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Permit • • CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00143 aid DEVELOPMENT SERVICES DATE ISSUED: 5/26/2004 ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11735 SW LYNN ST PARCEL: 2S103BA -00131 SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R - 4.5 BLOCK: LOT: 034 JURISDICTION: TIG REMARKS: 473sf garage addition with 490 sf habital space above. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 490 sf GARAGE: 473 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 60,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 490 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 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: GAS 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: 0 - 200 amp: 1 W/SVC OR FDR: 00 PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st IMO SVCIFDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 10 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. 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: $ 1,213.99 CONSTRUCTION INC This permit is subject to the regulations contained in the HUFTON, GARY AND MARTHA WBS CONSTRU W LYNN ST 7632 SW 34TH CTI Tigard Municipal Code, State of OR. Specialty Codes 11735 S 11735 S , OR 97223 PORTLAND, OR 97219 and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 590 - 4126 Phone: 503 - 452 - 9822 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 108690 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 Footing Insp Mechanical Insp Exterior Sheathing Insl Plumb Final Foundation Insp Plumb Top Out Insulation Insp Final inspection Post/Beam Structural Electrical Rough In Rain drain Insp Post/Beam Mechanical Framing Insp Electrical Final Footing /Foundation Dr; Shear Wall Insp Mechanical Final / / ` Issued By : _ S a � 1il Permittee Signature : /A. I A A t,I/. Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day • Building Perm' = / �� , • .r 5 `'x ' p FOR OFFICE USE ONLY -.....0.„ City of Tigard '�t . �� Received / Permit No.:��/ (...1 40 N3 13125 SW Hall Blvd., Tigard, OR.9722 Q Plan Review 7 Phone: 503.639.4171 Fax: 50,3548.1 �{' l: ti;'� i � DateBy: 9 ' 2 t^I � E c ` Other Permit: • • Inspection Line: 503.639.4175 �' ��rl,t.J E` _. Date Read n3 : AG oy Juris: ® See Attached Checklist for Internet: www.ci.tigard.or,us -, O w IGIC* Notified/Method: ' Supplemental Information g ..�„ U 'AVM 0It s ma R fi J do r`, • n r^ 1 r i .. �� ; �. .z�`,� } k'f4!$ WO . b ' , `s ..SxH�` m �- � = .M v + r w ' �k'r i � -3`CY ��� k Y " S Si��'$:r- W� io-, +�`^ - "i •�._r...: • • r: . 'z 40 j..xsrL + : .a...' 's i1 .,:: iet4;;a.:- "5 I.{: r +. -- `',R�. ^ -,,r,.t -- L. - - . 1 ' ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all rigi Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the 1 , ,;1 F " Y -r t. `". - 4', a. • w �:.rc- -r: b r# work indicated on this a : CATEGOIt'Y:, N s ,' s lication. ;*,�_�:-�!'�..�',� �b,;$ :'� ;ti .�. : - «><.r a+�•+.t, � ".� � fi "Ri.( yR �C�'��s: ". PP - •y 1Ir � . - r, V [i''•�3�.. ti`i ^.•� ! r . ,.Y. L1tV. gal- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 6 0 1 ////// r __ ❑ Accessory building ❑ Multi- family Number of bedrooms: CY (/U v ❑ Master builder ❑ Other: Number of bathrooms: Q s �i ' ;:'4 �, . " OB ' 3 '�. ? ,° '.' , r. „ Total number of floors: x w r;, , :J Y TLIFORMr1TIUN�AIYD'[ OCATCOP� :.; _.' �.°7)' Job site address: n 7 3 y 5 w 70, 5 A New dwelling area: C-f 9 0 square feet City/State/ZIP: _�� �� c'•7d r` 3 Garage carport area: c 73 square feet Suite/bldg, /apt. no.: I Project name: Covered porch area: square feet Cross street/directions to job site: J Deck area: square feet g e-ii, a 1 S� I-. 1 / 5/ 5�l � ,.l, / C 7 4 Other structure area: square feet REQUIRED DATA COMMERCIAL USE C . ' Subdivision: • I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: r k)C Cn f7 Indicate the value (rounded to the nearest dollar) of all r .1 , map/parcel no .: , . -i , „ ;�{ , �U _ � (2 7Jf 3 ' � tiz r' }�'' equipment, materials, labor, overhead, and the profit for the ,� - X . t'.4,: k 4; } ., §' DESCRi TI O F. := . ?� J ti < < � � 4 r.1 •' , ( t work indicated on this application. Id // ) / I Valuation: $ a l.0 d 44 T-r� 1,io yak / 5 faiaf c a /tCi 4 - �,,,,, �} ,7.-77., Existing building area: square feet (/ New building area: square feet ';''• r::P1'< D •, :.- T i Y- 1. ii 1 ; : e ,:. ' h',.. "d : a . TENA' .IY'`r •, ..tr:.r Number of stories: Name: (. 4, 70 6 k 4 Type of construction: Address: 11 7 34- 5w C-yHH Si". Occupancy groups: City / State/ZIP: / ( n J D/ q - 7avIR Existing: Phone: (6'0) ,S 0 '! Li /X, Fax: ( ) - ":tW1M(� 46::1 4iFi CANT;:> z� $; :- .'21;,sa,y.1.; : ti, .: =,, - ,, New: , -'� I l' .: !E ..!-4 i ' ;yam T1: j s °` d..e, F '' s T CON1'A 'PERSbPF:`X-... ,n «.;;., ' `�� "./:. i .- . +oa�_,;,yr..y+.7,:�1., _.1. �� g .r. t ,, -' .. .,� .� 4 : . 1 s` - k ?� ° ' � ': •s!' av � k� } W +•+_. - w,� k t' ' ,�� / _s: fr -a:':, 4"V . ∎- ' .'; IEEE11 r -1'' ' .:'`.s%=- 't.'�:r i:i',1' . Business name: 4 RS Go.- 5 T..vG All contractors and subcontractors are required to be Contact name: O BI ,. �� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 76,32- 7c, 3 t A -e jurisdiction in which work is being performed. If the City/ State/ZIP: P - / � ca ( 9 ai q applicant is exempt from licensing, the following reasons apply: Phone: (5- ) c )... — q q z..-r_ Fax: : (g 3) t. f6-)- ep 9'2. E -mail: 4 1�4 - �2k�: `"� $:.o '? £ • x ,. . -1 ;..;,:1wt.= :;:?,• _y�c ° , _ �, s:P �`''' .: {. `P+c'Py.p, • �ik l� : 'PF`.��ki .pr. �•+r i� ti'ar.•u'' �: Business e j < < name: t:tl . rri /u� J `.U�/ L.VG_ a•p-�+ � Ca of ep�,r-�a. ;itt.,,;�+ , y +11= ,.k�`,�'4 � R11'II� 4�Y`:� : ' ,.. �-n Address: <� , -�i �BUII,'b G pE �*t'f ° 7( 3 5 (.c/ 3 a 1,-t- Please refer to fee schedule City/ State/ZIP: 4�/.- M4 ,1 O. 1j .2/Q (� Fees due upon application Phone: (5 L.tit:)- ).. - q $Z - l Fax: ('- / 5------ CA; p 1 -g95--) CCB lic.: �1 q0 a � Amount received Date received: Authorized signature • g / This permit application expires if a permit is not obtained I Print name: //� / ' n �� within 180 days after it has been accepted as complete. �V �'1�'1 a. WY Q6' / t ..5 �7i a r ��( • Fee methodology set by Tri-County Building. Industry Service Board. lif �7 Q , W.Z. i:\BuildingWerrniu\BUP.Pem. doe 12/03 0404613T(I 1 /02/COWWEB) A • / 85/12/2804 88:82 5834525852 , �D WES C�TRJJGTION INC PAGE 82 Building Fixtures R V Plumbing Permit Application g i k Fop. OFrlcr 1 st'_ ONLY I li City of Tigard GA p �tiNeu ► TAU /•-`/l ` h j 13126 S W/ l a fltvd.. Niod, On. 97222 Girt OF . s N p Phone: 503,639M11 Inc: 409.599.1960 f . ' c M Ptandt114: 244fouylAep�onLine: 503.639,4175 BUILD IN t j y i ' �lypy. -, 3 for lloam* wwW.C '' r 6ud lh sulpplame�nbllnformdiiaa ilr" II I i i I . r �. •���.�.�: � 'bJJ{y ''�' ' �;�,,dt ? l� a '°" {� �',�rlJ ( i � I �..`; =..,fAi. 1 . �. . .111II,, j, G r i � -, { c5, 1 c�; �j,�, rI.ylgp r V ;1 �!:0 • I .:. 1 1!S�. '!• ti�:-i! + •. L� .�T [CJ;lu Lli .le�' �.4! ..�� ��� C�_: ? II�,I r A �• X Q NoW ooastiVadon C] Demolition For amid Information sae checklist, Datscttpo 2.. I F.a. _ I . Tul l F dditiam/a}tcratioa/rcplaleasocat ❑ O t h c r . Now1.2 -madly dwellings [weludec 100 f t . f a r utility connecti '-` III I�r �1; 2 a r '� R y lb.•� Lr ,� : lrCl r • PP, � 1' 1 h V . ..,....... -..- iIi' I I I titli'; } ,n a o fc7wic.0 4 � 'I:ui1, P.:1 - lq SFR(I)hnth I 249.30 IN- and 2-Srnily dulling _ D cornmereial/hadnatriat SFR (21 h fh 350.00 D Aaaecr ory building 0 Multi gay SS__ ( bads 399.00 Q Master builder ❑ Otter Each additional badtlkitchon 45.00 r . P:=fi r t• I ,. .. .T I Firs aprinldcr (_ en. f.) 2 i'4 r^' I'I,5 i� 1!� ryl ! n f' ��C , J E!'u�o II i.� �L�x>itd k�dll:2��i'�'r. : SL.�:;r v1'a]t'_,t ik •2 '!1.1' S tifititie6 Job site adder 3 u, .. N AMMIIIIIIMIM catch basin or area drab: 16.60 Cilyalat : 1 4 qd 0 rI 2 DI'S'a'all. barb lbw. or S1�neh drain 16.60 Suke/61dgJapt no.: i � r Projeetnamc: Pouting d (no. linear ft: ___,) _ Page 2 MmwAoalmrd lulu= up'}ilk; 110.00 clumsimatErixitions to job aim; • - - // • Manholes 16.60 St ;,k o .r TA -c k.....- 5 Rain drsitl otemee6or 16.60 Simitory News' (no. linear R: ___) Page 2 - - S sewer (no. h'near ft.: _____1 _____1 - St= Page 2 weer ',parka (en. titular 1.r _____.) per+ 7 Subtliviai0n: - Lel MU P'artarear item WC MaPiPanel q0. 3/4 1(1- Z _ 0 : ei / Absorption valve 16.60 ,ww...,...•�f;L� it !L'C i r ' lil d�,o:7:'Plh% �' 'YLJ 1 ri -- owprev/pW Paso 2 .? / lit . T1raI ;ckwvalve 16.E PifflriPPYRWMFAlLIWITTAIIIIINIFINIIIIIII Clatiems vast la 16 60 , �'_. DlshwasbQ 16.60 . j 7 ` I } ���� { ( tj i ti ; Drmld14 faualain _ 16.60 _ ,4.0.,u ein. F I I �f'.. .: . 11 ... I ,..r'.'..L;IIIIII,,1-' 1' .. .: . n lY �.' .' na'� 1 El sumo 16.60 Name: .1,-.. � .., Xi. >; on oak 16,60 Address: L f ..w S Firmatl_ar Gap 16,60 / J Floor d1'aitt/tloor tilrlhub - 16.60 Phony ( ) • Ram ( ) Gmlbagc disposed 1.6.60 - ��. , n , r E , w Hose bib (6.60 , ,'!G Ar G � t 41 'a 5 t 1�r g - �I ' • I; kg 16.60 Tipsiness a Iaeen:eptot/groose op _ L6.60 C t m t e c t a a m e : _ Medical gas (vain: $ ) Page 2 Ate Primer 16.60 Roof d rain (gal) 16,60 Plum( ) Fax:( ) sintdheclnllavtgary 16.60 Tnblaltower/showerpan - 16.60 y wan' 16.60 6 r r tit (1Gr l .T 1 ' I� I� Z r, .r -, �. r <al L�r �1,�li.l �� p � ;��.,� S i 1 I L niercloaeTi 60 ..... 16. fine- I�..z�i��*• t! �'�'� l ia.t�;r..'�2T�.Cf'_"�f t'�_vY�,.�i.. nt!,I,..,CIII.;rtu1.1111 J _ _ , Busint�s r.l . �A _ Water beater 16.60 - ' 1 _ CS1y/9tato$ZIP: c _ JP BaDWal1 Minimum=mu:fro 572,50 Pb , 3) j__ - ' f f� Pay ( ) Residential baekllew irdn mum peat the: $36.25 CCB. Lio.: ©d Plumbing Lie. ma: 2/ - d,' Plan review (2396 of vomit fee) State stnrh (9 Ofpwtmt fee) ,� - A �! TOTAL PERMIT PEE • Pat oat= / r e 4,4 G 4 4 "v a d 1 e - Daze:cr / _,/ I This permit application wires if u permit la not obtained *Min lea days alto 11. has Dana accepted AS 60ntplotc. 888 -1 100 /100'd 6P0 -1 9Z11999E09 >lulgwnld dW -WObd 61:01 PO-ZI -AVW FROM : ANCTIL Heating & Cooling PHONE NO. : 503 2825722 May. 12 2004 01:14PM P1 p5/12/204 :i.:06 I .5 $4 o s2 OS CONS - RUCTION 1NC PAUL 02 Mechanical gf'�if fppl.kaadon F 1 )R of l IU-•t 1_0:4, O\1_\ City of Tigard R 2004 .D -. (20/ , 2 2 t3123 SW lieu Blvd,Tlear 07 Fhema :503.639.4171 Fox: 303.5 `9 :;. t]tlt er P e:rto i et laspec o i l,a»a: 5ea.6a9.JTTY O I IGARD '1 ` _+I .� ► Da • .,; y; See Peso a (or IT1 "'°v`".``• -1 WILDING DIVISION -_. tao od+ Sepplemocnal tnforsssoA i . ' . � :` ' 1 i' '`',` I�n.'� =.�: l ' . ,t I; ; r ,,, }: . ? I c 6 ' ?' '' ❑ New a 't i ` M eets teal permit fees" are based on the -rata craw word txthetibtit tlet! Aldtlit on/81tCt8llodYtplBCettlent p u . Ir;Jl te the value (rounded se the mutes do t") 'brag i ❑ Demolition ❑ Other: mechanical rusierials, -. u • I, :actot ove lc,d aid raft ti n-rui G „ . 1e1. •'• rr+r IrI "' .,,rl l Sa ll: �( ia�enl�ir /w'.Vane: 5 I I � �^•y�!-I�/'V :'*��L/ +aM;.�T" J ®.i •and 24=4 dwelling U Commercial/industrial ❑ fteoessory building for 1 (nfdrmerloa titter ohdcklur, l ❑ M lti•fsndly ❑ Master builder ❑ Other: , Desolate!: IMNIZIN Total � iTtl atii11�:+Ft7ti I: w �m_.�ors:�-c -: � �4";�:: :La'�.�.t�:r p � qf4. . '(ki f��x1`k 11f' ��''p ��ra c�� -.Z «)- . u i° iz[c"r-" - 1. Coati � ,7 °.►�t:�, ��r?a', . �` �I, IiltrGnA, 4k,+> i��+ ri: �=. 2�ta± �i�ir�7. crlsr>tr'':y�:.lal�'Pde;���•... �•.i geadd ,.c...ca:i..' - Air condie oniag a heat pin ' I dZ1P: Furnace 100,000 WU(dvotaoe ) NM 14.00 l �F �r7' � / �t r•>:rnaae 100,00 * BTU (duara�riu41 17.911 ITAha hTeig. /err. stn.! �J � Prajtsct can c: +3ae beat warn _ 1 4.00 (mss mrea/dttecdons tt+Job site): Duct work ) 14,00 _, 111 0, _ 1 i4droa system 14.00 hot water syste 14.00 A - : /l "1 mcttltmtlal boitor (Vitiate( or tsddroaio) 14.00 ,"...,...■ UTTit hoot (*l.type, met: ine), is -wall in. or - dad oto. 1040 -- ........... Flue/vent for an of above 10.00 Subdivision: I Dew j 10.00 Tax >tpspl)aat>oe1110 7-- „, 0.r ; al AMIE Other Gte6Appl14ace+ • ' 411Fy ,. . h -i n • 1 .r ae,,., 7- o tl rn. 1}11 'y i'4lr� � Y 11 Water be beau 16.00 c;�r 1C<' f�1 H 1 "Ir ,n ;ln I_!{. �� - ., a � . �' 4i �l ]"40. 15 1.:.:119•• ;1 I , ,F . 111 110 ' fi l• � � I Floe it:r water beater or gas 10.00 FE �JT ,•^ - - 1 Nattier (coal I 1 �r PE 4- I y , �� Wood)pellet hove j 1000 1 Wood firepIR ltal4R 1 10.00 ,- • W, r u ,.k { +u� ` ter g a 3 � n4 " + 1 I Chin poyintleJfhiehent 10:90 1F' x lr il! a r . , . p i` rr d I .�� � �i11., i, , ,I: , -,, "�. ` r x a�L i .: Y °than � iD.00J i !'1i ;'Rlx�Ucl •.•::- 0.'n 1 q - " -" :'- f tr. -. ',. ,) i s d :RYi. , , i; a ,: , i : r l, ..- � :,t Name: = 1 I evHenmeotsl exhaust acid vantllatlne fta:tge h000/otner IOU= ' Milton: d 0- equipment 10.00 City' t ef,L<P: 7`x,..,1 1)01..2 I clothes dryer exhaust 10.00 i V > ninSitr4uct exhaust (bathrooms, 1 pa, ( ) toilet compartments, utility rooms) 6.50 1 he m -.F 7:71 7 .T . T � " 4 'ere` -1 . 'M c e " n� , drlereWlsrmee flats 10.00 1 �.iu �7 ■� ne_t. l Sy h kro .I rr „I , ,IJ�4t nl ,,, i,,- _ - vnA F l rT., e iE.. s^.1i`' '�1.1.. if1_�7,. .. 14' L. 1:'1,,c- , ,::::.:. :. - tiAh.3 ....,::1 iJl w3, eb l. ( . 10.411 j Baste= name: 1 name: Fuel QIp1ag C.n I $5.40 for best Evart V AG for tack addltioaal l Add esie Fntttae0. ota _ J Gas heatputoo ClIeStatc,ZW: Waillhuhmadc&unit hrater weber llwaar Flmn4: ( ) Fax; : ) Fireplace I li<ts & Range 1 ' ''' y H i l,'i' d A: 1 / 7 Y t'1 r0" i; ,4 ..nif 2, 7 , �i;111"* )' *".; ';� a?,1iR- _ 1`, Babe= �• 11 rr : 7 4..6∎ .11n' ,4ti Gr,�l!'�Y'�.rt .k, LK'.i..i',i61_44 ::. , ` ,!Sinv.zi ;.,22u.l.lir A ' 1 : Btelinem name: i 1_ Cal)( 4,0 CD Cleithei d> (Fa`1 Address: L 2t. .1) ►aIta i .s ,la � zt I'...;.. F My/Siam/EP! 1' V1e1� ``\ iff3e - 72 L / Subwtat q�-7 - • + Yaluimum permit iCC (772 l now (S p - 6 1 j ' I Fax: (sus ) .91 -- Flan ?review (25% dovish $4) Old lie.: • 0 . Sot svrehargc (1% of Permit (eel TOTAL PERMIT FEE - This wrest oppi atton emirta If i ttet�nit u cot ebtateed whtil tie Auahvl ailyl,alwe. days atte It has Won wocpecd hi tasiple s. 'Print I , , d.. DDm . Feenmsbodoursy eel byFm4County8 Odle/ f,t 9er ry viae &wrd I 1..e.a.IV.11•.,wr1111pr.o -. A-.1.1. ann ee44dI7t' 11/132 C0tarw»r May 12 04 03:42p p.1 lib/ 1'L/ 2994 19: 59 1 0 1052 WBS CONSTRUCTION INC PACE 02 I . Electrica1P pp licatiun FOR OFFICE USE ONLY __.. City of Tigard ?,; `) 2004 Received 50 13125 9w Nan Blvd., Tt d;OR 97223 Dste/B : f Pew t n t, ,, 1 ^ , ,. :\ ?lee rn , _ iP1"lA�� a I� - n.ralq �✓ Phone: 503.639.4171 Fa -0 Other Permit: Inspection Line: 509.6 ' yip or ` SI ON ,_ !�!a : _ '' Date Really/Ay: hm: RI See Page 1 toe • interact: www.ei.tigar•,. sr.,N' V I DIV Nlatlled/Melhod; Supplemantalloformotina ' I rr �;F'r+�3rv� ,'• ^ r T' t y� 1J l � .jr"T„28�. y^'c' 7'!�{Ilit�}T����1 y��i,�ty�y ILA I��a ,c _.!., .. ... �iii1t�1+i:. Il tft:J'L:3h. -•'; . i'.;li' '.��/ir� `,$UCV.1r x „,i 9trJ 'a�'. � . " °�•.cdlcrcllrlr�'en:.il:`. t ;. 9 r .. ..�. o New construction a Addition/alteratlon/replaeemelt Please check all that apply: ❑ Demolition El Other ❑Servkc over 225 amps, cOmm'I ❑Hazardous location T r� t ,, r , „ . � ., OSmau over 320 amps - rating ❑Bundng over 10,000 sq. f:., .0, s ,� , ,'; d u i ; ';e0 -,.. c i i , AP ?�% i � A'�...r.YJ 1t •� , ` 1.L p of I end 2- family dwellings 4 or more new residential 1- awl 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal manta in one sown= Mu1tt farrtii ❑Building OW three stories ❑t ccdcea, 400 amps or more 0 Master builder 0 Ot her ❑Occupant load ova 99 pcntons ❑Manufactured structures or i l 911 , ' : _ n , .^ o�s A l m T� r l i I t ' , �..7 frI 4 '� (-r`yi iiT�.i • 7 ! gi" -,, 11 !! 41. il, ti ,A,t: 1 04 i>t'?k•u ..r 1 �I ,�i rt r .,,:.4,.e i ,'` , , rte. ,U °.Q.,. hklIr `; � ❑F.(G as/lighung plan RV. park Job no.:CSYZ Job site address: 1 f 73c iii 5 r ❑ Heal th-care futility ❑ Other: ra n Submit 2 seta of plans with any of the above. City /Statc/ZIP: r�� r ��. q).1.12, 17n above we not applicable to temporary construction service. $uitc/bld / t no.: I ry i i t .I {9k:•� - qiS �it;v tl. a I nr '%.%.01,4-y. a t ;' t� '� ::. ';'; r ` g. ap 1 Project name: p. v t ii.l, l ,'.:. ' f // DartH ai lee T mnl Cross Street/directions to job Site: ' .4 1 ) j I Z.77,„, s', New residential single- or multi- family dwelli unit. � Includes attached garage. GQ � l/ O -✓ S 1,000 s . ft. or less -- (45.15 ' 4 Subdivision: 1 Lot no.: En. add'1500 sq..0. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map/parcel no.: 1 - i i r D Limited energy. Dan- residential 75.00 2 W I , I7 r^ ; T�', r f J Tii c Zr F � l r '' l l La .n �,�r r I ['!'"'Pr(y--' 1 �� ' 1 rt .. l I i, . 1 .P7 , } id G. !l { tl ; V I r''el�' :I�iI N.`,. - n, T 7 ,�' I � :n r .4IIIIl''f; I'll Ii . ] �l' 1 �,, : .,t Each manu£ae tuwd or modulo. dwelling, site and /or feeder 90.90 2 _ G � m ' t' 11- �' . Serv or feeders Installation, alteration, and/or relocation / 200 slaps a let. I 80.30 [i�7,7o, 2 _ itill �' it drY' " sy � .+ Z 'i 7 c�, n tom F� ail r l � U i j�'" l)t�- ri I. ROl straps to 400 amps 106.85 2 ;...W....1.:..1 .t1::. .6%1:Si,, ?1 ., 0. ,1Mr. lr'.! .,, 1� e !rc∎zgQmt :I' 401 mpg to 600 amps 160 -60 2 Name: m 4, 601 eropa to 1,000 amps 140.60 2 Address: / ! / 34 51A- �ql. 51 Over 1,000 amps or volts 1 454.65 2 Reconnect only 66.85 2 a City /State/ZIP: ( „/ d � o � q y J? Temporary services or (sedan installation, alteration, and/or Phone ( ) Fax: ( ) relocation � r 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 exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps I 1.33.75 2 Owner signature; Date; Drench cltcutt.- new, alteration, or execration, per panel . l f-F 1` dill ; 'y Ic 7II ' ii,7!;1 r S ill s '' :III , +'I11 I,. �t, i'!�n o4 �, }I: A. Fee for branch circuits with ..i, , 1,7 1.a .i „mar.:..t,,'1i.1t .Irk A... . vL ' u_ service or feeder fee, each � Humors nano: branch circuit 3 6.65 / yy, 2 B Fee for branch circuits Contact name: without service or feeder tee, 46.85 2 Address: each branch circuit _ Each add'l branch circuit 6.65 ! 2 City/State/ZIP: iMiscellaneous (servke or feeder not included) Phone: ( ) ( ) Pump or itrigstion circle 53 nil . ( 2 Fax: Sign or outline lighting 53.40 2 El-mail! Signal C1rC11 or limited -. e'•rW i !ff:,'�i 1 17,:liS'Dldill'i li•l;, a i-f7r a41, c t J;,y ' T fi en"" ergy panel, alteration. or I.lrrrt4l ' v lui..n••cst�i• dilly. �.ii.;.� via, AUt::;{, t�•ul•.,,.I��..il.s.•Ir:.`i'niL a.�1i3^;.. Business name; 5 d-14 F,....4. t _y r- L g extension. Describe: Page 2 2 Address: ,0,i/OK 24 ((f O Bath additional in.prrhnn over allowable in ally of the above Per inspection 62 SD City /State/ZIP. g p ;, ` Q/ ?7C�© 9' bwestigafion per hour (1 Iv nun) 62.50 Phone: ( ,1,1-1-72.5-7 Industrial pan per hour 79.7; co 3 ) ) tT Fax (SZT " ,;.r y.l lt ,,,- ; 0,. . �:i; r l'. _� „�r. -E CCB .Lie.: / We f S1! Electrical Lic.3 -2o C . Suprv. Lie.: (f f Subtotal 1a zs- s Suprv. Elcetrielan signature, required: 7i. �-.„„...,! Plan review (25% of permit fee) 1', iut,utw. ���� �/f 17atr. State surcharge (8% of permit ice) � r a � Z TOTAL PERMiT FEE Authorized signaturC•' � j TbH permit oppliestien eeplres It a permt it net obtained within 190 days deer it bas been steepled rd template Print Warne;/ / CA / J (� ij f G�Lle�.4 , ,, r I Date: =7/-6 ( • Pee metho dology alt by 3TI -Cowry Budding Industry Serv:cc Board C `• Number of iaapt:etiom per permit allowed. i•olsadmll?n la.C-ro ltoodoc 12/03 4154013T(1.0101ICOM/w6O 9May•11. 20041 1:50PMb$ :s4CLEAN WATER SERVICES 503 6814439 ':i1uN 1NU No.1437 P. 1= e1 May,, 6. 2004 11:42AM CLEAN WATER SERVICES 51 :' N0,116I P. 1 0 1 2 11 'n. .;11 umber MAY 0 6 2004 1 ) J Cean! ervic ( Our ce mjuihrien! ip clear. Se I: itivo Area Pre-Screed g Site Assessment • By_ Jurisdiction 7-74.040 Date 6 a /0 y Map & Tax I . nt,7 S l0 3 t A oat 1 Owner KmA Aurro N . Site Address / / 7 4 / . L. YAbti _._...t_ Rt __ N 7/4aig2 0C. Contact Proposed Activity �ti�� Address FA V C ' 1 TINA Phone �'0 3 -4,6 -i 2. Ax,1es. •y 2 15 RECEIVE Y N N� oo►►ve NOW MI5 Y N NA MA`( 1 "r 2004 of 0 ri Sensitive Area Composite Map ❑ .❑ Stormwater infrastructure maps CITY OF TIGARD Map # „5l ` A e-1 QS # Y3/7 BUILDING DIVISION r i Locally adopted studies or maps / Other ❑ � A ' Specif °�-� Specify 0..4c2. a rea / Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04-9: ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT, If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. ' P Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT on SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER 19 REQUIRED. Comments: Ot*g l r r__ re area 4voth..r_ ro e _ O.'vl d Reviewed By: Z. • Date: S7/ /70 V Returned tv Applicant Post -ir Fax Note 7671 Dares f, 4 Imes./ Mail Fax X Counter T / ' o F % /U�a�a / Da d /r i V By72 ' Co ./nePl. eor1i►r✓er;eg Co- Cc() 5 Phone # p F'rmne #5x03_ 63/ _lee • Fax #5- ' 0 5.0% .. 9 a Fox 11 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 0 " fti INSPECTION DIVISION Business Line: (503) 639 -4171 �,/ BUP ceived / � Date Requested " 4 PM BUP Location I AA Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR ILDIi Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof c is PASS PART FAIL PLUMBING Post & Beam Under Slab i 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 a, PART FAIL E TRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ,-"* PART FAIL SITE Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date Inspector Ext Other: _ Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD - -24 -Hour . BUILDING Inspection Line: (503) 639 -4175 MST add � � 6( " 36 fr) INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Req 1 7 AM PM BUP 7 Location / / / 3 S //L) Suite MEC Contact Person t i_ A ,L.4 Ph ( ) 3 9 — b 6 -- PLM / Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation `e C ( 1 Drywall Nailing ■ 1 I e aJI� i .1 �L , / P Firewall / / r_140. i / Fire Sprinkler ( '� r V Fire Alarm _ ./W/.// epyr� /'rs Susp'd Ceiling Roof Other: �A/9 A / +/ / Final / � !/ ` PASS PART FAIL PLUMBING Post & Beam Under Slab r Rough -In n Water Service N E Y�M'� Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final P ASS PART FAIL MECHANICAL 6 Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL , EC L O■lA / / Service Rough -In 414 UG/Slab V — Low Voltage Fire Alar gairl rA EI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. W 740 ' Li Please call for reinspection RE: / 0 Unable to inspect — no access Fire Supply Line n Approach/Sidewalk Date / 7 ^ v I nspector I g V Ext Other: Final DO NOT REMOVE this Inspectio record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 • INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received 2/ Date Requested AM PM BUP Location I 035 L j A-)' S Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing 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 Other: Final • PART FAIL Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan ASS 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 E Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 21 1 -110 ( Inspector (73 — �.� ,.��ti1a Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL