Permit a MASTER PERMIT
• A. CITY O F T I G A R D � PERMIT #: MST1999 -00159
� 1 DEVE ard, SERVICES 639 -417 / DATE ISSUED: 5/6/99 Blvd.,
SITE ADDRESS: 09595 SW LEWIS LN PARCEL: 1S135CD -03600
SUBDIVISION: RUTH * ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Single- family addition .
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 18 FIRST: 875 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 575 sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 5
VALUE: $ 100,978.00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: sf REAR: 45
PLUMBING
SINKS: WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 3 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: ' OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 6 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: 1 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: 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: $ 1,018.48
This permit is subject to the regulations contained in the
LEWIS, SEAN M + JANEL K OWNER Tigard Municipal Code, State of OR. Specialty Codes and
9595 SW LEWIS LN SIGNED RESPONSIBILITY FORM all other applicable laws. All work will be done in
TIGARD, OR 97223 IN FILE 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:
•
Phone:. Phone: • Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OIJNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion 844 -8444 Underfloor insulation Electrical Service Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Mechanical Final •
Foundation lnsp PLM /Underfloor Framing Insp Plumb Final
Post/Beam Structural Mechanical lnsp Insulation Insp Final inspection
Post/ m Mecha -I Plumb Top Out Rain drain Insp Building Final
Issu By : ' ■ .. ! , . Is Is. 2 A .0 Permittee Signature :. Ifrl II I I. _ a • •... ill
Call (503) 6394175 by 7:00 p.m. for an inspection needed th ,, business day
•
•
CITY'OF.TIGARD Residential Building Permit Application Plan Check# 9-4' 8 /.e •:13125 SW HALL BLVD. Additions or Alterations Date Recd4 - o-f
TIGARD, OR 97223 - Single Family Detached or Attached (Duplex) Date to P.E. •
V 503 - 639 -4171 Date to DST s -1I
F 503 -684 -7297 Permit # 015T I G�(
Print or Type Called ii
Incomplete or illegible applications will not be accepted 9 / //
, 415 ,,PPS• -1
Name of Project Name •
Job Ssto,ii 61„Si S t-taDEL f aD137?.l. S idNA y
- De_ it.vtii
Address Site Address Architect Mailing Address
ct515 5.1.... Leuits LA.
- 1(6.5 5,1,_N . Fig IQa
�m ..Cif /State Zip Phone
:SEAM S l t lI l-t� , OR —1 Lai-L-6655
• Name
Owner Mailing Address
9595 s -1.3 . Lt 1.4.1. is 5.0,--/-1
City/State Zip Phone Engineer Mailing Address
1 Cit. I12Z3 ‘341-102-7 City/State Zip Phone
General . Name
Contractor 6 64I,IER- Describe work New 0 Addition jl "Alteration 0 Repair 0
Mailing Address to be done:
Prior to permit Additional Description of Work:
issuance, a copy City /State Zip Phone
of all licenses
are required if Oregon Const. Cont. Board Exp. Date PROJECT J �� ���
expired in COT Lic.# VALUATION
database
Mechanical Name NEW CONSTRUCTION ONLY: •
Sub- C 4IJ Sq. Ft. House: Sq. Ft. Garage
Contractor Mailing Address /4Sa
Prior to permit Indicate the restricted energy installation by the electrical
issuance, a copy City/State Zip Phone s ubcontractor in the following areas
of all licenses Restricted Audio /Stereo
are required if Oregon Const. Cont. Board Exp. Date Energy. System arms
expired in COT Lic.# Installations Vacuum -- Irrigation
database System System
Plumbing Name (check all that Other:
Sub- O W I.LEP� apply)
Contractor Mailing Address Corner Lot YE ' NO Flag Lot YES NO
(check one) (check one) ,
Has the Su ' sion Plat recorded? ---- ----N/A YES NO
Prior to permit City/State Zip Phone - •- \
issuance, a copy
of all licenses are Oregon Const. Cont. Board Exp. Date
required if Lic.#
expired in COT I hearby acknowledge that I have read this application, that the
database Plumbing Lic. # Exp. Date information given is correct, that I am the owner or authorized agent
N of the owner, and that plans submitted are in compliance with
l - Oregon State laws.
