Beam - /111..,n Shear Anchors Ext Sheath/Shear V)t Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: PART FAIL • , _RING ° ,. 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 ° ri Please call for reinspection RE: E Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Dat Inspector ' i Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL