Permit AV CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00178
r� DEVELOPMENT SERVICES DATE ISSUED: 6/9/2005
'� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 AB -00400
SITE ADDRESS: 09100 SW MCDONALD ST ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Addition.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 560 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 528 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: THRD sf RIGHT: 5
VALUE: 64,574.40
OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 560 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: 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: CLOTHES DRYER: 1
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
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: 1 0 - 200 amp: W/SVC OR FDR: 5 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 • 400 amp: 201 - 400 amp: 1st IMO SVC/FOR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 800 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amp6•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:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
DITTY, JOSEPH MICHAEL OWNER and all other applicable laws. All work will be done in
9100 SW MCDONALD ST accordance with approved plans. This permit will expire
TIGARD, OR 97223 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
Phone: 503 - 624 - 6848 Phone: 503 - 475 - 3180 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
TOTAL FEES: $ 1,349.66 Reg #: direct questions to OUNC by calling 503- 246 -6699 or
1- 800 - 332 -2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Issued By : ., .. __ G _ _. .t-J Permittee Signature : /
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business thy.
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.
c
Building Permit Application FOR OFFICE USE ONLY
City of Tigard 2F� ECEIVE ► � RDeact 1� - Permit No.. ST.2 061 7}`"
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 P ;_i( - l I Date/By: /t1A 6 - .2 - U 5 Other Permit:
Inspection Line: 503.639.4175 t -_1_ Date Read B : 7uris: ® See Attached Checklist for
Internet: www.ci.tigard.or.us MAY 2 0 20 1 -� t Rea eth ���� r` � Supplemental Information
CITY OF TIGARD - 7 1'T t
11#4IISION REQUIRED DATA: 1- AND 2- 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
X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
�1 -and 2- family dwelling ❑ Commercial/industrial /
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: I
Job site address: 910 SW M' DoAmt_o 5T New dwelling area: 500 square feet
City/State /ZIP: 'y l C A g T OR C 7 22.3 Garage /carport area: 4 S.7 tare feet
Suite/bldg. /apt. no.: Project name: - j) / `; 12 ES 117EN CE Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
E /4 51 O F Q 3 1 — o v, M Donald Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
O FF/G.E /001 /art To EY, ST //UC- 1RE5 / DE ,iE G Valuation: $
GR R AG — ( D E Tn c-H ED ) Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: M /K6 / 7r y C #5 Type of construction:
Address: 9/00 5/../ M. 4 DO/4/1Z-/) Sr To3 - 7 y0' q>87 Occupancy groups:
City/State /ZIP: -7-/64 go wk 3121954 Existing:
Phone: (5o3) t (o /g Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
h apply:
Phone:( ) Fax::( )
E -mail:
CONTRACTOR
Business name: hO/YI6Qjv / Vfk
' BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.: .
Date received:
Authorized signature: M il�� D , This permit application expires if a permit is not obtained
'l within 180 days after It has been accepted as complete.
Print name: Ly//L� e.l L Date: 5 ZO OS * Fee methodology set by Tri -County Building Industry
Service Board.
i:\ Building \Permits\BUP- PennitApp.doc 12/03 440 - 4613T(11 /02 /COM/WEB)
One- and Two - Family Dwelling
. Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard
Received
Date ey: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 l ❑ Electrical ❑ Plumbing ❑ Mechanical
24- Hour Inspection Line: 503.639.4175 � `:—
Internet: www.ci.tigard.or.us ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
. 4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
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 Cojnplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
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 ap plicable 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, ❑ ❑ ❑
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 • `•' '�1V E It FOR OFFICE USE ONLY
City of Tigard Received Date/B : Pemit N ' 61 - , , 0 6 - 0 6 , 7 r
13125 SW Hall Blvd., Tigard, OR 9722�1�1 Ay 20 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 §6 z �f ; ,' 1 ' Date/B : Other Permit • Inspection Line: 503.639.4175 CITY OF TIGARD ` RD - - ''` 41_1 I I Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us
BUILDING ®I�B9���� Notified/Method: Supplemental Information
'..= ;: i'• .:s+ ;:;::e'r :I:
-, :'TYP E;'O '•' R
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; ; ��:' '�+.. _,.) , ... .. • •�. " ;i;�. =' ` - "�� .�:�''� �i;�'Z � .
;�{ ��' . 1 �.:: r:• _ °'i�• . 4..
�" ' "PLAN.-REYIE3'V.'
❑ New construction 4- Addition /alteration/replacement Please check all that apply:
❑ Demolition
OService over 225 amps, comm'l ['Hazardous location
❑ O ther:
j . ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
';'_';•J'-'f'''..7: „ar 1 'T , „�CATECOR qE C O NSTRUE,'f LOIN; ; - ry--`i` °" ,' %a= " "•=` of 1- and 2- family dwellings 4 or more new residential
1S1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
."P'.7 ' `:: : -'- OBSTE , ,IN
, , r� O OC ' 'a'` - •, .-. ' --,; ' RV park
'. :�, 5 r ' .: ^ � I ,... RAI.. ;< K,du . 7 . - O_N ' ,'s' =._ _ . ' ' ❑Egress/lighting plan P
Job no.: Job site address: 9 100 54..) Me - ❑Health -care facility ❑Other:
bG,e l At. D 5T Submit 2 sets of plans with any of the above.
City /State/ZIP: 'T7 G R. i O(Z. 9-7723 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: • i. . 1 ,. " ` F * <SC D.
. Description I Qty. I Fee. I Total I .•
Cross street/directions to job site: f as r .p 9 3 I New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
-.' 3 .1 ',...0.:::',i-.+., ` • 1, ` * 4'4' - ES [ O =}3 ' �u' r•` iy ' '' Each manufactured or modular •
OFF/C.- i 4 D )) 1 ill TO au STI ,o6- I/o yytE A >✓D dwelling, service rs installation, feeder 90.90 2
Services or feeders instaallation, alteration, and/or relocation
A Aica.) )7 ETA C HEl) G- 'A I2/t(st 200 amps or less I 80.30 2
'',.`,.'--• +° PROPER OWNER'''j" `" R" i` ; ' '' 4 ' ' ' ' ❑ TENANT - 3 ` , -' =' ,, 201 amps to 400 amps 106.85 2
I ` . ' - ••.. - 401 amps to 600 amps 160.60 2
Name: /Vl l ItC j7 (Ty 601 amps to 1,000 amps 240.60 2
Address: 1100 Sf.J me bok, }LD 5T Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: J (r/f 'R 3) OR q 223 Temporary services or feeders installation, alteration, and/or
(St�j ) (oZ 6$ yg, ( ) relocation
Phone: � Fax: 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, lease, rent, or exchan e according to ORS 447, 449, 670, and 701. 401 amps to 600 a 133.75 2
Owner signature: ..-- 1 1 .'t —34 'I Date: O f Branch circuits - new, alteration, or extension, per panel
°• �`' }' 4 A. Fee for branch circuits with 5 .
a: �: � u.. _ t, �',�lPPLIC'" ��.'� �',''� �.�d ��� .;x'k. il'' t 1VGT?:P � O ' �' ���,, -::•
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
ps - -,r .4+1 - '° ,TOR .r • � ' °` -,.r' • . `c ,_ u, energy panel, alteration or
,
!f•- K .spa- .,, :;r ..::::4 < �,.. { 'i ,:
/ extens Descr Page 2 2
Business name: (/ a)
Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/ State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
.. %.L:. " _-ET)ECT CAL :PERMTL.'•k ES'1,:'. .7.7...
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
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:\BuildinePer u\ELC- PennitApp.doc 17103 440-46 1 5T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
S!'
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
is \Building\Pmnin\ELC- PmrmApp.doc 04/03
Mechanical Permit Application FOR OFFICE USE ONLY
{^ E D Received
City of Tigard Date/By: Permit No.�/l S 1' S - t 11 e x
13125 SW Hall Blvd., Tigard, OR EiE P lan Review ���
Phone: 503.639.4171 Fax: 503.598.1960 Oe,.� • r ;\ Date/By: Other Permit:
6 ` G
Inspection Line: 503.639.4175 !a fl 0 2005 { 616•I I , Date ReadReady/By: Tuns: El See Page 2 for
Internet: www.ci.figard.or.us g Notified/Method: Supplemental Information
CITY OF TIIGARD • BUi, £kp i' Ni • _ „ COMMERCIAL FEE:', 'SCHEDULE -.USE CHECKLIST
0 New construction 4 Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• Value: $
CATEGORY OF CONSTRUCTION
m >, • RESIDENTIAL EQUIPMENT /,SYSTEMS FEES*
01- and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
' JOB SITE INFORMATION AND LOCATION .. • 1 ' Heating/cooling
M C N GD _ Air conditioning or heat pump
Job site address:
9 too SG_► /' 5y (requires site plan showing placement) 14.00
City/State/ZIP: -y j 6.-A R. b O 12 C 7 Z7-3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: D f 7)' - ge5 t Di. Ay e,
Gas heat pump 14.00
Cross street/directions to job site: Duct work / 14.00 1
CO n Hydronic hot water system 14.00
`EAST C O 7` Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK; . Water heater 10.00
Gas fireplace 10.00
0 E W OFF )GE AD D' n.) /flub Flue vent for water heater or gas
DE 7ftGfl. D G' P.A &f L og l igh 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER . 0 TENANT Chimney/liner /flue/vent 10.00
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT . •❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace / /
E -mail: Range
'-• ''' CONTRACTOR . • Barbecue
Business name: �C/Oii/f6-0,1/t/ Clothes dryer (gas)
/ , Other:
Address: MECHANICAL PERMIT FEES* "•. '' '' '
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
, A TOTAL PERMIT FEE
Authorized signature: L d/
ature: ,s- T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /4 / K 6 'D / TT j/ Date: 2.40,--pr • Fee methodology set by Tri- County Building Industry Service Board
i:i Building \Permits\INEC- PermitApp.doc 12/03 440- 4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard • ,
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: - Permit Fee: • .
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
' Building Fixtures
COVED
Plumbing Permit Ac tion FOR OFFICE USE ONLY
City of Ti and `` 2 0 2005 Received
13125 SW HallBlvd., Tigard, OR 97223 tH Date/By: Permit G f p276 9_c of 7 g'
qY OF TIGARD Date/By: Plan Review
Phone: 503.639.4171 Fax: 503.598. / /H°�'�c�y � ,�
Ca Other Permit No.:
24 Line: 503.639.4 Hour Ins ection •
p bd J IL®ING ® 'v8S'`. f:.- Date Ready/By: Juns: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK 1. , . - ... FEE* SCHEDULE..'
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
; CATEGORY OF CONSTRUCTION SFR (1) bath ki 249.20
›! 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
. Fire sprinkler ( sq. ft.) Page 2
. - JOB 'SITE INFORMATION AND LOCATION • , Site utilities
Job site address: 47 / O S (A) / Ji c /)pvili D g1-- Catch basin or area drain 16.60
City/State/ZIP: Tl &A (3 Drywell, leach line, or trench drain 16.60
Suitelbld /a t. no.: Pro ect ttame: Footing drain (no. linear ft.: Page 2
g P I J D l7Ty �kES I DE/.1C� Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
5i- ° .1(a p f Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• PROPERTY OWNER ' ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: M / KE 1) ''7ry
Expansion tank 16.60
Address: 9/ pp 5a.) M trebo N f L. D 5 * Fixture/sewer cap 16.60
City/State/ZIP: - 1 - 76-.A RD Floor drain/floor sink/hub 16.60
Phone: ( 503 ) ( Zy - (pgy g Fax: ( ) Garbage disposal 16.60
❑`APPLICANT ',,, . ❑ CONTACT PERSON Hose bib 16.60
- " " Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name:
Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) p ax:: ( ) Sink/basin/lavatory / 16.60
- Tub /shower /shower pan / 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet / 16.60
Business name: f/0/ 7)6R Water heater 16.60
Address: Other:
Subtotal
City/State/ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
TT • � /
State surcharge (8% of permit fee)
Authorized signature: J r TOTAL PERMIT FEE
Print name: " D / 7T y Date: s -- 2.0-05 This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pennits\PLMF- PcrmitApp.doc 12/03 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities - Qty. Fee_(e Total Square Footage: ` Permit Fee:^.; ;:.•4k ,
Footing drain - 1 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 -''
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' t 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item • Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00. •
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace ,
•
New Moved Existing C apped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ BuildingVermits \PLM- PermitApp.doe 3/03
Permit #: H' rbDO5 — O0/ 7 �
Address: goo e).) )-1C r
Issued by: ( K I L5 Date: IO g /05
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:
y 1. I own, reside in, or will reside in the completed structure.
4 L1 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
0 ,) 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
Q 1 4 114t- 9- . LCI:6 q9 1 D
(SYgnature of ermit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
43
•
• information Notice to Property Owners
. About Construction Responsibilities
Note: This Information Notice to Properly 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 Department 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. Ifyou 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 ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1- 800 -829 -1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the perm it holder for this project, you are responsible for resolving any fa i lure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see ifyou 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 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
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
DICKENSON'S ELECTRIC
8449 SW BARBUR BLVD.
PORTLAND, OR 97219
Electrical Signature Form
Permit #: MST2005 -00178
Date Issued: 6/9/2005
Parcel: 2S111 AB -00400
•
Site Address: 09100 SW MCDONALD ST
Subdivision: •
Block: Lot:
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on
scope of work.)
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:
DITTY, JOSEPH MICHAEL DICKENSON'S ELECTRIC
9100 SW MCDONALD ST 8449 SW BARBUR BLVD.
TIGARD, OR 97223 PORTLAND, OR 97219
Phone #: 503 - 624 -6848 Phone #: 503- 246 -3550
Reg #: LiC 65534
ELE 26 -140C
SUP 3100S
•
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature - upervising Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MSi':?t0t);': 4101713
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/200? Phone: (503) 639 -4171
A 9� ,'�
Inspection Requests (24 Hrs.): (503) 639 -4175 F__—
INSPECTION WORKSHEET FOR DATE: 51!2006 TIME: f:01AM PAGE: 0
SITE ADDRESS: 09100 SW MCDONALD S I CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: [)ITfY
DESCRIPTION: Garage addition. (9/9105, residential addition withdiown, gt,r:ige to rem on vcope of work.)
OWNER: Dil TY, JOSEPH MICHAEL, PHONE #: r■0:3 624-(4343
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 517/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Filial inz ection 029114-0 I 603.704-32136 N
Corrections /Comments /Instructions: a
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i1/f, 4 Date: 5 ---2---116 Phone #: (503) 718- 2_ l / 16--"/
CITY OF TIGARD m 5(
BUILDING DIVISION' PERMIT #:a065-__ do / 7
1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �f
Phone: (503) 639 -4171 1,„„Aii .
Inspection Requests (24 Hrs.): (503) 639 -4175 I L.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 9/ 0 / ' G D - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: fi
DESCRIPTION: j'
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: L— 7 -6 Pour Time:
ode # Inspection Description Confirm # Contact # Message
Z9' /, , - 7o6/ - 3 a 69 '
Corrections /Comments /Instructions:
A,G / <<= O 1
•
„...
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: . —7— 1 Phone #: (503) 718 - Z - r5--
CITY OF TIGARD .
BUILDING DIVI PERMIT #: MST2005`00178 I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/2005
Phone: (503) 639 -4171 A 1t Inspection Requests (24 Hrs.): (503) 639 -4175 _
INSPECTION WORKSHEET FOR DATE: 12/5/2005 TIME: 7:00AM PAGE: 25
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work.)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503 - 6246848
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 022932 -01 503 -704 -3286 N
Corrections /Comments/ Instructions:
I&j ( T _5
4111I ■
.ri r , ......_
. "((
•
[PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL , , IN ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
V ,
Inspector: 41 IZ-Date: e Phone #: (503) 718-
CITY OF TIGARD • ..
BUILDING DIVISION PERMIT #: MST2005 -00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/2005
Phone: (503) 639 -4171 nn S Ilh
Inspection Requests (24 Hrs.): (503) 639 -4175 ... 11.
INSPECTION WORKSHEET FOR DATE: 12/5/2005 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work.)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 5036246848
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 022932 -02 503 -704 -3286 N
Corrections/Comments/Instructions:
/— ' / f
; .---F ii-) OS' ".' _ ...,,,...,------
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIO AL F S ASSESSED
tif ilo
Inspector: ( Date: hone #: (503) 718-
CITY O TIGA. ...A
BUILDINfi. DIVISION PERMIT #: MST200!5 -00178
13125 SW Hall Blvd., Tigard, OR.97223 DATE ISSUED: EJ9/2005
Phone: (503) 639 -4171 — A
Inspection Requests (24 Hrs.): (503) 639 -4175 4 I I ..
INSPECTION WORKSHEET FOR DATE: 12(5/2005 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503624684E
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 022932 -02 503.704 -3286 N
Corrections/Comments/Instructions:
-1- F P kje,' ( 9"(...t___
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
' t7,/ !
