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12210 sw AN 14 COURT
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
_ Date Requested_ - L-7 AM _PM — BLD _
Location—��1� GTA.; 16— . — Suite MEC
Contact Person _ p Ph PLM
Contractor — -- Ph SWR
BUILDIN Tenant/Owner ELC
Retaining Wall ELR
Footing
Access:
Foundation y FPS
Ftg Drain I��1�( ------
Crawl D:,in Inspection Notes: SGN
P C' n
Slab lt/�'�
�_�----- -- SIT
Post$ Beam - — -
Ext Sheath/Shear
Int Sheath/Shear -- --
Frarning
Insulation -
Drywall Nailing
Firewall -_ --------- ��_.-----___.`--_
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling ------------- -- ------ ---
Roof
Misc: ---_ ---- —-- --
PART FAIL --- —•-- -_�_ _________-_
PEVMBING
Post 8 Beameam
- ---- --
Urder Slab
Tcp Out ---- —
Water Service
Sanitary Sewer -- --
Rain Drains
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
PASS PART FAIL
SITE
Backfill/Grading -- �T �---- ---
Sanitary Sewer
Storm Drain I ]Reinspection fee of$ rec,uired before next inspection Pay at City Hall, 1315 SW Hall Blvd
Catch Basin
Fite Supply Line I ]Please call for reinspection RE. —_ _ -- _ I ] Unable to inspect- no access
AA
Approach/Sidewalk nate ! �� (- C,' Dc
Other _ _-- 1� Irrspectcr _- �_— _ Ext _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Lined 639-4171
BUP
_ Date Requested__ 1Z ( AM �PM
— BLD _
Location 1 v 10 A YW C. Suite MEC _
Contact Person _ �JLtCi�' �(�n—� Ph (' y � -- PLM
Contractor —11L)I7 _..__ Ph — WIR -
BUILDING — Tenant/OwnerELS _
Retaining Wall - ELRQ(J'2 _
Footing Access.
Foundation FPS -
Ftg Drain -- SGN
Crawl Drain Inspection Notes: i
Slab - V r' laic,`-� j�r,n -_— SIT -
Post& Beam
Ext Sheath!Shear ----- -.
Int Sheath/Shear
Framing ------__.--
Insulation 1_
Drywall Nailing ___._-------- --�>�3 -. -.---- -- - -- - --
Firewall
Fire Sprinkler - ---------- ------- _ T-- -- ---- ------ -- - -
Fire Alarm
Susp'd Ceiling _—__ _— ----- �---- -_._-_-_----- ------ -
Roof
--
Final
PASS PART FAIL ------ - - -- ------------ -----------
PLUMBING
Post& Bearn
Under Slab
Top Out
Water Service ----- -------- -- - ---------- ------- --
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post&Beam --- -- - - ---- - - ------
Rougt In
Gas Line -
Smoke Dampers
Final ------------- __. _- - - ---- ___ -_ ----- ----- ------------------..--
PASS PALET FAIL
GTRICAL -- - - - -
Service _
Rough In
ow Voltav
FrreAlarm ---- --- - -- _-- --- ------ -- -._ ------- -
Fi
AS PART FAIL --- -- --- ------ --- -- ---- - - - ----
i3
Backfill/Grading _.---- __ ----- -- -__.--- ------- ----- --- -- _-_ . _.
Sanitary Sewer
Storm Drain l 1 Reinspection fee of$ _ - _required before next inspection Pay at City I fall, i 312.5 SW Hall Rhrd
Catch Basin
Fire Supply line [ ) Please call for reinspection RF _-_ [ J Unable in inspect NOacr.ess
ADA
Approach/Sidewalk
Other Date __. �- �7---- inspector--_= Ext ----
Final J"
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
DEVELOPMENT SERVICES FLECTRICAL_ PERMIT' —
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 RF ST R I CT!ED ENERGY
PERNTT #: FL.R97--0117
DATE TESUED: 04/1.4/97
PARCEL-: 2S 13BB 1-3000
91 TE ADDRESS. . . : : 10 SW ANN CT
SUBDIVISION. . . . ZONING:
131—OCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . Jl1R I SD T CT•N:
Project Description: INSTL BURGLAR ALARM
A. RESIDENTIAL------ S. COMMFHCIAL—
AUDIO 8. 13TF RFO. . . : ALID I O R STEREO. . : INTERCOM R PAGING. . :
AUPG!_AR AL..ARM. . . . : X BO I L.ER. . . . . . . . . . : 1_ANDSCAPE./I RR I GAT. . :
GARAGE OPFNER. . . . . CI_.00K. . . . . . . . . . . .. MEDICAL.. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . . DATA/TFL.E COMM. . . NURSE CALLS. . . . . . . . .
VACUUM SYSTEM. . . . : F T RE ALARM. . . . . . : OUTDOOR L-ANDSC L.I TE:
OTHER: : : HVAC. . . . . . . . . . . . : PROTECTIVE STGNAI_. . :
I NSTRUMFNTAT Inl`I. : nTHFR. . : . .
TOTAL_ # OF SYSTEMS: 0
Owner: ----------- -----___----•- --_____________.__-----.--___--- FEES
DAVTL• JACKSON type a m o int by cute recpt
12210 SW ANN CT PRMT is 4t0. 00 TAT 04/1.4/147 97-293209
TTGARD OR x97223 5,PCT $ J . 00 TAT 04/14/97 97-29320
9
Phone #: 924-6578
i.1 ; rFCUR I TY ALARMS $ 42. 00 TOTAL
07, NF HANCnCK
RE(;U I RED INSPECTIONS
PORTL_.AND r)R 97l Cei l i.ng Cover Elect' 1 Service
Phone #: 503-284-3265 Wall Laver Elect' l Final
Req #. . 000599
Thi hermit is Issued sah)!ct to the regulations contained :o the -
Tigard Municipal Code, State of '1re. Sp►cial�y Cod?s and all other Permibee\Si gnatur"
applicable laws. All Mork will be done in accordance with /
Anp^oved plans. This permit will expire if work is not ste,ted /
within 180 days of issuenre, or if work is suspended for gore
1,113n 160 days. I s,Yed Sv�
OWNER I NSTAI._LAT I ON ONL Y--_— -i-------•---------------- -- —
The installation is being made on property T own which is not intended for
sale. ) e<ase, or reit.
OWNF R' S S I SNATI.IRF: DATE:
INSTALLATION ONLY--------- --- --------- ----
SIGNATURE OF 9LIPR. E-1_FC' N: DATE:
I CENSE NO:
Call for insrection - 639-4175
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by:
13125 SW HALL BLVDDate Recd.
TIGARD OR 97223 c5 9 7 PRINT OR TYPE
V - 503-639-4171 X304Permit#: CL,, ��11' 7/�/
F - 503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd: _
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL
Restricted Energy Fee........................................ $40.00
(FOR ALL SYSTEMS)
JOB Street Address Ste#
ADDRESS 7 A � CT. .w Check Type of Work Involved:
- —�—� CitylS�t � Zip � Phone#i Audio and Stereo Systems
Name S Burglar Alarm
/ Garage Door Opener'
OWNER Mailing Address.
—� ❑ Heating,Ventilation and Air Conditioning System'
City/State Zip Phone#
Name ❑ Vacuum Systems'
Of SECUMTY SERY1ffS,MillIl Other
703 N ❑ — - ——
CONTRACTOR Mailing Ad
E"X11-3265 TYPE OF WORK INVOLVED -COMMERCIAL
(Prior to issuance a City/State TZip Phone# Fee for each system.............................................. $40.00
copy of all licenses _ I (SEE OAR 918-260-2.60)
are required if Oregon Contr.d # Exp Date
expired in C O T. LZ7 Check Type of Work Involved
data base) Electrical Contr, iExp Date rt
LJ Audio and Stereo Systems
C O or Metro Lic # Exp Date
Boiler Controls
Oamer's Name
❑ Clock Systems
OWNER - Mailing Address
F—]APPLICANT Data Telecommunication Installation
City/State Zip Phone#
Fire,alarm Installation
This permit is issued under OAE 918-320-370 1 his applicant agrees to ❑
make only restricted energy installations(100 volt amps or less)under this HVAC
permit and to do the following ❑
Instrumentatior,
I Only use electrical licensed persons to do installations where required
Certain residential and other transactions are exempt from licensing ❑ Intercom and Paqing Systems
These have asterisks(') All others need licensing,
Landscape Irrigation Control'
2 Call for inspections when installation under this permit are ready for
inspection at 503-6394175; ❑ Medical
3 Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit,
4 Assume responsibility for assuring that ail corrertior s required by the ❑ Outdoor Landscape Lighting'
inspector are done.and; ❑
Protective Signa:ing
5 Assume responsibility for calling foi a final inspe- on when all of the
correction3 are completed Other _
Permits are non-transferable and non refundable and expire i(work is not
started within 180 days of issuance or if work is suspendNd fx 180 days _ __Number of Systems
The person signing for this permit must be the•jpplr„ant or a person No licenses are required Licenses are mqu rad for all other installations
authorized to bind the applicant ——
�-r _ FEES: �}-�
/ l ENTER FEES $_ L><� ' v '�
ignatu �
(: 5%SUl'CHARGE(.05).TOTAL ABOVE) $
A,tthonty if other than Applicant TOTAL $ L
vesere doc 12196
� CITY OF T I G A R D MASTER PERMIT
HERMIT #: MST1999-00139
DEVELOPMENT SERVICES DATE ISSUED: 4/19/99
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12210 SW ANN CT PARCEL: 2S103BB-13000
:SUBDIVISION: LAKE TERRACE NO, 2 ZONING: R-4.5
BLOCK: LOT: 023 JURISDICTION: TIG
REMARKS: 140 sq. ft, accessory structure
BUILDING
REISSUE: STORIES: I FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 13 FIRST, 14n of BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 4n SECOND: sf GARAGE: sf FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: of RIGHT:
VALUE" S-IApo un
OCCUPANCY GRP: R3 BDRM: BATH- T01AL: of REAR: 5
PLUMBING -�
SINKS: WATER CLOSETS WAS141NG MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS. FLOOR DRAINS: SEWER LINES: 5F RAIN DRAINS: CATCH BASINS:
TUBISHOWERS: GARBAGE DISP'. WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GRE 4SE 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 FURNAN^,ES: VENTS: WOODSTOVES: GA,;OUTLETS.
ELECTRICAL.
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD L INsr ECTIONS
1000 SF OR LESS: 0 200 amp: U 200 amp: WISVC OR FDR: PUMPORRIGATION. PER INSPECTION:
EA ADD'L 500SF: 201 400 snip: 201 400 amp: 1st W/O SVC/FDR SIGN/OUT"LIN LT: PER HOUR.
LIMITED ENERGY: 401 - 600 snip: 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL IN PLANT.
MANU HMISVCIFDR. 501 - 1000 amp: 601.anlps•1000y: MINOR LABEL:
1000•amplvolt.
PLAN REVIEW SECTION
Reconnect only: --4 RFS UNITS SVCIFUR-225 A.: >600 V NOMINAL CLS AREAISPC 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: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR.
HVAC. DATA/TELE COMM: NURSE CALLS TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 105.46
D JACKSON OWNER This permit Is subject to the regulations contained in the
DAVID
ANN C7 SIGNED RESPONSIBILITY FORM Tigard Municipal Code,Slate of OR Specialty Codes and
122 10 all other applicable laws All work will be done in
PGARD,OR 97223 IN FILE 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
Phone 67a-r5re hone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those noes are set
R a n forth in OAR 952-001-0010 through 952-0010080 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Footing Insp
Framing Insp
Final inspection
Building Final
Issued By :,fa1t1"t'1 '` V1tL _ _ Permittee Signatur
Call (503) 639-4175 by 7:00 p.m. for an inspection need ths_ne�t bufl (ess dW
1
Ian
CITY OF TIGARD Residential Building permit Application Recd ec'dBvck#
13125 SW HALL BLVD. Additions or Alterations
Date Fee
ed
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E
V 503-639-4171 Date to DST t= 'r t !f R/
F 503-684-7297 Permit##T1
Print or Type Called
Incomplete or illegible applications will not be accepted
Name of Project LO i Name
Job
1-47Af. Vii«/��`1 � Architect Mailing Address
Address Site Address
/ via :71J City/State Zip Phone
ame
1:Lt) i i i") Name
Owner Mailing Address n 1
r n ` j Mailing Address
_city/State A Zip Phone Engineer
__ I r r.,"r ) U r •=1 (-'N-( );- City/State Zip Phone
`General Narnii
Contractor j` (� `_ - , r, Describe work New® Addition O Alteration O Repair O
Mailing Address to be done:
Prior to permit 1 11 i Additional Descript ion of Work:
issuance e,copy City/State Zip Phone l
of all licensest ,,iJ
are required if Ore n Const.Cont Board Exp. Date PROJECT
expired in COT Lic.# VALUATION _ ��'
database
Mechanical Name ---- NEW CONSTRUCT ON ONLY:
Sub- Sq. Ft. House: Sq. Ft. Garage
Contractor Mailing Address - _ — -
Indicate the restricted energy installation by the electrical
Prior to permit subcontractor in the following areas
issuance,a copy City/State Z_ip Phone Restricted Audio/Stereo
of all licenses _ _
are required if Oregon Const Cont Board Exp.Date T Energy S sY tem Alarms
expired in COT Lic* Installations Vacuum Irrigation
_database
System System
Plumbing Name (check all that Other:
Sub- apply) _
Mallin Address Corner Lot YES NO Flag Lot YES NO
Contractor g _(check one) (check one)
Hai the Subdivision Plat recorded? N/A YES NO
Prior to permit City/State Zip Phone
issuance a ropy
of all licenses are Oregon Const Cont Board Exp Late
required if Lic# I hearby acknowledge that I have read this application,that the
expired in COT
database Plumbing Lic # � Exp Date information given is correct.that I am the owner or authorized agent
of the owner, and that plans submitted are in compliance with
Oregon State laws.
Name ' Signature o Owner/Agent Date
1. 4..
Electrical
Phone#
Sub- Mailing Address tact p ��atTte�
Contractor
City/State Zip Phone
Prior to permit
issuance,a copy FOR OFFICE 66E MY: _.
of all licenses are Oregon Const Cont Board Exp Date -_�T.r i';!�-� Ma 'Lc
required if Lic# Plat#
' +,�
expired in COT —_
database Electrical Lic # Exp Date Sptbac
Electrical Supervisor Lic # Exp Date En n acing Approval: Plannin Approval: TIF:
i'.jstsNforms\sfaddaft doc 11/20/98
Address:
�h w Issued by: Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction per►nit 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 (lie appropriate blanks and initial boxes I and 2, and either box 3A or 313:
may; 1. 1 own, reside in, or will reside in the completed structure.
CJ 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
3B. i will be my own general contractor.
1r I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If 1 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.
1 hereby certil' that the above infor-mat inn is correct and that 1 have read and do understand the Information
Notice to Property ( ers about ('onstruction Responsibilities on the reverse side of this form.
(Signature perm plicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
:t
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