Permit C ITY OF TIGARD MASTER PERMIT
� il �
PERMIT #: MST2003 -00396
n t DEVELOPMENT SERVICES DATE ISSUED: 7/30/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11720 SW SUMMER CREST DR PARCEL: 1S134CD -06400
SUBDIVISION: BURLWOOD NO.3 ZONING: R - 4.5
BLOCK: LOT: 024 JURISDICTION: TIG
REMARKS: Addition of 360 sq ft family room addition.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD. sf RIGHT:
VALUE: 24
OCCUPANCY GRP: BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDC BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601+amps -1000v: MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 749.44
This permit is subject to the regulations contained in the
LASERSOHN, JEFF C OWNER Tigard Municipal Code, State of OR. Specialty Codes and
11720 SW SUMMER CREST DR all other applicable laws. All work will be done in
_ TIGARD, OR 97223 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Shear Wall Insp Rain drain Insp
Slab Insp Exterior Sheathing Ins[ Electrical Final
Mechanical Insp Gas Line Insp Mechanical Final
Electrical Rough In Gas Fireplace Plumb Final
Framin Insulation Insp Building Final
Iss ed By : _1.41,2-- ' 4 Perm Signature :. t PL_ /,
r AI r
Call ( I • 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Applicatiw FOR OFFICE USE ONLY
IL VI _ Received Building
+' \ Date/By: 7 1404 3 Permit No.: �) S-4037,4
y Tigard of Ti and Planning Approval Other
Plan Review ermit No.:
13125 SW Hall Blvd. 'pQ ,
Plan Rev Other
Tigard, Oregon 97223 Jul_ Date/By: Permit No.:
° °° ^ Post - Review Land Use
Phone: 503 - 639 - 4171 Fax: 503�5�$ " -j9 0 : ' G ' IEllI
�„ • a Date/By: Case No.
Internet: www.ci.tigard.or.us ,. ,I. q ,) - Contact ] El See Page 2 for
24 -hour Inspection Request: 503` = 6'3'9=4175 Name /Method: ' 4a Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
[ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
lam& 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
. - head and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $ ( S
JOB SITE INFORMATION and LOCATION No. of bedrooms: 3 No. of baths: ' ,-
Job site address: //1-2.40 e..Oc) �i - t�w++C-� .�, Total number of floors
G' New dwelling area (sq. ft.) ` r
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) :..� .
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Ti � - Other structure area (sq. ft.)
r�7{ ,ter, ` ukv+.,. v�fi '`-�.
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DCRIPTION OF WORK ,��
the value (rounded to the nearest dollar) of all equipment, materials, labor,
�
O t `f` /'/�, 1 A' ^ � K overhead and profit for the work indicated on this application.
Y ! w Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
124ROPERT NER • I ❑ TENANT Type of construction
Name: .�S , t,1 Occupancy group(s): Existing:
i New:
Address: fl? 40 ) y /Lot' L 4 - r,
City/State/Zip: ( Gag- 6 rg22 - �
Phone: ' 3 - Fax: 1- '-'� j ^ G p ( NOTICE: All contractors and subcontractors are required to be
❑ APPLICANT ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under
. provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 7 from licensing, the following reason applies:
Address: t
City /State /Zip: .
Phone: Fax:
E -mall: BUILDING PERMIT FEES*
Please refer to fee schedule.
, CONTRACTOR
Business Name: Fees due upon application $
Address: c3 L0
City /State /Zip: Amount received $
_ Phone: Fax: Date received:
CCB Lic. #:
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: '� :� / ` . —
i_Gt/ Date: 2 f 180 days after it has been accepted as complete.
�4P .A. '"' di (1 *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
One- and Two - Family Dwelling
Reference
.�� Building Permit Application Checklist
City of Tigard City Of Tigard • Associated permits:
ty g ❑ Electrical l7 Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
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 O plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 ' Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project 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 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (6/00/COM)
Mechanical Permi =t tlbri Received O FOR OFFICE USE ONLY
Mechanical p�
Date/By: 7/5,0 5 Permit No.: I �TP497 4 ' 03 7 / 4
City of Tigard
i Planning Approval Building
i ', �� Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 0 s,' \.4 Cc' r"1;s_A-',_1 Dat'By: Permit No.:
Phone: 503 - 639 -4171 Fax: 50- 59SWIn a � (, � Post Review Land Use
� Date/By: Case No.:
�
Internet: www.ci.tigard.or.us . e l I Contact �] ® See Page 2 for
-
24 - hour Inspection Request: 503 639 - 4175 - Name/Method: —/ t 0• , Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
[/ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
E r& 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
El Master Builder El Other: Description I Qty I Fee(ea.) I Total
Hea
JOB SITE INFORMATION and LOCATION
Furnace - add-on air conditioning ** 1/ 1 14.00
Job site address: I R -20 <(.4..) 'ias"nvlsz,/c.re-d i(L ', Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 1 14.00 /`/ "
Project Name: Hydronic hot water system 14.00
Cross street/Direc ons to job site: Residential boiler 14.00
(for radiator or hydronic system)
T1 i ���` Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) ` 10.00 /p, oe
Subdivision: I Lot #: Repair units 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
D SCRLPTION OF WORK Gas fireplace 1 10.00 /o • '
•A t -4-1/'' ✓ v Flue vent (water heater /gas fireplace) 2 10.00 „Tp, 00
7.1 I4 f � a , 9, ` Log lighter (gas) 10.00
��F ' Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
ROPERTY O NER I ❑ TENANT L HS t � H. IV Other: , 10.00
Name: D �C (ice 7Y / ''� � , Environmental Exhaust & Ventilation
Range hood/other kitchen equipment / 10.00
Address: I (',� —W ! v ,1%ta� z. i
City /State /Zip: ('1 t� ��� Clothes dryer exhaust 10.00
' r! ) Single duct exhaust
Phone: :3e3 — Fax: 521 —01 ( (bathrooms, toilet compartments,
0 APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: • • Attic/crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: I Fax: Furnace, etc. i **
Gas heat pump * *
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater ** .5-0
Business Name: _..A 60-/P -- Fireplace 1 **
Address: Range 4 **
BBQ as
City /State /Zip: Clothes dryer (gas) **
Phone: I Fax: Other: **
CCB Lic. #i , / Total:
Authorized yLW,,A.r., / Mecha nical Pe Fees*
Si ature: � � Subtotal: $
gn - Dat e: Minimum Permit Fee $72.50 $
i �1 �1 Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
■
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information •
Commercial Fee Schedule: _
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00. "
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
• fraction thereof, to and including
$25,000.00.
$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 and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof. •
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955 •
ducts & vents •
Furnace > 100,000 BTU including ducts 1,170
•
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
<3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to I mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 .
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 .
Air handling unit >10,000 cfm 1,170 ,
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
A
Electrical Permit A lication FOR OFFICE USE O NLY
Received 2., d 3 Electrical rj -693,4
Date/By: Permit No.: N
R I `1�
City of Ti and Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. JUL 30 20 ( Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503OWW1NI TIGi . 's fi Post- Review Land Use
Internet: www.ci.tigard.or.us , , W,';`,1111 Date/By:
1UI�DING DI _ ^^ Contact Case No.:
!yas See Page 2 for
g �
24 -hour Inspection Request: 503- 639 -4175 Name/Method: MS- Supplemental Information.
. TYPE OF WORK PLAN REVIEW (Please check all that apply) .. . '
❑ N W Construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
d dition/alteration/replacement El Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
[]<-& 2- Family dwelling El Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building El Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
El Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB, SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1 11-20 54.0 SC4rnvite_re.ife — FEE* SCHEDULE -
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross stree irections jqb site: New residential - single or multi- family per 1
dwelling unit. Includes attached garage.
"Zri, Wt tt.Z-re Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 l
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
• - DESCRIPTION OF WORK service and/or feeder 90.90 2
�
` Services or feeders - installation,
', 56( 441iP i N. I/`ef� alteration or relocation:
0 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
' 2 ROP (J
ERTY WNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
// p Over 1000 amps or volts 454.65 2
Name: ' e66I Reconnect only 66.85 2
Address: 10.2? /4_/ yiliMl&�L='t/ s'r' .()f Temporary services or feeders - installation,
��//�� alteration, or relocation:
City /State /Zip Gi. C / 2 _ 41 200 amps or less 66.85 1
Phone: 103 — 1 Fax: 411 Gam/ 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT . . ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of 46.85 i • ? 2
/
service or feeder fee, first branch circuit
Phone: I Fax: Each additional branch circuit 6.65 •( U 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: OW /J re- - alteration, or extension Page 2 2
Description:
Address:
City/ State/Zip: Each additional inspection over the allowable in any of the above:
y p Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
Electrical Permit Fees*
Supervising electrician Subtotal $ -2 3 . yS
signature required: Plan Review (25% of Permit Fee) $
Print Name: I Lic. #: State Surcharge (8% of Permit Fee) $ 5 • SS
TOTAL PERMIT FEE $ '79. 3
Authorized / Notice: This permit application expires if a permit is not obtained within
Signature: ili -- Date: �' 2 1 �� 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY: •
Fee for all systems $75.00
Check Type of Work Involved:
11 Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
•
Check Type of Work Involved:
Audio and Stereo Systems
0 Boiler Controls
0 Clock Systems
Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
Instrumentation -
El Intercom and Paging Systems
El Landscape Irrigation Control
El Medical
n Nurse Calls
Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
Permit #: 900 — 00 3 96
Add - . - . ,,,, , 0 ■ d u 1-iNI6 ' c_. !C e.T �,Q.
Is ed by: , 1 4 0 P ' ' . Date: 7/x/.5
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
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
.I' 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owne . bout Con truction Re / +onsibilities on the reverse side of this form.
( s i gnature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
:Vote: This information Notice to Properly Owners about Construction Responsibilities
was developed he the Construction Contractors Board in accordance with ORS 701.055(5).
if you are acting as your on 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 ofa residential structure, you will. in most instances, be ruled to be an employer and the people
you hire w ill 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 Nvages 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. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs ifone ofyour employ ees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Serf ices at 945 -7888.
U.S. internal Revenue Service: As an employer. yon 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 fai 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 I3ox 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
BUILDING DIVISION PERMIT #: 'vim }t1I73.0039C
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3IU:?0I:)3
Phone: (503) 639- 4171 �. , n� j1l
Inspection Requests (24 Hrs.): (503) 639 -4175 : `:_..
INSPECTION WORKSHEET FOR DATE: 1/17/2006 TIME: 7 :0 JAM . PAGE: 16
SITE ADDRESS: 11720 SW SUMMER CREff DR CLASS OF WORK:
SUBDIVISION: BURI WOOD NO 3 LOT #: 024 TYPE OF USE:
PROJECT NAME: 1 ASERSOHN
DESCRIPTION: Addition of 360 col ft family room addition. 11/29/06: THIS PERMIT IS REINSTATED FOR
PURPOSE_ OF FINAL. INSPECTION::I FOR A PERIOD OF THIRTY DAYS.
OWNER: 1ASERSOHN, JEFF C, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date 1 /11720U(i Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 025077 -02 503 -679 2271 N
Corrections/Comments/Instructions:
•
*C��� / . z S - 0 c ' C Ce � u)S
Go r< -7
•
K ID_ASS % 'ARTIAL APPROVAL ❑ CANCEL ` 111 NO ACCESS
II] FAIL / CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspecto Date: r / O Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I►�sr. }c>c>'0t�tiPi
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7f 50� : }UU:
Phone: (503) 639 - 4171 fir- u� ' � ,
Inspection Requests (24 Hrs.): (503) 639 -4175 �+` P 'I ��
INSPECTION WORKSHEET FOR DATE: 1/17/2006 TIME: 7 :05AM PAGE: 17
SITE ADDRESS: 11720 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: E3URLWOOt.) NO.3 LOT #: 024 TYPE OF USE:
PROJECT NAME: I ASE.RSOHN
DESCRIPTION: Addition of 360 cq ft family room addition. 11/2B/0 THIS PERMI1 IS REINSTATEt) FOR
PURP0 :47: OF FINAL INSPECTIONS FOR A PERIOD OF THIR IY DAYS.
OWNER: IASERSOIIN. JEFF G. PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact -# a:- -
399 Plumbing final 026077 -01 ti 34,79.221'i
Corrections /Comments /Instructions: a C--
* � 3
. ( (.... az�. % �k// _ _ - - A ZT c' /Z(:30
K L` 0K- - / - 8 - oS-- 6-1:0 c_,e) (U= c- z0 vv S
co et--t t — L1 -T"z- .
•
V N .e ... ,!■ss El P' - TIA ' PPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • CA F. - INSPECTION ❑ ADDITIONAL FEES ASSESSED
r
Inspector: ■ __ _ _ Date: ( 7.0 Phone #: (503) 718 -
CITY OF TIGARD v
BUILDING DIVISION PERMIT #: M� >T20t1'. G0i',6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/30 003
Phone: (503) 639 -4171 ' U i ' I `
Inspection Requests (24 Hrs.): (503) 639 -4175 .,. I I�
INSPECTION WORKSHEET FOR DATE: 12/28/2005 TIME: 7:02AM PAGE: 17
SITE ADDRESS: 11720 SW "SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BURLWC)OD NO.3 LOT #: 0241 TYPE OF USE:
PROJECT NAME: LASERSOHN
DESCRIPTION: Addition of 360 sq ft family room addition. 11/2810f): THIS PERMIT IS REINS FOR
PURPOSF OF FINAL INSPECTIONS FOR A PERIOD OF THIRTY DAYS.
OWNER: LASERSOHN, JEFF C, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12J213/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 02 -03 x,03-103.14419 Y
orrections /Comments/ Instructions:
I PIZONti b�� 2 /CAI L._(-=; -bc am$
I. PASS i IAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A.
In AIL % ' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
.....
f2 Phone Inspector: . _ Date: #: (503) 718-
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 6 9 dea 5 - 3
DIVISION Business Line: (503) 639 -4171
` BUP
Received D e Requested / �� 7 AM PM BUP
Location //20" c-� S
v a �- �'1 -�-2 ' f Suite MEC
Contact Person — re Ph ( ) C.1' PLM
Contractor Ph ( ) 7 - 7 / 9 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
ZO --
Fire Sprinkler y /Ai/ i
Fire Alarm /
Susp'd Ceiling
Roof
Other:
Final
=ART FAIL
Post & Beam
Unde - -
' gh -1
= ice
Sanitary Sewer
•
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
44, PART FAIL
HANICAL
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 ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line G � /
ADA
Approac h/Sidewalk Date ! Inspector Ext
Other:
Final DO NO REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2003- 00396
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/30/200?
Phone: (503) 639 -4171 En
Inspection Requests (24 Hrs.): (503) 639 -4175 .- _—_- "I � ..
INSPECTION WORKSHEET FOR DATE: 1,J20/2005 TIME: / :02AM PAGE: 11
IZ/ S1 SUrincnc CX(:_s PC_
SITE ADDRESS: 11720 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BURI WOOD NO.3 LOT #: 024 TYPE OF USE:
PROJECT NAME: LASERSOHN
DESCRIPTION: Aditition of 360 r ;q ft family room addition. 11/2W05: THIS PERMIT IS REINSTATED FOR
PURPOSE OF FINAL INSPECTIONS FOR A PERIOD OF THIRIY Y DAYS..
OWNER: LASERSOHN, JEFF C, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/28/20O5 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 024092 -04 0Z /0 Y
orrections /Comments/ tructions :
IZ �
Nt ( r� -c.3'
❑ PASS r d - A - TIAL APPROVAL
t _ r y ❑ CANCEL❑ NO ACCESS
),KAIL •ALL FOR INSPECTION ❑ADDITIONAL FEES ASSESSED
nspector: ,_ ---..°1".1 Date: /Z' #: (503) 718 -
glb
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2003-00396
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/30120(1;;
Phone: (503) 639- 4171a
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12080Q05 TIME: 7 :02AM PAGE: 13
SITE ADDRESS: 11720 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BUR( WOOD NO.3 LOT #: 024 TYPE OF USE:
PROJECT NAME: LASERSOHN
DESCRIPTION: Addition of 360 sq ft family room addition. 11/28105: THIS PERMIT IS REINSTATED FOR
PURPOSE OF FINAL INSPECTIONS FOR A PERIOD OF TFIIR fY DAYS
OWNER: LASERSOHN, JEFF C, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/21312005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 024092 -02 503.703.7449 N
Corrections /Comments /Instructions:
p — - e..._ t o
❑PASS ART ‘' APPROVAL CANCEL ❑ NO ACCESS
El C FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ate: /1.jZg) #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M ,1 20(13- 013[36
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 713012(10 :%
Phone: (503) 639 -4171 �d I�It
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/29/1005 TIME: 7 :02AM PAGE: 14
SITE ADDRESS: 11720 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.3 LOT #: 011 TYPE OF USE:
PROJECT NAME: LASERSOHN
DESCRIPTION: Addition of 360 IN ft family room addition. 11/2W06: THIS PERMIT IS RFINSTA1ED FOR
PURPOSE OF FINAL INSPECTIONS FOR A PERIOD OF THIRTY DAYS.
OWNER: LASERSOHN, JEFF C, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12129/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 024092 -01 603- 703 -7449 N
Corrections/Comments/Instructions:
•
PASS I 'A ; L APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL F/, C L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspecto Date: 023 Phone #: (503) 718 -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST v 3 3 ?
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date R - • uested AM PM BUP
Location ' IL ' A _ 4 _-e cglSuite MEC
Contact Person
(W./ Ph ( V ) 5 71 - - -7 I 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 I�et d 10 . u �' )
Drywall c' 7 /`1 P�
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
UG /Slab
Low Voltage
Fire Alarm
Fi Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S E 0 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line (
ADA D ! — Inspector Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspecti%rdfroeJobslt s.
PASS PA RT FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST g400,3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received — Date Requ steel tr AM PM BUP
Location eA-e -, Suite MEC
Contact Person 91Z( Ph ( ) s l y J 22.7 / PLM
Contractor Ph ( ) 70 3 -7 SWR
BUILDING Tenant/Owner ELC
Footing '
Foundation Access: L }1 q ELC
Ftg Drain ( G / ' ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing 1 \
Insulation I ` �-1'I r' �n �� G? - (1��) � C ., p r ) t l J
Drywall Nailing J/ J
Firewall V—•\1\
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL _
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
i °ough- n
a•
ow Voltag:
Fir- • -
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
•r-- PAR
SIT ❑ 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 rom the J site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: •03) 639 -4175 MST AO 3' 7 • 9
INSPECTION DIVISION Business Line: 503 • =2.
76° BUP
Received t t Date Requested AM P BUP
Location _ / •
,.� ' r ulte MEC
Contact Person Ph ) PLM
Contractor P r ( ) SWR
BUILDING Tenant/Owner /4 1 ; 7 zz 7/ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Fram'ng
u ation
• ^ - ailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Fi
ASS PART FAIL
L MBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date OK - � � Ext
Other: a
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 1 ) 3 - 4 3 .37
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Co - `I 7 " Date Requested AM PM BUP
Location // Suite MEC
Contact Person 94fif Ph ( ) 703 — 79 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
Insu ation
Drywall Nailing C, C2' r` Irt
Firewall •
Fire Sprinkler �� =S J �` AL--
Fire Alarm ' �� –�� , (
Susp'd Ceiling
Roof
Other:
Final
PASS , _ PART )AIL
PLU BIN F
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date /o 4—" 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 40P �' , a 3 , 0050
INSPECTION DIVISION Business ine: (503) 639 -4171 �!
/6 y BUP
Received C Requested AM 9: PM BUP
Location /7 2 c 1 i ei-caz � e...""ef T Suite MEC
Contact Person 7' C Ph ( ) 57? — ??7 / PLM
Contractor Ph ( ) — 203 — 7 Y SWR
I11M2 Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int S Shear
rmin �A C ��G� .<i�GcJ L CJ�� -
Drywall Nailing � � �`«�� dJ/�i �- � - s S � S 7 . 4 ' c� -�eK
Fire wall �� �,
Fire Sprinkler ? L_
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS AIL
PLUMBIC '
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA ART FAIL
ECHA AL —
s Besim
dough -1
Oas ine
Smoke Dampers
Final
PART FAIL
CTRICAL
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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date � 9 _ 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 3 —
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /-" ' AM PM BUP
Location MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/200 9r6( 70 3 - 7 Vy ELC
Footing 5 7 9'- Z Z 7/ 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
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In .
s
Smok: Dampers
FAIL
im.- ECTRICAL
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 D Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA r
Approach/Sidewalk Date I Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour c�
BUILDING Inspection Line: (503) 639 -4175 MST 3 - D 3 /
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re `uested — i `t' AM PM BUP
Location o- ? 4 - - ���Au- 1_� -_ a Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 5 7 SWR
BUILDING Tenant/Owner ELC
otin ELC
oundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing � c vr„ �, - ��.c S</L/�r7 — c✓• t- 5 : ��/lcv
Insulation
Drywall Nailing
Firewall
Fire Sprinkler /1 4 - v' %S 5e 7:5
Fire Alarm <1.144,
Susp'd Ceiling
Roof
Other: i ' 1
Final
• :M PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA : p� /1/ Ext
Approach/Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL