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OCCUPANCY
CITY OF TIGARD PERIMIT #. . . . . . : MIST950456
13125 SW Hall Blvd. Tigard,Oregon 97223o8199 (503)639-4171
SUBDIVISION- - i HILLSHIRE WOODS ZONING: P- 7 PD
CLASS OF WORK. tNEW
OCCUPANCY GRP. i
SHELBURNE DEV
700S SW NYBERG RD
."AL_ . ^.. OR ' ' ~~^
Phone #: 692-6383
Contractmri -------'------ ------ '--- -- i
SHEL8URNE DEVELOPML-NT
7008 84 NYBER8 RD
lUAiATlN OR 97082
Phone #: 692-6303
Reg #. , : 4i�'388
`hie Lertificat e g,'anty occupm"cy of the above rrfcrpnced boildirig or pov�tion
'`preof and confirms that the building han bepn rispected for compliance with
| /.m State f 8 Specialty Codes for the ncy, and ume under
| ~ - - � ~ '
/`ich the fissued.
---------------- - -----'~~-- - ' ------ —'--------'''------'
'/JLDlNG 1NSPECrOn 9UlLD]NO OFr}rlAL
| POGT IN CONSPICUOUG PLACE
^
` ]
^ �
CITY OF TIGARD tb. . 2t
MST�� - 4
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8194 (503)838-4171
ZONING R- 7 r.r
TQRIES.......; FLM; AtEAC DASDV�rl.... 0 sf PE7JPr.:
EIGHT........1 26 FIRST. 2074 sf GARAGE.....: 728 sf LEFT.......... : -_-_•_-
-LOOP LOA!'...., 40 :ECO^_ . . 57: sf rM ...... ;C; . •_ Ci
SWELLING NITS: I FINBNENT: 0 sf RIGHT.......... 6
:DPM: 2 BATH: 2 TOTAL-_-__ 0 sf VALUE..is 18311'4 REAR,.........; 50
PLUMBING
.....,• _ WATER CLOS:TS. . WAMING MACH.. . I LAMDRY TR.AYS.: r ' '" DRAIN ft: 3 TRAP'
•" 1IT,"1).., ; 1 FLOOR DRAINS..: 0 r WER LINE ft. 2 RAIN DRAINS: 1 CATCH BASINS..: ".
_...._.__ .._.. 1 WATER 0TEPS.. 1 WATER i_INE ft. '00 ".."LW PREVNTR: I GREASE TRAPS—: �
HOODS.........: 1
A% INF.: 0 :-. - 0 WOODS'09ES....: E1
TTES" SR'1C/FEEDERS-- ---BRANCH C - ._ __�NEUri - - INSRECTIOt,:
RCS, ,l*1 SER�,,L.
:000 7 OF. LESS: I 0 2010 ? a 200 Dep..: 0 W/SVC OR FDR, ,t 0 PUK :71GATIONt 0 REp 7`12N: 0
"A ADD*L Ste'.: 4 G01 400 Dar. 2�j! hN amp..: 0 Is'. WIG 5; "Ir: 0 SIGN/CUT LIN L': P PER 1lCi:' . 0
AMIM, ENERGY.: 0 4Bi - 600 C 41 6110 Dep..: 0 EA Ar n. nR _:R; C SISNAL/PARC.,.: 2 IN f"LAA'......:
"SIF FfNrSVClrOR; 0 601 "No amp.: 0 601+ampti 1000 V; 0 KINCR LACE'
IM' anp/r:1:. : 0 _.. . .__.. _ __. PAN RE6'IEW SECTION
Reconnect only.: 1 %4 RE') UNIT;.. . CV.,'rDR)=2A.: 1 601 V NOM' iL; CLE AF:
---- ELE"T.RI2F RESTRI6-TED ENERGY __.._ _..... _.___.__...... ..
r -•-r,..rAL.,__.._------._...__--..-_-_--- B. CWRCIAL_ .._____._____.._.._____.._____.
vAylAllrt SYSTC"... AT.1C a SITREO. : rIPS krliM...... SNTEP^rIM/PASING: 7!T Trl LNrsr
7TH: .. % BODER.......... HVAC. . SCAPE
LAND /IRRIG: ..
CLQ:'/........... . INSTRU-01Tn'AON. 1GICAI..,......:
DATA/Tt;C "M.M.. NURSE CAI.LC..... h -
___.___ ....... _.... _ TOTAL FEES:$ 412:. -
_ SI MRNE DEVELOPMENT
7008 SW NnERG RD
TUUIIN OR 9706E
Phone A: 02 6392
RFQ if..: 42.
epulations con: . .:_
_:�-da:lce with ::rpr:ved plans. TFTs persi•, tiill vpire if w,lk is n:t started
yp Board Insp Electrical Final
d-air Insp Mechanical rico'
- 'dater Line Insp ^lae4 Final
y. �Fprr' dNl+ Ins,G Z:OS:Cr Car.tro; __
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit $i
Phone (503) 639-4171 Date Issued
FAX (503) 684-7297 Issued by
CITY OF TIIGARD TDD No. (503) 684-2772 -�-- --""
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development�[6 t, jy/iQ f )o _—_ Number of Inspections per permit allowed ---
Address !.6T ? '/ Service Included Items Cost(ea) Sum
City/State/Zip 4s. Residential- per unit
I017,0 sq it or lose $11000
Name (or name of business) �� uY Each acldAbnal 500 sq it or D�
f'�/ E v' portwn thereof $2600 0
I.mded Energy $2500
Commercial❑ Residential
f ach Manul'd Hom r or Modular
Dwelling Service or Feeder $6600
2a. Contractor installation only: 4b.services or Feeders
Installation,alteration,or relocation '
Electrical Contractor hk )4eQ 4 S S+AI 'C 200 amps or less $e0 00 ?
Address Sr (,v oc, 5 i C1lr-4ot. RLycj. 201 amps to 400 amps $8000
401 amps to 600 amps $12000
City PC R i State_QZip 9 Z DL 601 amp@ to 1000 amps $18000
Phone No 2;7t-1- /l '>(; Over 1000 amps or volts 1614000
Contrac',or's License No. 2(a -A/-3 — c- Reconnect only $6000
Contractor's Board Rag. No lit N 4c. Temporary Services or Feeders
Inslalation,alteration,or relocation
Signature of Supr. Elec'n � <' .r J_ _ 206 amps or less $50 00 –
--'—�'�'— 201 amps In 400 amps $7500 _
i License No. IS-Do Phone No. 7 Z�, 401 amps to 800 amps $10000
Over 600 amps to 1000 volts
2b. For owner installations: see•b'above
4d. Branch Circuits
Print Owner's Name _ New,alteration or extension per panel
Address a)The lee for branch circuds with
� - purchase o/ rvlee or Aeede►Am. 7
(�'Ih`7 State Zip — eeEach branch circuit $500
Phone No. b)The fee for branch arcude without
The installation is being made on property I own which is purchase of service or Awdsr AI»,
not intended for sale, lease or rent. Fac additional
arced $$600
F.ach addAwnsl branch arced $5 00 ,
Owner's Sijnature _ _ 4e. Miscellaneous
(Sorvice or feeder not included)
3. Plan Review section (if required): Each pump or imgalion ardo $4000
Each sign or oullins lighting $40 00
Signal circud(s)or a landed energy 2
Please check appropriate item and enter fee in section 56, panel,alteration or extension ��–L $4000 4/0,CO
4 or more residential units in one structure Minor labels(lo) $10000
Service and feeder 225 amps or more
I 41. Each additional inape a ab over
System over 600 volts nominal
Classified area or structure containing special occupancy the allowable in any of the above
as described in N E C Chapter 5 lief Inspection $65 00
Per hour $6500
in Plant --- $55 00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction"Moes. 5, Fees:
NOTICE I 5s, Enter total of above fees $
5%Surcharge(05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of lines A`or
CONSTRUC-i ION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if inquired(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ _
COMMENCED ❑ Trus;Account a $
(Balance Due $
eexcl[aebrN�e pm atp
_J
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97:23 lJr , 1
(503) 639-4171
Jobsite Address: _��I, _5 /a.�Cl n S �- U✓
Subdivision: LC Lot # Oce Use Only
U !� _ _—
Contact Date / ! Initials,
Valuation: _ U. _ Result
New Construction Only: (Square Footage) Planck/Rec # _
House. Z � S O Gara e,: Permit # y7 l y" =
- — g72 Reissue-- Reissue off
,i� Map S TL # %�5 o y c c �✓ �';2
Corner Lo;7 Y O% Flag Lot? Y CN Zone
Owner: ��NE- C a 4 AEPlat #
Approvals Required
>cidress: _ ��•� ����
Planning Setbacks r'� ff Solar
Engineering
Phone I -� i _!� I �_ ( 1 „z---- Other
Contractor: Iterns Required
i
Subcontractors _
Address �M� —�Q�oUI�✓_— Truss Details
Other
_
Phone. �-----�-------- Notes—--- —
Contractor's License I —
attach copy of current Oregon uceose)
Contact Name �G�_(A,— / _ --' ----
Contact
— —Contact Phone
Subcontractors: Architect/Engineer: STA, �G'sQlL ice_
Plumbing _—�� ---- Address
Mechanical. S6, L(i�_r���M'�
(attach copy of current OR Cr itractor s License)
E
/C jq/ r�� S ''� Phone. ( SPI ) (2 Z-
/ .�
JOB DE IPT'I J �ONIT' /VG -
-- P3
A ant gr ature — — Applicant Phone number
Received by: ' C l - __— Date Received —
Permit# Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) 64 3, 1 1" .,;-i .
Plumb. Permit (PLUMB) ,Z/y
Mech. Permit (MECIA) `'� �7 A
6/k
f�
Bldg: _5 ' • v , �s 5
Plumb: // 1
Mech: _ �_ S+ •�
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
—A-ifj-0523 Sewer Connection (SWUSA) & 0 � vy
Sewer Inspection (SWINSP) _ _j
Parks Dev Charge (PKSDC) cr
Residenti•il TIF (TIF-R) 70_
_
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-;S)
Office TIF (TIF-0)
Water Quality (WQUAL) ! 601) rpy
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) �' _Y Gj�•o v
Erosion Planck/USA (ERPLAN) _at �i _�D,VV
Erosion Planck/COT (EROSN)
TOTALS: 3 L Znri�i�rr�rr�
W
0e
`o
4 �
� I
0
L
MA'10�.
CON�-
A5 RVQCd.I IL"
3 Xxk
vCS
r�k 40 + h
I G
TO.,0 0 �0O
S.cJ• N/LL SN/,ef_ c✓oodl D.�
Lo T' Z q SNe�aua�v�
HILL.SN!RE ,U)OOG'S 63 F'S
i
PLUMPING PERMIT
CITY OF TIGARD DATEIISSUED: . O6/-'7/966-Oi76
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639-4171 PARCEL: 2S 1 O4CC-HWO,=-
'4
,;1IE ADDRESS. . . : 13311 SW ASCENSION DR
SUBDIVISION. . . . : H I LUSH I RE WOODS ZONING: R-7 FAD
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :24
CLASS OF WORK. . :ADD GARBA13E DISPOSALS. - 0 MOBILE HOME SPACES. :-0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . 0
STORIES. . . . . . . . .. 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
1" .I XTURES------------ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . 0 UR I NAL..S. . . . . . . . . . . . 0 GREASE TRAPS. . . 0
I..AVATOR IES. . . . . : 0 OTHER FIXTURES. . . . : 0
IUB/SHOWERS. . . . : 0 SEWER LINE (ft) . . . : 0
WATER CLOSETS. . : 0 WATER LINE (ft ) . . . 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Installing backflow prevention device
Owger-: --- -__.___._____..____._____._________.____.__________.____-- FEES
SHELBURNE DEV type all,.,1_Int by date recpt
7008 SW NYBERG RD PRMT .15. 00 B 06/27/96 96--L,8107_
5 P G T 0. 75 B 06/27/96 96-261O1 '
TUAL_ATIN OR 9-7062
PI•ione #: 692-G383
Conty^actor:
MASTER' S TOUCH SERVICES INC
DONALD BURTON
2202 SW MICHAEL_ DR
WE_S-1 LINN OR 97068 ...._.----_-_-.___-_____---.____------_.-_-
Phone #: 655,-6436 f 15. 75 TOTAL
Req #. . : 11509
REQUIRED INSPECTIONS
--
This permit is issued subject to the regulations contained in the RP/backflow Pr-ev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if wbrk is not started
within I88 days of issuance, or if work i5 suspended for more
than 180 days.
I e r m i t t e e S i g n a t -ire :
J s i_i e d By : --_& �✓
Call for, inspection - 639-4175
City of T�garc' PLLl1AF31NG P(=RMIT APPLICA71C1N Planck, /Rec. #
'i 3'I"i S V F�ali %,IvG. Permit # 'I�1�✓
Tigard, CR �7223
(503) 6::9-"? '1 MINIMUM $2i.00 PERMIT FEE + ST. SURCHARGE
_� —�-- — Ne Singe Family Residences Only
NorN
` --- - f 1 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195 00
"' ❑ 3 BATH HOUSE$225.00
Job _.. y �l� ..�hJ Ley+a�D ��'j
Ire sFee includes all plumbing fixtures in the dwelling and the first 100 feet
—. nv
�,� �ZL /)v`C of water service, sanitary sewer and storm sewer See fees below
--ice-- --�(J— '— _ FIXTURES QTY PRICE AMT
9.00
Sink
i 'b --
= '�;--�'► Lavatory 9.00
v / Tub or Tub/Shower Comb 9.00
Owner 9.00
Zip Shower Only _
I Water Closet 9.00
9.00
--
N.(t.n.me°r bu.n.." Dishwasher
Garbage Disposal _ 9.00 ----
Occupant per^ Washing Machine 9.00
Mrr,p AAtre".
Floor Drain 9.00
-- zo Water Heater 9 00
-
Laundry Room Tray 9.00
Unnal 9.00
Other Fixtures (Specify) 9.00
9.00
e+r, aa ata out. atv , --
Contractor 2402 S.W.Michael Drive 9.00
._ --- 9.00
3000
Sewer 1 st '100' _
Sewer ea Addit. 100' 25.00
Slot.R.wn.u°n Nn 30.00
c� Water Service 1st 100'
25.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit 200' —__
information given is correct, that I am the owner or authorized agent of Storm &Rain Drain 1st 100' 30.00
the owner, that plans submitted are in compliance with State laws, that Storm 8 Rain Drain Addit. 100' 25.00
I am registered with the Construction Contractor's Board, that the — —
number given is correct (If exempt from State registration, please Mobile Home Space 25.0,0
give season below.) --BackPre -
Flow vention
(Device or Anti-Pollution Device 9.00 --
rocun^ Any Trap or Waste Not
° ""pM Connected to a Fixture 9.00Catch Basin 9.00
e work new rJ addition Q alteration Q repair O 4000fhione residential (� non-residential Q Insp. of Exist�Plumbing
Specially Requested Inspections
Rain Drain, single family dwelling 3000 use of or property --- Residential backflow p•-.ventiondpvices 5.0Ued use of or property — —.-- -- •(Ex�ti. r reside,dal bachuuw
prev i, d:vices)
NOTICE "Minima s $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUC'.ION _ s%SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED C R ABANDONED I
FOR A PERIOD Or 180 DAYS AT ANY TIME. AFTER WORK IS PLAN REVIEW 25% OF SUBTOTAL
COMMENCED, — x�
TOTAL
Speci Conditions --
Date issued oy — �—
I
FFCITY OF TIGARD BUILDING INSPECTION NOTICE
Inspect;an Line: 639-4175 Business Phone: 639-4171
Footing
Rain Drain Cover/Service FINAL:
Foundatior
Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing
-Mech.
Plbg.Und/Fir/Slab Plbg.Top Out Insulation
-Ele
Post/Beam Strutt. Mech. Rough-in Gyp. Bd. 9•
SanA. Sewer Gas Line PPr/Sdwlk Reins.
Other: ----� T !
Date: a/ _ A..M.. P.M. Er•.try:
Address: —1 a—`
Ste:-- MST
Tenant: — -- - BUP: —_ I
Con/Own:. _ --- ��`--�— PLMi _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: — --
V ---
Ins ec
--- —— Date:
PPROVED _DISAPPROVED/CALL FOR REINSP. CF CO
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. PERMIT#t�� �Q ' Q;51
Tigard,OR 97223 -
1 Phone(503)639-4171 DATE ISSUED
FAX(503)684-7297 --- --- -
CITY OF TIGARD TDD No. (503)684-2772
Inspection (503)639-4175 ISSUED BY
PLEASE COMPLETE_ ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE Of WORK
Address RESIDENTIAL—Restricted Enemy Fee. . . . . . . . . ,44sD.0Q
(FOR ALL SYST&S)
774,#&Da
City VState Zip 4heskTvt�e of_WorliJdtY4lYt�ll
PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK r0 Audio and Stereo Systems*
IS NOT STARTED WITHIN 1110 DAYS OF ISSUANCF OR IF WORK IS SUSPENDED FOR El Burglar Alarm
180 DAYS.
❑ Garage Door Opener*
2. CONTRACTOR APPLICATION 1 / ❑ Heating,Ventilation and Air Conditioning System*
ContractorCe-OAR JA6K 5 Type_ _C ❑ Varuum Systems*
/ Other -,tX _
Address7s
Date__�c k' COMMERCIAL—Fee for each system . . . . . . . . . 640,00
(SEE OAR 918-260-260)
Property Owner" L, `a �uH' - - — ShesKIM of Work Involved:
Contractor's Board Reg. No. rP13 ❑ Audio and Stereo Systems'
❑ Boiler Controls
Phone? � � r r _- - ❑ Clock Systems
Data Telecommunication Installations
3. OWNER APPLICATION ❑ Fire Alarm Installation
_ ❑ HVAC
Print Owners Name Phone No ❑ Instrumentation
❑ Intercom and Paging Systems
Address ❑ Landscape Irrigation Control*
City State Zip ❑ Medical
ThispermIt Is Issued under OAR 918.320.370.This applicant agrees to make only
❑ Nurse Calls
nestrIZ energy installations(I oo volt amps or less)under this permit and to do the ❑ Outdoor Landscape Lighting'
following: ❑ Protective Signaling
1. Only use electrical licensed persons to do instaliutions where required.(Certain ❑ Ther
resHential and other transactions are exempt from licensing.These have _. --
asterisks(•).All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready /
for Inspection at 503.619.4175. ❑ Number of Systems
{ Purchase separate permits for all installations that are not ready for inspection
whet,the inspector is out to inspect under this permit. •No licenses are required Licenses are required for all other installations.
4 Assume responsibility for assuring that all corrections required by the inspector — ---- -- ---are done,and
5 .Assume responsibility fnr calling for a final inspection when all of th-corrections 5. FEES
are completed.
�i
The person signing for this permit must be the applicant or a person a. Enter Fees $ '90
authorized to bid the applicant. 00
b. 5% Surcharge(.05 x total above) $__
Signature00
TOTAL $ 'z
Authority if other than applicant
ENERGAP.CHP
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
BUP
t2' ate Requested — AM_ PM BLD
Locaiion �� ,��� �� t U NJ U �Z-- Suite MEC
Contact Person Ph — PLM
Contractor — Ph — —_ SWR
BUILDING Tenait/Owner ELC
Retaining Wall tLR I�l
Footing Acr NOT REQUESTED FPS
Foundation
Ftg Drain FOUND DURING RESEARCH SGN
Crawl Drain Ills NO INSPECI'ION(s) IN FILE `—
Slab _ SIT
Post& Beam
Ext Sheath/Shear
Int Sheath!Shear
Framing -- --- ----- ---- ---
insulation
Drywall Nailing
Firewall
Fire Sprinkler ---- ---- -----
Fire Alarm
Susp'd Ceiling - - ..... ----- -- —_--- _.—
Roof
Misc: ---
Final -
PASS PART FAIL - -- -------------- — --- - — — —
PLUMBING
most& Beam ___--___ —_--------- — ------- -------------------
Under Slab
Top Out
Water Service
Sanitary Sewer --------_---
Rain Drans
Final -
PASS PART FAIT.
MECHANICAL
Post
Post& Beam ----------
Rough In
Gas Line ------ --- - --- --- — ---------
Smoke Dampers
Final -- — ---- -._ — -----
PA PART FAIL
gLECTRIJOAL ----- _-_ - — —•
Service /``{SC`�1 ---------- — --- - -- - --- -
Rough In
11G/Slab --
1 ow Voltage
Fiie Alarm —
Fjnz►
PASS PART FAIL —.— —.—SITE
Backfill/Grading - --` -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required befo-e next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: [ ]Unable to inspect no access
ADA
Approach/Sidewalk Date Inspector Ext
Other _ --- ----.. __ _ _ _----
Final
PASS PART FAIL DO NOT RIFMOVE this inspection record from the job vitt-.