Name Si :ture of O+ nelent D to
Electrical 01► -T1. — / ' `' -99
Sub- Mailing Address --Cg a �" , L, I S o q I ci/ ce ll
Contractor 631' 4 o 21
City/State Zip Phone • 1, bile
Prior to permit
issuance, a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const. Cont. Board Exp. Date Plat #: Map/TL#:
required if Lic.# p
expired in COT ,
database Electrical Lic. # Exp. Date - -- - _ Setbacks: Zone: ,p _ � Solar: // _
Electrical Supervisor Lic. # Exp. Date Engineering Approval: Planning Approval: TIF:
• i:\dsts \forms\sfaddalt.doc 11/20/98
J
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit #: MST1999 -00159
Date Issued: 5/6/99
Parcel: 1 S135CD -03600
Site Address: 09595 SW LEWIS LN
Subdivision: RUTH
Block: Lot: onl
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Single- family addition
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 Dept.
No electrical inspections will be authorized until this completed form is received
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: ELECTRICAL CONTRACTOR:
LEWIS, SEAN M + JANEL K OWNER
9595 SW LEWIS LN
TIGARD, OR 97223
Phone #: Phone #:
Reg #:
X vUY
Sig - re of Supervising rician
If you have any Questions. please call (503) 639 -4171. ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Plumbing Signature Form
Permit #: MST1999 -00159
Date Issued: 5/6/99
Parcel: 1 S135CD -03600
Site Address: 09595 SW LEWIS LN
Subdivision: RUTH
Block: Lot: 001
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Single- family addition
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work .
No plumbing inspections will be authorized until this completed form is received
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: PLUMBING CONTRACTOR:
LEWIS, SEAN M + JANEL K OWNER
9595 SW LEWIS LN
TIGARD, OR 97223
Phone #: Phone #:
Reg #:
i ' • ' IA
Sig; ure of Authorized '" rber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any Questions, please call (503) 639 -4171, ext. # 310
Permit #: R,P7999— 0 /5 '
OF 0
% "'�' Addrg SW G E G cJi S 'cJ •
. - ,,, Iss ed by: I. , . . / iii■ AI ., ' #i .te: lP F7
Li---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:
``! . I own, reside in, or will reside in the completed structure.
goo 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
WI 01 before or upon completion.
ri 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
•
r i B. I will be my own general contractor.
IF
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of thi for .
Ali Il ! b _ ._!.y1r, 5
OP o permit applicant) ',ate)
(Signature P PP ) ) - --
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945 -8091.
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 Division at the Department of Human Resources
at 378 -3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at I - 800 -829 -1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re -done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you ,have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052,
503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop- own.pm4
1 /94
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 1 g ooi59
INSPECTION DIVISION Business Line: (503) 639 -4171
q BUP
Received _ Date Reque� ed ! a ( AM ' PM BUP
Location s 9 S i Suite MEC
Contact Person Ph ( ) 52-2- S-Ltel PLM
Contractor Ph ( ) SWR
UILDING Tenant/Owner ELC
Foundation ELC
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 ,,��//�� �
/47 fi r: 19 I
/412a_ PART FAIL
Post • - -; m
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole � 5 741/ / /'
Storm Drain
Shower Pan
FAIL � ^
F /
CHANIC. 7
PosT$eam
Rough -In
Gas Line
Smo a Dampers
T FAIL
ELECTRICAL
e1
Rough -In
UG/Slab
Low Voltage
= Alarm
1111 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line —
ADA
Approach/Sidewalk Date - _ nspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART • FAIL