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15440 SW ALDERBROOK DRIVE
Residential Building Permit Application
City of *igard Cc,13125 SN Hall Blvd.
Tigard, OR 97223 S>
(503) 6394171
Jobsite okddress• I -,v✓ �fi
Office Use On�y
Subdivision: `�y/vMCF-Fk Lr _ Lot #
�8� oo Contact Date I I Initials ..
Vacation: .-_� �,__— - -- Result
New Construction Only: (Square Footage) Planck/Rec #
Permit # 6 'J
Garage: _.—_ Reissue of—
Map & TL,# D('>'
Corner Lot? Y g7 Flag Lot? Y (1�l Zone (`l
Plat #
Owner:
A_ pprovals Required
Address: , fa �w L1Lj�3z�1=-G�k: �_ n
Planning Setbacks _ Solar /
(VAr2v o � Engineering
Other _--
Items Required
Contractor. /�l��!►JSL�.t�-__��- ''til=`.-�
Subcontractors
Addre is: ,!_3'�2 S�_ -tet `'t--`�1— Truss Details
��� Other _—
Notes
Phone _�b ) "LU f31 —_
Contractor's License #
(attach copy of current Oregon license)
Contact Name:
Contact Phone: (Sb"3 --
Subcontractors: Architect./Engineer: SDI Efl Utz �_ r'N�
Plumbing. H( � — Address: 1 325 Sw
0 "1-72.2 3
�
Mechanical: --�� � - ---
(attach copy of current OR Contractor's License) 5� O.� �.� _- 0I
Phone.
JOB DESCRIPTION
:�_-� -_' '�-- + ,ate
;C:c��ijart Sign t rF Applicant Phone number
Date Received
Received by
Permit Account Description Amount AML Pd. Bal, Due
Bldg. Permit (P'.Al-D) 5 '
Plumb. Permit (PLUMB)
Mech. Permit (MEC H) _
State Tax (TAX)
Bldg: , 1.
Plumb:
Mech:
Plan Check (PLANCK)
3ldg:
Plumb:
Mech:
Sewer Connection (SWUSA) _.,
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-11
Institutional TIF (TIF-IS)
Office TIF ITIF-C)
Water QUa:ity (WQUAL)
Water Quantiri ('NQUANT)
Fire Life Safe.'/ (FLS) _-
Eresi,�n Cntrl Permit (ERPRM T)
Erosion PlanckJUSA (E.RPLAi', —
Erosion PlanckICOT (EROSN)
L14o 7-3
T O T A L S. '.rrrrrrir,rrr,
PROPOSED ALTERATION
Dr. 1� Mrs F. Dean Curtis
t '0 =W Ade-b-ook give
c01 Architecru�e $.%nning
_..- _ __.....� . ... ,,.....�... ._...•...,„,o.e 9ord, OR (50a) rv20-1Ota
The 04 of Tioard, Oregon.or
its w'mployee,. shall not be re.:pansible !or
discrepancies which may appear hereon.
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EXISTING STRUCTURE
Dr. It Mrs E. Dean Curtis
1541-0 5`N'A:,e-b-oo6 Dive
Togo-c. OS
Tlgo-d, OR (50�j 6Y?-1078
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -.—.— —
E►UP _
Date Requested U -( 3 - /, AM _PM -- BLD
Location j,S t 5 w 4 Id e i ��' Ad e.6 J f'� Suite MEC UCS 3
Contact Person — Ph -S� _ S�" 'z z Z� PLM — -- —
Contractor Ph _ --- SWR -__---
BUILDING Tenant/Owner -- - ELC �'>C.'c _
Retaining Wall ELR
Footing Access FPS
Foundation -
Fig Drain SGN
Crawl Drain Inspection Notes: --
Slab ____. —_— --- SIT
Post& Beam
Ext Sheath/Shear -- --- --
Im Sheath/Shear
Framing -- -
Insulation
Drywall Nailing ---.T
Firewall
Fire Sprinkler j.enc i4
/
Fire
Alarm
Susp'o Ceiling ---
Roof
Misc: _- -
Final
PASS PART FAIL -- - --- -
PLUMBING _
Post& Beam
Under Slab
Top Out
Water Service in
Sanitary Sewer
Rain Drains —
Final
PASS PART FAIL -- -----.--- -
ECHANI
A IN
Post& eam ---- - - -- --- ----- -
Rough In
Gas Line — ---- ----
Smoke Dampers --
FAIL
IC
EW
Service __ _ - --- -- -
;RoughIn
tltage
rm PART FAIL ---
Backfill/Grading — —`
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$_ _ reauired before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Unable to inspect-no access
Fire Supply Line ( J Please call for-einspection RE: - ( 1
ADA
Approach/Sidewalk Date / Q� actorExt_ Insp
Other
Final
PASS PART FAIL 00 NOT REMOVE this iiispection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24.-Hour Inspection Line: 6394175 Business Phone: 639-4171
Date Requested: `t "—�> ��q q _- — A.M. P.M. MST:
Location: l `t n� ��C .� Cf• (�',�_tJ0�? J.tU __— BUR
Tenant: Suite: Bldg: MEC:
Contractor: Phone: PLM:q 703
(honer: Phone: ELC:
ELR:
SIT:
BUILDING BLDG(coe't) PLUMB�IG,_. MECHANICAL ELECTRICAL SITE
Site Post/Beam os Post/Beam
Cover/Service Sewer/Storm
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top Out as Line Rough-In UG Sprinkler
Foundation Insulation Sewer o0d)1)uct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling :lain Drain A/C UG Slab
Shear/Sheath Fire Spklr/AIm Crawl/Found DA I lent Pump Low Volt
Approvedve Approved Approved Approved
Appr/Sdwlk Not Approved pproved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
-- -- - --
O Call for reinspection O Reinspection fee of S �._required before next inspection C3 Unable to inspect
Insixxtor: ---- Date Page of
CITY OF TIGARD
DEVELOPMENT SERVICES
AMAKM 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
v
',TY OF IIGA,Hr,; Plumbing Application Recd By
1175 SW Ht"kl.l.. BLVD. Commercial and Residential Date Recd__..
Otte to P E.
�:? 97223 /� � � / �^/�
/ `� / Date to DST_�
iCJj 539-4171Lls �l�/N 7�vZ?
Print or Type Related SWR 0_�.
lni:omplet_Q ^r illegible applications will not be accepted Called
-._•i Name ofUrAllopmentil',•v" FIXTURES;pndlvidwll)
Jab sink �9.00 �` -
/irii:re;9S."to La� 9.00
e4i'd6Y 40'At or.I Tub or Tut)/Shower Comb. 9,00 -
Bldg 0 City/State ZIP Shower Only 900
_-. 7T 1'i141 water Closet 9,00
Dishwasher 9.00
Wins 1 l I rr Garbage Disposal 9.00
Owner Mailing Aoaraaa J/�l �+
I S tiau fi,�, ilcr6ro '�r. was"Mature - 9.00
City/State Zip Phone Flour Dram 2' 900
--- -
'7-444,l a4( I?Zq Zv• 7 3- 9.00
Name4. 9.00
Same
Ocrupant h'ttaillrigAddmu Suite water Fleeter goo
Laundry Room Tray iF00 -
city/State ---Zip Phone L rYhai 9.00
Name Ocher Fixtures(Specify) 9.Oo
C zi3. 11 ta r/C h 9.00
.Qntra.:►or MailingAddiess /; suite 9.00
/I �G F A,/ Puc.lil -
- 9.00
riot to iaswrnAe City/Stam Zip Phone - 9.00
Applicant must ,.t,/' Get y 7 Z t ; CZ-q-7 T V
provide all txn Const.Cont.Board Lic.0 Exp.Date _ 9.00
r.att-actors z 71 Y - 9.00
liana PkurMxng Lic.0 - Exp.Date Sewer-lit 100" 30.00
iMormation Barrer-each additional 100' 25.00 for CUT COT Busnv s Tax or Metro a Exp. Date
databa"). Water 5ervwro.1st 100' 30.00
Nanny ---- Water Serwce each additional 200• 25.00
Architect storm a Rain Drain• 1st loft 30.00
or Mading Addraxs ---- Suite Storm 1.Ran Dram-each additional 100' 23.00
Mobile Norrie Space -- _ 25.00
E:nginet,r C4y/State _ Zip-�- Phone Commeraal Back Flow Prevention Device or Anti- 25.00
Pokition Device
^esctbe wore New 0 Addition O Alteration O Repair O` Resdentwd Backflow Preventlon Device` 15.00 -I{
i fie!done: ResdentiarA. Non-mskdenbal O Any Trap o�W3ste Not Connected to a Fixtwa 900
adituonal desc mpoon of work
Catch Bas - --- -
� u,!tA� ;��- ��L� 1�.�1t/k-ti•-.- ic 900 -
7��IJ/" Insp.of Ex Jung P1.-mbkng 40,00
per/hr
---
:ling use / .100Kaily .equttsiado,ropeaions � 40.00
r�7 e __ _ __ per/hr
ling o<prroperty--- -- (ir, Drat m.siNk.family dwelling ---- 30.00
,j-osed use of (",area,,T_ -raps - 4.00
ding or property_- ' i Mi e _--
___ QUANTTTY TOTAL
e you capping, moving or r"Aaang any fixtures? Yes Qi NO Q 1Wrn ,c,s.now diagram is nkitarad a nuanh TOM to >9 _ 1..� •:.►
f yes see back of form) _ _ *SUBTOTAL
ereby acknowledge that I ha+e read this application,that tine information
en is correct that I am it*owner or authorized agent of the owner and 5%SURCHARGE
at clans sutxitMed are rn comoiiance with Oregon Slate Laws
grutura of OwnerlAgent Datil PLAN REVIEW 25% OF SU@TOTAL
i Reovrad MW f ftft"my "is>_9 .
���_�Ctf�=- _ • � TOTAL - tG•Lf
.antact Person Name Phone
�-•�� `f /
*Minimum permit fee is S25 •5%surcharge.except Residential Bscxftow
1E/�� ( A01-1 G7v•73(! Pre.ention Device.which is$15- 5%surchaige
- -- L\plmapp.doc 1196 (dst)
EASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
:OMMENTS REGARDING ABOVE:
L\phapp.doc 13,'96 (dst)