Permit 11 .
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00492
� , DEVELOPMENT SERVICES DATE ISSUED: 10/9/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 06815 SW WALNUT TERR PARCEL: 1S125DA -02400
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
REMARKS: Add 320 square feet to existing garage.
BUILDING
REISSUE: CUSTOM STORIES' 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT. 12 FIRST: sf BASEMENT. sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE' 344 sf FRONT. 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD sf RIGHT: 5
VALUE: 8 20
OCCUPANCY GRP: R3 BDRM: BATH. TOTAL. 0 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:
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'
EAADD'L 500SF: 201 - 400 amp 201 - 400 amp. 1st W/O SVC/FDR• 00 SIGN /OUT LIN LT. PER HOUR:
LIMITED ENERGY: 401 • 600 amp' 401 - 600 amp' EAADDL BR CIR: 100 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: $ 322.17
O OWNER This permit Is subject to the regulations contained in the
GAR
GAR TERRACE Tigard Municipal Code, State of OR. Specialty Codes and
6815 SW WALNUT NUT 3 all other applicable laws. All work will be done in
S SW WRIGHT IGH
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' 503 701 - 3577 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
Grading Inspection Exterior Sheathing Insl
Slab Insp Rain drain Insp
Electrical Rough In Electrical Final
Framing Insp Final inspection
Shear Wall Insp
Issued By �� 2 - - c-- - %_ ( /� Permittee Signatur- � /. 1 L i A\
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n 4 • usiness day
F
Buildin 'Permit • • FOR OFFICE USE ONLY
eceivep „Z Building q "'' n
Date/By: / `' ` U Permit No.: l AX),,5 -69 7,0
Cit of Tl and Planning Approval Other V1
Y g e �� b �� Date/By PemvtNo. • C3
13125 SW Hall Blvd. c� Plan Review Other
Tigard, Oregon 97223 Date/By ( - /0 7 Permit No
Phone: 503- 639 -4171 Fax 503 -691 y1 71G'�m , pV,+ ;`\ Post - Review Land Use
Internet: www.ci.tigard.or.us BUILDING Dl , i s').� Date/By Case No
Contact ® See Page 2 for
24 -ho Insp ction Request: 503- 639 -4175 Name/Method. Supplemental Information
9414, 05 1" ��� ° r,. Warr ' ° ��9.. t / . !�0 iCJ
,�
, F -
.. TYPP.OE�WORK � � x ,`a • . ; ,k ' ” ' •4REQUIRED DAT x;,
U New construction El Demolition " &'2 • .1 FAMILY DWELL N( -
% Addition /alteration/replacement ❑ Other:
- CAT.EGORYIOF,CONS`);RUCTI"ON "' , - a . Note: Permit fees* are based on the total value of the work performed. Indicate
the value (rounded to the nearest dollar) o all equipment, matenals, labor, p
1 & 2- Family dwelling ❑ Commercial/Industrial b
3 o
� overhead and profit for the work indicated on this application. 35 9
El Accessory Building ❑ Multi- Family 4 3 ®�
El Master Builder El Other: Valuation I .� $
JOB';,SITE- 11 LOC' T ION "'� +;� +' ..' > . No of bedrooms: CP No of baths: ] P t--
Job site address: (p$ ■ S S W wQQl� &-tom - Total number of floors 1'
New dwelling area (sq. ft.) 4
Suite #: `- Bldg. /Apt. #: Garage /carport area (sq. ft.) 3
Project Name: YV I RA (_ rtgc d ljdiaC ' Covered porch area (sq. ft.) ,
Cross street/Directions job site: g Deck area (sq. ft )
fi `moo I " �,�, Other structure area (sq. ft.)
1
� C 4V wt �� i�tAeC .; i � i ; �:. REQU = 's
T.
`. ' . C O MM E R CIA L - USE•CHE .,
Subdivision: Lot #: ""`' � '"
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed Indicate W
'`':DESCRIPTION'OF WORK ` " _. - - .A ?,;t ',- ;. the value (rounded to the nearest dollar) of all equipment, materials, labor,
/1�� �l V /°' overhead and profit for the work indicated on this application
C / Valuation $
Existing building area (sq. ft.) r-
New building area (sq ft.)
Number of stories
IV -PROPER WNE1 ❑:-TENANT, `.. �` , 4 .t.;• ; "` Type of construction
• 11!! ,„ �� ..,,JJ L Occupancy group(s): Existing:
e: W New:
Address: (02) 51 1 tival (n) +-URA C•t_ \
City/State /Zip: T GCA - NZ-b oIL 411:2,3
Phone: '701 — 35t! I ) Fax: C W 1 4,0S NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
, ID: APPLICIOTTs - - ❑ _CONTACT PERSON,,
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: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: I Fax: L,
E-mail.: , , ' B`UJLD'ING FEES* ,'r' •
. K
' : °`'_r• ' _ . . CONTRACTOB�, . _ .. ' . .. ' ,Please�refer fo;feeschedule.; .
''''` • ,
Business Name: O(Oti Ea_■' Fees due upon application $
Address:
City/State /Zip: Amount received $
Phone: I Fax: Date received -
CCB Lic. #: A _ /
Authorized �I
'�1 L _ , � : te: Q
( Notice: 180 This after permit it has application been expires as complet if a pee.
rmit is not obtained within
Signature: L ■; days accepted
6 a 20 , *Fee methodology set by Tri County Building Industry Service Board.
W (Please pri name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
One- and Two - Family Dwelling
4; Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard `� b ❑ Electrical ❑ Plumbing ❑ 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 pernut.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 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 mom 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)
Electrical FOR OFFICE USE ONLY
ical Permit Application
Received (� // Electrical 1 /� ' p
RECEIVED Date/By. / OItroval !O °��� l 7 iA0c1d 7 /
City 13125 Planning of Tigard App Sign
g Date /By Permit No : /7 Permit No..
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 SEP Z b 2003 Date/By: Permit No.•
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use •
Internet: www.ci.tigard.or.usCITY OF TIGARD a ,.i � I I Co case No
Contact jtigr� Su See Page 2 for
24 -hour Inspection Request BJ 1118lSl • `' " " - --• " Name/ ' /� Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
74ddition/alteration/replacement ❑ 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
❑ 1 & 2- Family dwelling 11 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
/ :/ ^! S � � ,���� The above are not ap plicable to temporary construction service.
l
Job site address: E5 FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Wgio6 — c Cte Description Qty Fee(ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per 1
6Es-Cif -4T3 dwelling unit. Includes attached garage.
{ B, / Service included:
W
'� � i X 7 0 tti .k ° 1 a N �0 1� l �, 1 i 1 ^ N -r 1000 sq. ft. or less 145 15 4
D\- Each additional 500 sq ft. or portion thereof 33 40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: 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,
alteration or relocation:
200 amps or less 80 30 2
201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
PROPERTY OWNER 0 601 amps to 1000 amps 240 60 2
2
�� p I p ® n Over 1000 amps or volts 466 85
a me: � ��! �C°�Y / l Reconnect only 66 85 2
Address: CoS1 S SIA) Woa Tittf1Atc Temporary services or feeders - installation,
alteration, or relocation:
City/State /Zip: 1('\ Lori ! Oa— qln,-/,3 _ 200 amps or less 66 85 1
Phone: 50S - Id WI/ Fax: (no— 74,0S 201 amps to 400 amps 100.30 2
401 to ❑ APPLICANT ❑ CONTACT PERSON Branch h amps 133.75 2
c
Br circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6 65 2
service or feeder fee, each branch circuit
City /State /Zip: B Fee for branch circuits without purchase of
service or feeder fee, first branch circuit I 46 85 2
Phone: Fax: Each additional branch circuit I 6.65 2
E -mail: Misc (Service or feeder not included).
CONTRACTOR Each pump or imgation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 0 (A) Nita----- Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
Descnption
Address:
City/State/Zip: Each additional inspection over the allowable in any of the above:
P Per inspection per hour (mm I hour) 62 50
Phone: Fax: Investigation fee
CCB Lic. #: Lic. #: Other:
Su Supervising electrician Electrical Permit Fees*
P g Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: L • . #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized /k Notice: This permit application expires if a permit is not obtained within
Signature: Ah vj k c7
AVAN. Date. 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
` iltioa ,, F --/-1J (Please pnnt ame)
I \Dsts \Permit Forms \ElcPermitApp d 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:
Audio and Stereo Systems
n Burglar Alarm
El Garage Door Opener
n 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
Fl Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
0 Instrumentation
El Intercom and Paging Systems
n Landscape Imgation Control
El Medical
❑ Nurse Calls
n Outdoor Landscape Lighting
❑ 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 #: e/g
Address: L ) g / aej &- /CST 7 % 6°.
