Permit III IIII CITY OF TIGARD MASTER PERMIT
PERMIT #: MT2007
' COMMUNITY DEVELOPMENT DATEISSUED: 0/15/200 7
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 14 B D - 01600
SITE ADDRESS: 09790 SW RIVERWOOD LN ZONING: R -4.5
SUBDIVISION: COPPER CREEK STAGE 2 LOT: 043 JURISDICTION: TIG
PROJECT: NELSON
Project Description: 335 square foot addition. Other plumbing fixture: backwater valve.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 13 FIRST: 355 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 33,721.45
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 355 sf REAR: 15
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: 1
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 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: WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 1 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2, 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:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
GORDON NELSON OWNER laws. All work will be done in accordance with approved plans. This
9790 SW RIVERWOOD LN permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97224 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules 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 direct
Phone: 971 - 221 - 8223 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 848.25
REQUIRED ITEMS AND REPORTS
Issued By : Permittee Signature
Call 503.639.4175 by 7:00 a.m. for an inspection that busin day.
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:) x gLi ,, 9 9 :=--
Building Permit Applicati i FOR OFFICE ICE USI ONLY
City of Tigard ' , 4:1:12 _ B ea 7 � 7 0 '
i ; /0 � D Pe rmit No.:
114
° 1 3125 SW Hall Blvd., Tigard, 97223 ` "
g ' -Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/13 : / • 4 . 0 1: Other Permit:
TI G A R D Inspection Line: 503.639.4175 UL T 0 3 2001 Date ReadyBy: See Attached Checklist for
Internet: www.tigard- or.gov Notifie � {to Q // ,0
�/ Supplemental Info
' SGT; 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
Eg Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $ 56 7a./ 0 0
1 - and 2-family g ❑ Commercial/industrial /
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: c 1-c o , u. ft venwnod �.q to d.. New dwelling area: 35-3- square feet
City/State /ZIP: ^1- 1 a,,.. d / 0 R. 9 4 2:2_9 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area square feet \ U`1
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: / %._, per C.., re_e_ I Lot no.: Z Permit fees* are based on the value of the work performed. \ N4
Tax map /parcel no.: rr 2. S 6 D O 00 Indicate the value (rounded to the nearest dollar) of all I
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
0 d . r Valuation: $
O -- trcoo. a dot +0 IIVt area o �t.tSG
( Rea,' . J Existing building area square feet
)
New building area: square feet
'PROPERTY OWNER ❑ TENANT Number of stories:
Name: Gordo to .l Ii o Vt Type of construction:
Address: p s ,,,
/1 ye , wood La vt e Occupancy groups:
City/State /ZIP: ¶' 5 a,r l 0 Q el 7 2-2- y Existing:
Phone: Cry ) 2Z / _ 8Z Z 3 Fax: ( ) New:
jiil APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
� / V2�So licensed with the Oregon Construction Contractors Board
Contact name:
tJl 0ly d ovl under ORS 701 and may be required to be l in the
Address: t r}qo S 1.J P.; I Ve4ruJoo4 L.-a h e jurisdiction in which work is being performed. If the
City/State /ZIP: 7i a.rd 0 T 7_2-'1 apply:
is exempt from licensing, the following reasons
PP l y:
Phone: (97/) 2,z/, g213 I Fax::( )
E-mail: gDC e1 Son e k 1-iv I . e_0"-. `j CONTRACTOR
Business name: 141,1", G ac.....) h ell' _ BUILDING PERMIT FEES*
Address: (Please refer to fee schedale)ii
Structural plan review fee (or deposit): Q(
City /State /ZIP:
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
Total i lic.: otal fees due upon application: 5 09150 .
Amount received: —
Authorized signa r
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date:' 0 -.2- -Q * Fee methodology set by Tri- County Building Industry
Service Board.
I.\Building\Permits : UP ermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB)
•
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.: J l / p w-7�yp .
t3' g Date/By: / 5 07
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
N 1 7 • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/13y: . luris: M See Page 2 for
TIGARD n
Internet: www.tigard or.gov Notified/Method: /, Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction - fKAddition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial =use agricultural
J`' �( 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E " "1 -2 ", "1 -3 ",
/� � n 100HP or more. occupancy.
Job no.: Job site address:
`/ T� S " (VQPt Jop� LI/t , ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Q 1 t ❑ Health -care facilities. ❑ Supply voltage for more than
T Ll ✓' f V 1 Zz T ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description. I Qty I Fee. I Total I
New residential single- or multi- family dwelling unit.
• Includes attached garage.
,�"" 1,000 sq. ft. or less 145.15 4
Subdivision: ,/fit? ✓ et_ yC L ot no.: 'Z
no.: p Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel
Z S I H 'p D 0 1700 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
' 200 amps or less 80.30 2
gl PROPERTY OWNER ❑ TENANT 201 amps to 400 amps , 106.85 2
Name: N�1 401 amps to 600 amps 160.60' 2
or do So N 601 amps to 1,000 amps 240.60 . 2
Address: el q 0 S t,J 12 ►ve r t,�ood 1 Over 1,000 amps or volts 454.65 • 2
-�� co- Temporary services or feeders installation, alteration, and/or
City/State /ZIP: .
1 t a✓ o( t 0 7-2- y relocation
Phone: 171) 224- B 22-3 Fax: ( ) • 200 amps or less 66.85 1
Owner installation: This ' • t: Ilation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
/0-2 - Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
XI • ANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit -
Business name: B. Fee for branch circuits
Contact name: AA� without service or feeder fee, 46.85 2
67 0 t/'d 0 Pt Ale /3O1n first branch circuit
Address: q q O S t.J .1 ivetr wood .1 tt e. Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: T,. ° V R 6 1 7- 2-2- ii Each manufactured or modular 90.90 2
t dwelling, service and/or feeder
Phone: (pp zzr 57 2 3 Fax:: ( ) ` Reconnect only 66.85 ' 2
E -mail' 0�� eel h e fay\ CD /v j e vil, s i . Co `NN Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
•
Business name: Signal circuit(s) or limited -
e o w i.t.e. it energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 '
' CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 .
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: •
Print name: Date: Plan review (25 %of.permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: •
Print name: " /�� �� fy/� Date: This Permit application after expires if a permit is not obtained within 180
` days after it has been accepted as complete-
' Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB ,
Electrical Permit Application - City of Tigard
A
Page 2 - Supplemental Information .1.
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: 1
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems* ' S ' '
❑ Burglar Alarm
. ❑ Gara Door Opener* '
❑ Heating, Ventilation and Air Conditioning System* '
❑ Vacuum Systems*
• ❑ Other:
COMMERCIAL WORK ONLY: J
Fee for each commercial $75.00
system -
(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 \Permits\ELC- PermitApp.doc 03/23/06
Plumbing Permit Application ' °
' Site Utilities FOR OFFICE USE ONLY
R eceived
City of Tigard N
Permit o.:
lig
a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: /O 07 9!'jZO�?�t� ��Q
C . DateBy:
Phone: 503.639.4171 Fax: 503.598.1960 an Review Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date ReadyBy: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / If' Supplemental Information
TYPE OF WORK 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 249.20
I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: Gil-c10 S Lo R: ✓er woad H e Catch basin or area drain 16.60
City/State /ZIP: ` ' q el ird 0 a. c 1 �- Drywell, leach line, or trench drain 16.60
J , Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: G ,d y Creek Lot no.: 2_
Water service (no. linear ft.: ) I F'qe 2
�{ pp Fixture or item
Z (
Tax map /parcel no.: S I I' 0 0 11- 00 Absorption valve 16.60
DESCRIPTION OF WORK n I Backflow preventer Page 2
�
OIn - yoovn 610,0 , I �'o.^ 4 f I v1 ✓t� a Ifea o{ - Ina..tle Backwater valve 1 16.60
(D � \ . Clothes washer 16.60
1 � J Dishwasher 16.60
g PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
� / Ejectors /sump 16.60
Name: � or ( /✓e /so ti Expansion tank 16.60
Address: O 4 , , j 2 rVGlr l,Joao, /..-41 ii e. Fixture/sewer cap 16.60
City/State /ZIP: -f etfo 0 - '7. Z 2...L/ Floor drain/floor sink/hub 16.60
Phone: (q / Z _ 12 Fax: ( ) Garbage disposal 16.60
fiti APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: 6- 0 y c{ n o vt Ale. I o In Medical gas (value: $ ) Page 2
Address: I Primer 16.60 e City/State /ZIP: --T-t9 a✓r7( l D R Cl --4--2--2- H Roof drain (commercial) 16.60
Phone: (971 )-y2 J 9 2. . 2 ,3 Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: 9 ` nC '5 O ( ® 1, I. Urinal 16.60
/ CONTRACTOR Water closet 16.60
Business name: / t E- lisp y , _Water heater 16.60
Address: Other:
City/State /ZIP: Subtotal
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)
State surcharge (8% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: (.; 06 y - ) 6%.„ 1 Date: /0.2-67 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 \Permits\PLMU- PermitApp.doc 12/27/06 440 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 (ea) Total Square Footage: Permit Fee:
Footing drain - 1 a 100' 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
' $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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
•
.
f
mi Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm
sewer and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
- • " 4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I: \Building \Forms \PLM- PlanSubReq.doc 06/29/06
Construction Contractors Board Permit #: Hgeal7+GblQa
700 Summer St NE Suite 300 Address:. 9790 ,:e4) kic.)e2 &)Dz) AJ
PO Box 14140
Salem OR 97309 -5052
-•r: Issued by: Date:
Phone: 503 - 378 -4621
Web Address: www.ccb.state.or.us
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensed 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 licensing 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:
75 1. I own, reside in, or will reside in the completed structure.
2. I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion.
❑ 3A. My general contractor is
(Name) (CCB #)
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
OR
3B. I will be my own general contractor. •
If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
licensed 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 Pro Owners about Construction Responsibilities on the reverse side of this form. -
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file, pink copy to applicant.)
Property_owner.doc 06 -01 -04
. .
. . . .
, r
• - Acting as Y our General Contractor?
• .
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), passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing
structure, you can prevenfmany problerris by being aware of the following responsibilities and concerns.
Employer Responsibilities
You will,.in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if
you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assi in the
construction or improvement of a residential structdre. As the employer, you must comply with the following:
. •
Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wagesat 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 Department of Revenue at 503-378-4988.
Unemployment Insurance Tax: As an employer, you are required to pay a tax for insurance purposeS-.
on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488.
• • •
----
The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formspay.htmll for the
appropriate forms. •
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 could be subject to penalties and be liable for all claim costs if one of you - employees is injured on the
job. For more information, call the Workers' Compensation Division at the Department of ConSilmer" and Business
Services at 503-947-7815.
•
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 a Federal EIN number, call the
IRS at 1-800-829-4933 or visit their web site at wivw:irs.gov. • . .
. .
Other Responsibilities and Areas of Concerns
•
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 accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or
work that musthe • : ,".
. •
Time: Make sure you have sufficient time to supervise your employees. •
Expertise: Make sure you have the skills to act as'your oWri general contractor; to coordinate the work of rbugh-in
and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections.
If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052.
• .
Property_owner.doc 06-01-04
2 �, Oc , 8. 2007 9.51 d l , , No. 3350 P. 1 P.01
•
N it @ T U E 11 \.- .
s
OCT —1 2047
C1eanWtter �`' Sc_-_,..-- � c; By ,
Cs o, t'p 6,u51oit'151 lF p 1 , J
WS Vile Number
i Sensitive Area Pre - Screening I 67- p p+(06','f,
Site Assessment , .
Jurisdiction' t�g�
Property Information: (example 15234A801400) Owner information:
Taxlot iD(s): S I I 'i i Q] b 0 Name: G pti 34 r rte! N e S Or
- Company:
Address: 0 - _ t 11eriii c lo j_ -
site Address: 9490 c : . ii. RtvefwooD Lw
, Or* a R • 0 7 f 1-1 Phone /Fax: /1 L?J- $ L2-3 / • ' Z • . ,
Nearest Cross Street: _ E -mail: • • • 1 . • ' •. a 0 a n • . 1Vt
Development Activity; Checail that apply Applicant Information: ' ,
i4nr.
Addition to Single Family Rmse (moms, deck, garage) Name: Gar') o'e) i, nV NIS o
Lot Line Adjustment ji Minor Land Partition ci Company:
Residential Condominium 12] Commercial Condominium ❑ Address: • - ` 1 r ° i lia d r
Residential Subdivision [] Commercial Subdivision in ,• r 1 9q� 1 DR 77.
Sin le Lot Commercial Q Mu01 Lot Commercial : Phone /Fax: 7 1 - 4 t ¢'Z2 3 I 4 - I • 17 SUN)
Other E-mail: rte • ► ,, re
Will the project invoke any of •site work: YES ❑ NON Unknown ❑ Location and description of off•elte work:
Additional comments or Infomation that may be needed to understand your project: -
This application does NOT replec a he need for Grading and Erosion Control Permits, Connection Permits, Building Permits, Bite Development
Permits, DEQ 12004 Permit or othe permits as Issued by the Deportment of Environmental Quality, Department of stale Lands andlor Department. of
the Army COE. All required permiteand approvals must be obtained end completed tinder applicable local, Stale, and federal law.
By signing this form, the owner or Owwre authorized Agent ar representative, acknowledges and agrees that employees of Clean Water Services have authority
to enter the protect site at all reason:ID - s for the purpose or inspecting project site conditions and gathering information related to the protect site. I ter* that I am familiar with the informa r =trod no
in this document, and to the heel of my kwledge end belief. this Information is true, complete, and accurate.
Print/Type Name: ti . s L r II PrintlType Title: ,
Signature: _ _ _, _ _ Date: / ` /. — .9 7^ . •
FOR DISTRICT USE ONLY '
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A Sly ASSESSMENT
PRIQR TO ISSUANGE_OF A SERVICE PROVIDER LETT . If Sensitive Areas exist on the site. or Within 200 feet on
adjacent properties, a Natural Resources Assessment Report may also be required. - -
❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or
within 2D0' of the site. This Sensitive Area Fre- Screening Site Assessment does NOT eliminate the need to evaluate and
protect water quality - sensitive areas if they are subsequently discovered. This document will serve as your Service Provider
letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and
completed under applicable local, State, and federal law.
•
Based an review of the submitted materials and best available information the above referenced project will not significantly
impact the existing or potentially sensitive aree(s) found near the site. This Sensitive Area Pre•Screening Assessment
does= eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently
discovered. This document will serve es your Service Provider letter as required by Resolution and Order 07 -20, Section
3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law.
A This Service Provider Letter Is not valid unless J CWS approved sits plans) are Attached -
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE
ASSESSMENT R SERVICE PROVIDER LETTER IS REQUIRED; .
Reviewed By: `isat
Date: /1 0
2560 SW Hillsboro Highway. Mlleborc. OreLan 0121
Phone: (503) 601.6100. Karr. (503) OO1oAse • vviesegameakervicts.on
A.,lad: Ma 8.2007 -
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2O()7 00190
13125 SW Hall Blvd., Tigard', OR 97223 DATE ISSUED: 10115/2007
Phone: (503) 639 -4171
• Inspection Requests (24 Hrs.): (503) 639 -4175 '_�..
INSPECTION WORKSHEET FOR DATE: 3125/2008 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 09790 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT. #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot addition. Other plumbing fixture_ baclwater valve. 03/18/0 added (2) branch
circuits.
OWNER: NELSON, GORDON PHONE #: 871 - 221 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 3/2612008 Pour Time:
Code # Inspection Description Confirm # Contact #' Message.
299 • Final inspection 067357 -02 971.221 -8223 N
Corrections/Comments/Instructions:
•
,
•
•
•
•
• •
•
PASS . ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
: • ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
3/26710
Inspector: � � Date: Phone #: (503) 718-
,
CITY OF TIGAR® •
BUILDING DIVISION PERMIT #: MST2007 -00190
• 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /01/512007
Phone: (503) 639 -4171 '61j�1�
Inspection Requests (24 Hrs.): (503) 639 -4175 L
- INSPECTION WORKSHEET FOR DATE: 3/20/2008 TIME: 7:02AM PAGE: 21
SITE ADDRESS: 09790 SW RIVERWOOD LN • CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 • LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON •
DESCRIPTION: 335 square foot addition. Other plumbing fixture: backwater valve. 0311R!08 added (2) branch
circuits.
OWNER: NELSON, GORDON PHONE #: 971-221-9223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 3/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067037 -01 971- 221 -8223 Y
• 02 ALSO
Corrections /Comments /Instructions:
CAti- 1 6bvtP1l cE
•
•
I I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V ' Date: 31 Phone #: (503) 718- )-1/1-#
CITY OF TIGARD " '
BUILDING DIVISION PERMIT #: mmT7007 -00190
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: - 1(Uft/2QO17
Phone: (503) 639 -4171 l 1
Inspection Requests (24 Hrs.): (503) 639 -4175 '� '1 lilt'
INSPECTION WORKSHEET FOR DATE: 1/30813()8 TIME: 7:02AM PAGE: 66
SITE ADDRESS: 09790 SW RIVERWOOD LN ASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 336 square foot addition. Other plumbing fixture: backev er valve.
OWNER: NELSON, GORDON PHONE #: 971 - 221 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: .ir. * 2108 Pour Time:
Code # Inspection Description Confir Contact # Message
120 Electrical rough -in 05/1 13 -02 971- 221 -8223 N
Corrections /Comments/ Instructions:
�' i I . �/
y il a.,.. CL'01 .■4: d "-
..i. /_ _L_ _
. / PT
/ / # '& 1 — e A Ci,T A007,
hi /CJ e i J d -e_ R J L f, 5 /1-)
Y
D i fr - weis , ---- / - 73 -- O kit__ iL • • ..
Aiii — i G '
I
•
PASS 0 P' 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL R ' ALL F! ' :IP ECTION ❑ ADDITI NAL F ES ASSESSED ■ / , � Y e D� ‘2__,/:
Inspector: / ` • Date Phone #: (503) 718
CITY OF TIGARD • 44
p Or,
BUILDING DIVISION PERMIT #: IvIST2007-00190
13125 SW Hall Blvd., Tigard, OR 97223 L tejr*A.j DATE ISSUED: 10/16/2007
Phone: (503) 639-4171 711
/ter%
Inspection Requests (24 Hrs.): (503) 639-4175 •
INSPECTION WORKSHEET FOR DATE: 3/26/2008 TIME: 7:00AM PAGE: 29
SITE ADDRESS: 09790 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 336 square foot addition, Other plumbing fixture: backwater valve. 0311F1/06 added (2) branch
circuits.
OWNER: NELSON, GORDON PHONE #: 971-221-6223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 30612000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
109 Electrical final 067357-01 971-221-0223 11 /
o
‘I P; ebta [I/V1/
Corrections/CommentS/Instructions:
•
' PASS [1] PARTIAL APPROVAL CANCEL 0 NO ACCESS
fl FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: g< Phone #: (503) 718-
_CITY OF TIGARD - •
BUILDING DIVISION PERMIT #: MST2007-00190
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 10/15/2007
Jo' Phone: (503) 639-4171
4 ' 10 10
Inspection Requests (24 Hrs.): (503) 639-4175 A44-
INSPECTION WORKSHEET FOR DATE: 3/20/200B TIME: 7:02AM PAGE: 20
SITE ADDRESS: 09790 SW RI VER WOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
' PROJECT NAME: NELSON
DESCRIPTION: 336 square foot addition. Other plumbing fixture: backwater valve. 03/1R/00 added (2) branch
• circuits.
OWNER: NELSON, GORDON
CONTRACTOR: OWNER PHONE #: 971
PHONE #:
!".
Inspection Request Scheduled For: Date: 31200008 . Pour Time:
liti Code # • Inspection Description Confirm # Contact # Message
2'39 • Final impectiOn 067037-02 971-221-8223
Corrections/Comments/Instructions:
?IT t • E (6 CA C F: 6.16L
•
•
•
• ;, • 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
r I N FAIL 0 CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
G • 1066(--
Inspector: Date: 3 121 0 1 01 Phone #: (503) 718- ALM
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- O0"190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10 {16/007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 4
INSPECTION WORKSHEET FOR DATE: 21E/20088 TIME: 7 : 00Am PAGE: 26
SITE ADDRESS: 03790 SW RIVERWOOD LW CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot addition. Other plumbing fixture: backwater Yalve.
OWNER: NELSON, GORDON PHONE #: 871 - 2.21 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 064610 -01 971.221 -8223 N
Corrections /Comments/ Instructions:
il_
S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 Date: '.-6,—s -sue- Phone #: (503) 718-
CITY OF TIGARD - ,
BUILDING DIVISION PERMIT #: MST2007- 00190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: fed f?J "�Otl'T
Phone: (50) 639 -4171 C
Inspection Requests (24 Hrs.): (503) 639 -4175 A- ell
INSPECTION WORKSHEET FOR DATE: 2/612008 TIME: 7 :01AM PAGE:
SITE ADDRESS: 09790 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE ?. LOT #: (.}43 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 33!i rquafe foot addition. Other plumbing fixture: backwater valve.
OWNER: NELSON, GORDON PHONE #: 971 -221- 8223
CONTRACTOR: OWNER PHONE #:
•
Inspection Request Scheduled For: Date: 2/5p000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 064479-01 971.221 -8223 Y
Corrections /Comments /Instructions:
' ! - o.-c-5 1 ` C1 ;- ao,,1.S4/2'97 Fl o -,-
0
•
•
•
(l PASS F TEAL APPROVAL • ❑ CANCEL ❑ NO ACCESS
❑ FAIL MI CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Z• Phone #: (503) 718 - _ /
.2,,,, -,.",/-
CITY OF TIGAR® T---2 „
BUILDING DIVISION 114,°;;;,k ` PERMIT #: MST2007- 001!:)0
13125 SW Hall Blvd., Tigard, OR 97223 / DATE ISS D: 10/150007
Phone: (503) 639 -4171 U / u
Inspection Requests (24 Hrs.): (503) 639 -4175 / ? . ��4 : . .! 1.1-
INSPECTION WORKSHEET FOR DATE: 1/30/2008 TIME: 7:0° M PAGE: 85
SITE ADDRESS: 09790 SW RIVERWOOD I_N CLASS OF WORK:
^
COPPER SUBDIVISION: C.,Ol�PEFt �,REG:K STAGE 2 LOT #: , , TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 336 square foot addition. Other plumbing lixtur backwater valve.
OWNER: NELSON, GORDON PHONE #: 971- 221 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/30 /2008 "_ Pour Time:
Code # Inspection Description Confirm # Contact # Message
276 Framing 064137-03 971•"221 -8223 N
Corrections /Comments /Instructions:
a‘____ i __ • "
/ )4ASS ❑ P' 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑
FAIL ALL Fen = 'ECTION ❑ ADDITIONAL F S ASSESSED
r
Inspector: r A _ Date Phone #: (503) —R31°7‘,.
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2OO7 -00190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 101 15/7007
Phone: (503) 639 -4171 // ,u I iiiA
Inspection Requests (24 Hrs.): (503) 639 -4175 r__..
INSPECTION WORKSHEET FOR DATE: 1/30/2008 IME: 7 :02AM PAGE: 57
SITE ADDRESS: 09790 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 L• #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 336 square foot addition. Other plumbin + ixture: backvrater valve.
OWNER: NELSON, GORDON PHONE #: 971 -721 -:3273
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/30/7008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
230 Undeifluor insulation 064137 -01 971- 221 -6223 N
Corrections /Comments/ Instructions:
PASS ❑ P' ^TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL Pi(ALL F•',v ' ION ❑ ADDITIONAL FEES ASSESSED
Inspector: � / A. Date: i Phone #: (503) 718
CITY OF TIGARD ' .
BUILDING DIVISION PERMIT #: M 3T 007 -00190 'IWit
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: J2007
Phone: (503) 639- 4 171�' � I
Inspection Requests (24 Hrs.): (503) 639 -4175 ..•.': � P -_
r
INSPECTION WORKSHEET FOR DATE: 10131/2007 TIME: 7 :00AM PAGE: 67 f
SITE ADDRESS: 09790 SW RI VERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 squar'� foot addition. Other plumbing fixture: backwater Valve.
OWNER: NELSON, GORDON PHONE #: 971 -221 -8223
CONTRACTOR: OWNER PHONE #:
. Inspection Request Scheduled For: Date: 10/3 Pour Time:
Code # Inspection Description Confirm # Contact # Message
226 Post/beam structural 05t3720-.01 971 - 221 -8223 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL . CALL FOR INSPECTION ❑ADDITIONAL FEES ASSESSED ..
,,4 Inspector: • ' Date: / 3/ 0 > Phone #: (503) 718 - --z—it-4-
` CITY OF TIGARD
BUILDING DIVISION . PERMIT #: MSl2807 Ot1l9D
F
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 10/1i12.007 , 7
Phone: (503) 639 -4171'
Inspection Requests (24 Hrs.): (503) 639 -4175 ° .
INSPECTION WORKSHEET FOR DATE: 10/31/2007 TIME: 7 :00AM PAGE: 68
SITE ADDRESS: 09790 SW RI VER WOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE ? LOT #: (43 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot. addition. Other plumbing fixture: backwater valve.
OWNER: NELSON, GORDON PHONE #: 971 -221 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/310007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
236 Shear walls/anchors 058720.02 971- 221 -8223 N
Corrections /Comments /Instructions:
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/
Inspector: Date: /''— 3— c' � Phone #: (503) 718 - "�4 -9-%—_
• CITY OF TIGARD . , ..
BUILDING DIVISION PERMIT #: Si 20177 0ff'31�0
D AT
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/150007
Phone: (503) 639 -4171 ZiAt � ie Inspection Requests (24 Hrs.): (503) 639 -4175 ....
INSPECTION WORKSHEET FOR DATE: 1013112007 TIME: 7:00AM PAGE: 65
SITE ADDRESS: 09790 SW RI VERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot addition. Other plumbing fixture: backwater valve.
OWNER: NELSON, GORDON PHONE #: 971 -221 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10 {31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 058720 -03 971 - 221 -8223 N
Corrections /Comments /Instructions:
'
Pi 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
_ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
✓-
Inspector: ,� Date: /0 — Y' -0 Phone #: (503) 718- "Z-51--
CITY OF.TIGARD
BUILDING DIVISION PERMIT #: MS 2007- 00190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/15/)007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/30/2007 TIME: 7:02AM PAGE 24 •
SITE ADDRESS: 09790 SW PJVERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF. USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot addition. Other plumbing fixture: backwater valve.
OWNER: NELSON, GORDON PHONE #: 971 -721 -8223
CONTRACTOR: OMER PHONE #:
•
Inspection Request Scheduled For: Date: 10/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
310 Crawl drain � 058821 -01 971- 221 -8223 N
f-,Nab•
Corrections /Comments /Instructions: .
v F► -o o/ VDi u LA) % - M I or Ua (v-c, e J j 7v Rte.,✓ lJ �"1, CAA 14 a ,
• "VV..
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: db\v1.A. - Ji .1) th,,,... Date: 10 J0) Phone #: (503).718-
CITY OF TIGARD • •
BUILDING DIVISION PERMIT #: MST2007 -00190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/ 15/200•7
Phone: (503) 639 -4171 •
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR 'DATE: 10/18/2007 TIME: 7:01AM PAGE: 88
SITE ADDRESS: 09790 5W RI VER WOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot addition. Other plumbing fixture: backwater valve..
OWNER: NELSON, GORDON • PHONE #: 971 -2.21 -8223
CONTRACTOR: OWNER PHONE #:
•
Inspection Request Scheduled For: Date: 10/18/2007 Pour Time: • vim
Code # Inspection Description Confirm # Contact' # Message
20 Footing 0x7670 -01 971- 221 -8223 N
Corrections /Comments /Instructions:
•
•
ASS n PARTIAL APPROVAL ❑ CANCEL • ❑ NO ACCESS •
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /b— Q> Phone #: (503) 718- �s �
•
1 ■
CITY TIGARD ,
CI ■ i OF ■ IG/ _R
BUILDING DIVISION PERMIT #: M5T2007 00180
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/15/2007
Phone: (503) 639-4171 „_.'64111t
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 1011W2007 TIME: 7:01AM PAGE: 07
SITE ADDRESS: 0979() SW RI VERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: 335 square foot addition. Other plumbing fixture: backwater valve. ,
OWNER: NELSON, GORDON PHONE #: 971- 221 -8223
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/113/2007 Pour Time: . 11:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 057570.02 971- 221 -8223 N '
Corrections/Comments/Instructions:
or
k ! J GAS 2792 Z A-.e. .c%%/z ..%2 47 -i , 76 42 75,7/ 7. ,/!� SA4 u_, .._
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: AO -g---0 ? Phone #: (503) 718 - 2-94-.5