Inspector: Date: fir' - -Phone #: (503) 718 -
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: MST2005 -00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/2005
Phone: (503) 639 -4171 �,, 11 yy �i�l� l
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ":_a
INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06AM PAGE: 23
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work.)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503- 624 -6848
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
215 Footing drain 020246-01 503- 704 -3286 N
Corrections/Comments/Instructions:
0 -- t - 2..,6 - -t44,0•Ne4:5 C 'S 0 e 1-14 C— RZL-0 v(--- -- z1 7- 0
J )/re-- Lc-- C= i LC,
Ti 4ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑TALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / / ----6 Phone #: (503) 718-
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: MST2006 00178
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 61912005
Phone: (503) 639 -4171 +
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/2/2005 TIME: 7:04AM PAGE: 8
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Garage addition. (9/9105, residential addition withdrawn, garage to remain on scope of work.)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503-624-6848
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/2/2005 Pour Time: 2:00
Code # Inspection Description Confirm # Contact # Message
220 Slab 020148-01 503-704 -3286 N
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: //-2- Phone #: (503) 718-
CITY OF TIGARD AA 51 q
BUILDING DIVISION PERMIT #: 9-005 00 i 78
13125 SW Hall Blvd., Tigard, OR 97223 i_________ DATE ISSUED:
Phone: (503) 639 -4171 .unto�r it
Inspection Requests (24 Hrs.): (503) 639 -4175 "I
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 9 / 0 v — Yr / C ige YI CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #: ‘,.1 107—
3 a E�
Inspection Request Scheduled For: Date: / d y our Tim ion 0
Code # Inspection Description Confirm # Contact # Message P
aw
Corrections/Comments/Instructions:
V i ....PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASS SED
Inspector: VA V (/ Date: r 6 Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2005- 0017f3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/2005
Phone: (503) 639 -4171
A l k yl i � ll
Inspection Requests (24 Hrs.): (503) 639 -4175 _
INSPECTION WORKSHEET FOR DATE: 9/29/2005 TIME: 7 :08AM PAGE: 36
SITE ADDRESS: U9100 SW MCDONAI ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DITTY
DESCRIPTION: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503 - 624 -6848
CONTRACTOR: PHONE #:
OWNER
Inspection Request Scheduled For: Date: 9/2912005 Pour Time: 200
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 016997 -01 503 -704 -3286 N
Corrections /Comments /Instructions:
A-Pacr L P. .
❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: -- Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 -00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 619/2005
Phone: (503) 639 -4171 . p° j � i
l
Inspection Requests (24 Hrs.): (503) 639 -4175 .._�.
INSPECTION WORKSHEET FOR DATE: 9/13/2005 TIME: 7:05AM PAGE: 83
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: -- LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Addition. 9/9/05, residential addition withdrawn, garage to remain on scope of work.
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503- 624 -6848
CONTRACTOR: OWNER PHONE #: 503. 475
Inspection Request Scheduled For: Date: 9/13 /2005 Pour Time: 10:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 015467 -01 503-704 -3286 N
Corrections /Comments /Instructions: .-' )
- 7/ - _Ak - u aoyi V ( c
0 c
A ZAS... II PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL % ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: " / ,3 - C Phone #: (503) 718-
CITY OF TIGARD. MST200300178
BUILDING DIVISION #: 6/9/2005 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 m �' �„ f ' , 1�
' Inspection Requests (24 Hrs.): (503) 639 -4175 1
1 10/24/2005 7:02AM 86
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
09100 SW MCDONALD ST
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: DITTY LOT #: TYPE OF USE:
PROJECT NAME: G arage addition. (9/9/05, residential addition withdrawn, garage to remain on scope o f work.)
DESCRIPTION:
DITTY, JOSEPH MICHAEL,
. PHONE #:
503
OWNER: OWNER
CONTRACTOR: PHONE #:
10/24/2005
Inspection Request Scheduled For: Date: Pour Time:
Co g # Inecdion Description SI & C$p3t� 3283 Melage
Corrections /Comments/ Instructions:
1
/ L
. 2 / - c ._- /-
„,a-leee,ge 2
❑ PASS di_ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: lial Date: c UP 7/1' Phone #: (503) 718-
CITY OF TIGARD MST -00176
• BUILDING DIVISION PERMIT #: 6/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
10/24/2005 7 :02AM 87
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
09100 SW MCDONALD ST
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: DITTY LOT #: TYPE OF USE:
PROJECT NAME: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work.)
DESCRIPTION:
DITTY, JOSEPH MICHAEL, 503 - 624 - 6848
OWNER: OWNER PHONE #:
CONTRACTOR: PHONE #:
10/24/2005
Inspection Request Scheduled For: Date: Pour Time:
Cc1% # Irmctiodn ram Description 0��09att1 8g- 1283 Mellage
mg
Corrections /Comments /Instructions:
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
4 141L ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /1 / t , Date: G �2 1 hone #: (503) 718-
CITY OF TIGARD. _ .
BUILDING DIVISION PERMIT #: MST2005 00 re
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9 /2005
Phone: (503) 639 -4171 Np� ( r
Inspection Requests (24 Hrs.): (503) 639 -4175 li
INSPECTION WORKSHEET FOR DATE: 4/11/2006 TIME: 1:07AM PAGE: 61
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: Garage addition. (9/9/05, residential addition withdrawn, garage to remain on scope of work.)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503 -624 -61348
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 027714 -01 503-519A529 N
Corrections /Comments /Instructions:
1 0 ' 4 0 (''
I
❑ PASS ❑ PARTIAL APPROVAL .r CANCEL ❑ NO ACCESS
1
❑ FAIL ❑ CALL FOR1INSPECTION II ' DDITIONAL FEES ASSESSED
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Inspector: Date: one #: (503) 718-
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CITY OF TIGARD .
.
BUILDING DIVISION PERMIT #:M � —a o / 7g
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 4Om , I l, ,
I Requests (24 Hrs.): (503) 639 -4175 °_
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS:C( I P O MC [D- O —ai0Q CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: - n� �!' sC w�F ` t_ - PHONE #: s. - 0 7 - S' x-19 2-2-
CONTRACTOR: /)' PHONE #:
Inspection Request Scheduled For: Date: z j '�. 1' Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions:
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K PASS j? . RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL .a ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - — —..■ Date: J q Phone #: (503) 718
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2005 -00176
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/2005
Phone: (503) 639 -4171
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Inspection Requests (24 Hrs.): (503) 639 -4175 _ IL .
INSPECTION WORKSHEET FOR DATE: 11/23/2005 TIME: 7:00AM PAGE: 60
SITE ADDRESS: 09100 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DITTY
DESCRIPTION: a ge addition (9/9/05, residential addition withdrawn, garage to remain on scope of work.)
OWNER: DITTY, JOSEPH MICHAEL, PHONE #: 503- 624 -6848
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 022314 -01 503- 515 -2922
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Corrections/Comments/Instructions:
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a PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins ector: v N('-(3 : tL Z� 0 —J - p Date. Phone #: (503) 718
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.
Building Division RECEIVED
t f Applicant Request -for Permit Action
City of Tigard SEP 0 9 2005
CITY OF TIGARD
TO: CITY OF TIGARD, BUILDING OFFICIAL BUILDING DIVISION
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
FROM: Applicant Name: pi kE / 7?TY
Mailing Address: 9/00 5 i A) m e boP/9G b sr
City /State /Zip: -77 64/2 0 1 q7 zz V
Phone No.: S33 - 6 2 / - 0 /
Fax No.:
PLEASE TAKE ACTION CHECKED (1) FOR THE FOLLOWING PERMIT:
❑ CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES.,
I 7/2//05
Permit No.: /SST .e v s -0r) I -) E
7 `TE-�ivn/1' Type of Permit: jp A D D /ASS
VD / b 77/6" ,pjj'c Site Address:
/pg ,vs, 9 - -ec'. R Subdivision: _ N /A
,z4 Lot No.: J /A
S7 Lc_ 09 -CIA f
EXPLANATION: ADDsr = cm) Te „cs zv j & Da Al
/ G AgiAL. - TP) 2.411A -I- Al _
Signature: •74,1 `- 4 ” l- ' Date: ?-- 9-0
Print Name: /X/ k6 D' 7 1 /
FOR OFFICE ON LY • ' _.
Route to Admin.: Date: By:
Permit Canceled: Date: ii/ !9- By :
Refund Processed: Date; 605 By
Cashier'Receipt: Date: k q ps #: o em25 Amnt: $
Payment Type: CAL eic j S ( 3L Per:
i:\BuildingWorms\ReqPermitAction 09- 27- 04.doc