Issued by: Rfln1/t LDate: l Dl 9 l 3
•
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 i the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
i M 1. I own, reside in, or will reside in the completed structure. •
r4r 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
/L.
1. 0 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners rhout Con truction Responsibilities on the reverse side of th• form
4 - - • .1 -74 o fi
(Signature • f p rmit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
RroforHation Notice to Property Owners
About Construction F; esponsibipities
Note This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor, in constructing or assisting in the
construction or improt+ernent of a residential structure, you will, in most instances,,be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer. you must withhold income taxes froniemployeewagcsatthetimeemployees
are paid. You «•ill 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 uneniployrnent 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. Ify'ou fail to obtain workers' compensation insurance, you may•,
be subject to penalties and will be liable for all claim costs if one ofyour employees is injured on the job. For more information; •
call the Workers' Coniperisatiori Division at the Department of Consumer and Business Services at 945 - 7'888.
U.S. internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue- Service
at 1- 800 -829 -1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see ifyou have adequate insurance coverage for
accidents and omissions such as falling tools, paint,overspray, waterdamage from pipe punctures. tire, or work that must be
re -done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish
trades. and to notify building officials'at the appropriate times so they can perform the required inspections.
.
If you have additional questions, write or call the Construction Contractors Board (PO Box I4,140, Salem,'OR 97309-5052,
503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem''
prop- own.pm4
1194
!] �i�s �€
S["P 301003
CleanWater Services i File Number
Our commitment is clear.- Sensitive �� ��
/5/ZS
Jurisdiction CI 4 6 a k Date /C 0
Map & Tax Lot Lai ci Kittiti,4 «va Owner
Site Address - lAS 51,,) 1NrnlNA Tom"
‘1121.3 Contact , - 4 WA -
Proposed Activity 1 CIe A-4,4 Address log l 5 S WALN iAt T
Tl cxva p ,et— 1 Z 1ti�
50 ° 2_44- — ?-S Phone '03 - 7
Y N NA Y N NA
Sensitive Area Composite Map Stormwater Infrastructure maps
I I ❑ Map # / Sl w b El ❑ � QS # 91 Z
❑ I I r' Locally adopted studies or maps ❑ ❑ ® Other
�' Specify Specify
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 00 -7:
❑ 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.
DCK, 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 OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
n The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
P arcwrta.�� 7 S e"s ;r v 40. eftes e. ` o .�ed
Reviewed By: Date: t/7fr 3
Returned to Applicant
Mail A Fax Counter
Date /d/ 7/05 Bye
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124
Phone: (503) 846 -8621 • Fax: (503) 846 -3525
www.cleanwaterservices.orq
i.\Building \Forms \CWS- SensAreaPreScm.doc 07/01/03
CITY OF TIGARD 2 4 - Hour
BUILDING Inspection Line: (503) 63' 4175 &_)3 — CO C 2 - ,
INSPECTION DIVISION Business Line: (50 7,171
BUP
Received fi /L 'lc - O / 22 - Date Requested 4/- AM PM / BUP 1
CD
Location ��� L L. Suite MEC
Contact Person LAX" t()iu U M Ph ( ) 70 / — 3 5 7 7 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 "1 /� i� 1 ' Ilk \ , o ( / . z.-,(A
Framing �•�/
Insulation s\ /� ` - \ 2! / o C
Drywall Nailing
Firewall `�^ D ` 0 c- s —1 ,,_rte
Fire Sprinkler
Fire Alarm
Susp'd Ceiling .. A
Ro
of r _ 1 l/�' w`-� e ` Q om ` 1 �1�
Fins
- �' :. RT FAIL ���
LUMBIN 4
Post B am , /V , \ ',&`� C` \� L'--
Under Slab
Rough -In
Water Service
Sanitary Sewer
g+
Catc :asin / Manhole
Storm Drain r
Shower Pan
Other:
Fine
ASS PART FAIL
HANICAL
Post & Beam
Rough-In
Cir
Gas Line
Smoke Dampers
,,,,,,,'""( ' .
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 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: 0 Unable to inspect — no access
Fire Supply Line
ADA \J�\ v �-
f i
Approach/Sidewalk Date q v I nspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL