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4
CITY OF T MASTER PERMIT
DEVELOPMENT SERVICES PERMIT ISSUED:
MST97-0336
DATE ISSSUED: 088/ 8197
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
PARCEL: 2SI02AB-00202
S 1 TE ADDRESS. . . :09455 SW CENTER ST �Ow
SUBDIVTSION. . . . :MARIELL I�7�a� ZONING: P-4. 5
BL.00K. . . . . . . . . LOT. . . . . . . . . . . . . :�' JURISDICTION: TIG
Remarks: Addition to existing single family dwelling.
--------------------------------------- - _-_--- --------- BUILDING -----------...--------------------•------------------------------
REISSUE: STORIES.......: 2 FLOOR AREAS----------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED----------•---
CLASS OF WORK..ADD HEIGHT........: 22 FIRST....: 440 sf GARAGE.....: 0 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 440 sf FRONT.........: 20 PARKING SPACES:
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 5
OCCl1PANCY GRP.:R3 BDRH.- i 60H. i Tirr 6U sf VALUi..i,: aui 2 REAR........... i5
------------------------------------------------------------ PLUMBING —-------------------- ---------------------------------------
SINKS.........: 0 WATER CLOSETS.: I WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 180 TRAPS.........: 0
LAVATORIES....: 1 DISHWASHERS—: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0
TUB/SHOWERS...: 1 GAkBAGE DISP..: 0 WATER HEATEPS.: 0 WATER LINE ft: 100 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
---__----------------------------------------------------------- MECHANICAL ----------------------------------------------------------------
FUEL TYPES ---- FURN ( INK ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: 0
FURN )=1001! .. : 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNAC15: P VENTS.........: 0 WOODSTOVES....: 8 GTS OUTLE'_,...: 0
-- ELECTRICAL ---------------------------------------------------- -----------
--RESIDEN(IAL UNIT--- ---SERVICE/FEEDER-- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS---- --- -ADD L INSPECTIONS--
1000 SF OR LESS: I 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 5W.: 1 201 - 400 amp..: 0 201 - 400 amp..: 0 Ist W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR....... 0
LIMITED ENERGY.: 0 401 - 680. amp..: 0 401 - 60Q amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MANE HM/SVC/FDR: 0 601 - 1080 amp.: 0 601+amps-1000 V: 0 MINOR LABEL -10: 0
INM+ amp/volt.: 0 ------------------------------------ PLAN REVIEW SECTION ------- -----------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
- -- -- ---- -- ------------—-----— ----------- ELECTRICAL - RESTRICTED ENERGY ------------------------------------ -------
A. SF RESIDENTIAL--- ---- ----------- -- --- B. COMMERCIAL-- ----- --------------- -------" --
AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO I STERE('.: FIRE ALARM...... INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM-: 0TH: :: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIFA,:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL A SYSTEMS: 0
Owner: ---------- -------------- ------Contractor: ---------------------- TOTAL FEES:$ 816.55
LARRY HART OWNER This permit is subject to the regulations contained in the
9455 SW CENTER STREET Tigard Municipal Code, State of Ore. Specialty Codes and all
TIGARD OR 97223 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone 1: Phone t: not started within 188 days of issuance, or if the work is
Reg C.: 000800 suspended for more than 180 days. ATTENTION: Oregon law
-----.----.--------------------_ ------------------------- requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 9521014010 through OAR 952-081-0080. You may ohtain copies of these riles or
direct questions to OUNC by calling (503)246-1987.
REQUIRED INSPECTIONS ----------------------------------------------------------- -
Erosion Contol Crawl Drain Shear Wall Insp Plumb Final
Footing Insp PLM/Underfloor Insulation Insp Final inspection
Foundation Insp Plumb Top Out Gyp Board Insp Building Final
Post/Beam Struct Electrical Rough Rain drain Insp
Underfloor insul Fra nsp� Electrical Final
Issi.:ed By: _____ Permittee Signature:
++++++++ +i+++++++ +-F-1-++++++t+++++++4-++++++i•+•F++++++-4-++i-+ + .
Call 639-4175 by 6:00 p. m. for an inspection needed th next bLkSine ns day
Plan Check
'Y OF TIGARD Residential Building Permit Application Recd By ,-
3125 SAI HALL: BLVD. New Construction Additions or Alterations Oan Rer'd 4
"GARD, OR 97273 Single Family Detached or Attached (Duplex) Data top E
503-839-1171 Data to OST ". r q
iO3-684-7297 PWmrtr -O -
Print or Type called (4-
Incomplete or illegible ap iications will not be accepted
Name of Protect Norrie
.lob � Architect M*rrw Address
Address Site Address
_ -.0 caylstate zip Phons
Name
Name
Owner Mailing Address
Engineer Mail
C4tyf5tale zip —7 Phone
Mailing Address
I-k le
tdyrstata Zip Phone
Name
General ^ O*S=be work New O AdditonA Alteration O Repair O
Contractor Maung Addrosa to bs done:
Additional Description of Work: / 1,
Cay/State Zip Phon. ^
- /1A
Creqan Cone Cont. Board Lice ExP.Data
Attach Copy of
Current COT Business Tax or Metro rill Exp.Date PROJECT n
u_unses VALUATION V
Nan" NEW CONSTRUCTION ONLY:
Mechanical Sq. Ft. House: Sq. Ft. Garage
Sub- Mailing Address 's
Contractor Comer Lot YES =lag Lot YES N9
CityrState il
Zip Phan* (check one) (check one)
Oregon Const_Cont. Bosro L,c.s Exp.Date - Restricted Audio/Ste,eo Burglar
Attach Copy of Energy _ 6stem Alarm
Current COT 3usines,- Tax or Metfo 0 Exp. Date Installation �j arage Door HVAC
t-icensas_ _ Opener Systems
Name (check all thatOther.
Plumbing _ app ) ..----
Sub- ma"ing Address 'rill the electrical subcontractor wire for all YES NO
restricted energy installations?
Contractor Has the Subdivision Plat recorded? NIA Y 1 NO
C+tylstate Li0 I Phone —
tonna lJcrt Exp-Due Reissue of MST Solar Compliance
Oregon Const. Cont.
Attach copy of (Calculation Attached)l�l/
CurrentFiumoing LUc 0 i Exp.Date I hemby acknowledge that I have read this application, that the^
Uunsss information given is correct, that i am the owner or authorized
COT Business Tax or Metro$0 Exp. Date Agent of the owner,and that plans submitted are in compliance
-! with Orecpn State laws. aIName -..Sig of Owned Cate(_lectrical L / _ (V r,°If / Y
Sub- Fc
ating A dress on ct Person Name Phone
/ '( , �, �,t„/ ( a '�' q("y-6o �
ontractor '
-tyrS,ate Lp Phone FOR OFFICE USE ONLY: _
no
UrOrt-,onon Const re Cant. Board �c Date
cv. 3a
Tach Copy of _ SetbagXs: f:R Zon Solar.
N
Current ;:!ectncai Ler x :Xo. Date j= S X_ y .
Licenses Engtneenng Ap roval: Plarningroval: I TIF.
COT Business Tan or Metros I Exp.Cate �I
r
I:;FAPC)00C (OS 1)
Permit 0 Acct. Descritpion COT WACO Amount Amt. Pd. Sal.Ous
A15�9�•03j(r MST. Permit
(BUILD) (UBUILD) _
Plumb. Permit (PLUMB) (UPLUMB)
Mech. Permit (MECH) (UMECH)
ELC/ELR Permit (ELPRMT) (UELPMT) '
J
State Tax (TAX) (UTAX)
BLDG.
KUMB:
MECH:
ELCIELR:
r-
Pian Check
'I MST: (BUPPLN) (UBUPLN) :�-
o� Plumb: (PLUMB) (UPLUMB)
.a Mech: "—
�° (MECPLN) (UMEPLN)
�d CDC Review(BUILD) (CDCBLD) (UCDC)
CDC Review(PLN) (CDCPLN) N/A
Sewer Connon (SWUSA) (USWUSA)
Reimbur. District ( ) ( )
Sewer Inspection (SVANSP) (USWINS) — -�
Parks Dev Charge (PKSDC) N/A — �^
,p Residential _nF MF-R) (UTIF-R)
V) Mass Transit PF (TIF-4IT) (UTIF-M)
Water Quality (WQUAL) (UWQUAL) -_
Water Quantity (WQUANT) (UWQANT)
s
J Erosion Control Prmt (ERPRMT) (UERPMT)
Erosion P!anck/USA (ERPLN) (UERPLN)
Erosion P!anck/COT (EROSN) (UEROSN)
—
Fire Life Safety (FLS) (UFLS)
TOTALS:
I SFAPQ 00C (DST) a97
Perini( #:
Address:
issued by: _ Date: _ I
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 I and 2, and either box 3A or 38:
1. 1 own, reside in, or will reside in the completed structure.
{ 2. 1 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
1�7 (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
u 313. 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.
1 hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Prope Owners abo C nstructiun Responsibilities on the reverse side of this form.
a �
( igna(ure of permit applicant) (Date)
(White copy to issuing agency permit file,
rink copy to applicant)
Information Notice to Property Owners
s'�bout �.onst!'1.1t-tion Responsibilities
ti!�rr,�LOYf FR RESPONSIBILITIEC
.i. f.. � ,I; �, •1 `Illl;lt� .•( 1t1l11r(, �i I,
€t ,.i. ,^ 7M111!I�titl trU tati },)�1' :II!".'ll,lr r,t'1,r'(1t .. ,,,! .,�'ifl.l,r,� I :,,i•..,!!lt";l':' }C;r711 i'nli-,1!t
!:,Ix IY ,111! 111 it .,,r, :�11i1' i!.11!t I1 litlll�'!!I tho).iv; 1'1,.111
! .. It;t,.lTial ti- fi 11t'In� : ,.,,1�''1 1.. .1,r :rr1 1,1,r'r••. � tii
It 1111 rl`r l.r� 1,1; :
I I,lf)ilii .ttttl I►ru�►1 i tt rlatT►:l a iu�tlrallct',
I I;l• (I1_I ! !I11 'I t ,tll i! 1 ;,,(lil!E, to,AI' !l;,l + 'n' i 1,111100- IIOln 1)i
I'11t34In `:U111'1'41`<' t'TII})IJI I'f". I T
4'Yfs�1'tISQ`' �ll l�t` ;nl':, t`11tl,l\'r"}: t C'}lr•tilrl`1 ';!('t.'t'•. '111I'!mnurt—iIcontrtt ir,torootdin-it othr tv(tri!nfT't'Il
:')
,itIdiIIollo ,IIIc4r;1 rl, rn:.' OI%,:l! the ( r' u(( t I I q : ,:ntt,I,I 't'ti thxltdtFh 1 ti„ r 1411• s�llylr+.
hr licwnf 1•. L,; ,11:•c! :11 'lul ,uminct '•1 `:I suite iNl, In Salem.
Solar Balance Point Standard Worksheet
Address
Box A calculations: North-South dimension for the lot. Box A.
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point.
Firms, determine which property line is the Nor-,h for line. The North lot line is the line
with the smailest angle from a line drawn east-west and intersecting the northern most
point of the lot_
450
t t
gar w N North-South
Dimension for lot:
Measure the distance from the midpoint of the North lot line to the South lot line along
the described line.
t feet
N
Box 8 calculations: Shade point height for ynur residences
Box B:
1. Determine whe++-er measurements will be based on the peak or eave cf your Which describes
struczum. The orientancn of the ridge is also important.
your residence?
1 a: If the rmf line runs North-South, measurements will t (circle one)
be based on the peak Of the roof. TOCCOT
1A 16 1C
1 b: If ti-e roof line runs East-West and the roof pitch is
less :rias 3/1?, measurements will _e _area on -,! e
e3b e.
9MCtr Csa W
1 c: If the rcof lire runs East—vest and the roof pitch is
3/12 or steeper, measurements will be based on the
peak. _
Box B. continued Box B:
'. ,1leasure change ;n elevation from front property line to finished floor elevatior,. If
the got slopes up from the front lot line to the foundation, the figure is po;;:iv,e. If ft
the lot slopes down from the front lot line to the foundation, the figure is negative.
3. Measure distance from finished floor elevation to the affected peak/eave. + 15- ft
4. If the roof line runs lNorth-South, deduct three feet If the roof line runs cast-West, ft
deduct nothing.
S. Subtract one loot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slopes up from the frunt to the rear. If the
lot has no slope or slopes up from the rear to the front, ceduct nothing. 3. 5 ft
6. Total figure for box B: :,( , ft
Box C Distance to the shade reduction line. Box Q
1. Measure the distance from ;he North property line to the foundation near the I it
arfet.ted peak/eave.
2. Measure the distance from the foundation to the atfect d pe,--k or eave. + ft
3. Total figure far box C: ft
it is meat useful to draw a verod rine to mVnnent the appruprim*m k nd in bort'^'and a horizontal Gane to represent the
appmprutR figure fowl in box'C'.The intersemon of the vetand horizontal lines dete+mYnes the value found in box'0'.The value
in box 'D'shouid be compared to the value in box'9';if the value in box'9'is less than or equal to the value found in box'C", then
:he building is .n wmpaance with th,-solar balance code_ if you have any questions, pie".contaa to at 639—+171,x304 or at the
oommuruty Oevelopmesu Counter.
MAM MUM PERMITTED SHADE POINT HEIGHT (In Feet)
Distance to worth-south bt dimension(un feet
srQde 100+ 95 90 85 80 75 70 65 60 55 SO a5 40
M-_duabon line
from norther
lct tnt an feet"
70 40 40 40 41 4� 43 -.4
65 38 38 38 39 40 41, 42 43
60 36 36 36 37 3� 39 40 41 42
55 34 .3.4 3.4 35 3fir 37 38 39 40 41
30 32 32 32 33 : 35 36 37 33 39 40
30 30 30 31 33 34 35 36 37 38 39
»0 28 2s "-s 29 3 31 32 33 34 35 36 37 38
.5 26 26 26 27 29 30 31 32 33 34 35 36
:0 24 24 24 25 27 28 :9 30 31 32 33 34
=5 _2 2_' 12 23 25 :6 27 28 29 30 31 32
:0 :0 20 20 21 23 24 25 26 27 28 29 30
13 18 /8 18 19 21 22 23 24 25 26 27 28
10 16 16 16 17 10 19 20 21 22 23 24 25 26
5 14 14 14 15 16 17 18 19 :0 21 22 23 24
Box D. Maximum allowed shade point height_ feet
h: . wlar.ctio
M - ELV
1.7&4.0
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CITY OF TIGARQ 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received __— Date Requested—f-� � AM PM___ BUP
Location _ �;! -�s (f 61f 7 ' z S 7 Suite— MEC --
Contact Person _ Ph PLM
Contractor— Ph( ) — — — SWR _
ro
UILDIN71i Tenant/Owner ELC _
oo ing ELC
Foundation Access:
Ftg •ain ELR _
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors — -
Ext Sheath/Shear --_
Int Sheath/Shear
Framing - — -- ------
Insulation
Drywall Nailing —
Firewall �
Fire Sprinkler
Fire Alarm No � J -
Susp'd Ceiling
Roof
Other:
aB
PART FAILam
Under Slab --- ------ - -------
Hough-In
Water Service -- - ------- ---
Sanitery Sewer
Rain Gains ------ ____----_-- --_--.
Catch Basin/Manhole
Storm Drain ---- -- ___.--_---------___--
Shower Pan
Other:
al - ------- --- -- -- --
S) PART- FAIL
ANICA --- ---- - - - - - ---\ —
PO-STWiNlam --
Rough-In -- - ---- --
Gas Line
S l e Dampers -
,VART FAIL -
L RICAL -
Service (Cl / /J
Rough.-In
Low Voltage ---
Fire larm
En
TX
SS PART FAIL F-1 Reinspection fee of$ required before next inspection. Pay at City hall, 13125 SW Hall Blvd.
SI Please call for reinspection RE-_ _- ---_ Unable to inspect-no access
Fire Supply Line _ �.----
ADA
Approach/Sidewalk Dab r v _ Inspodor ---Ext
Other:
Final DO NOT REMOVE this Inspection record from the fob site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 lqq?fro"Y
INSPECTION DIVIS0N Business Line: (501)639-4171 �s J
BUP
Received .� Z �' 7''_Date Requestpd AM PM BUP
Location _ _ �–Suite MEC
Contact Person _. ��►' -_ Ph( .) .�'� 3d3.S PLM
Contract9t _—_ __ Ph( ) _ SWR
BUILDIN _ Tenan wn ril�--k%Yrr, / f 9� (00 l�tr LC (�0 - 00&_J b
Foundation �4f;.`_ ,' GZ.-' cA
Access:
Ftg Drnin Etp " / •0 �- SGS
Crawl Drain
Slab Inspection Notes: �/"" ✓f2 S fi. SIT
Post&Beam --,�_—_ unit✓+ /'��� 7� /
Shear Anchors r Fr L.Z 7 �t
Ext Sheath/Shear
Int Sheath/Shear / _
Framing —v C.� Id S
Insulation
Drywall Nailing �/'�
Firewall Q 0 Q
Fire Sprinkler —
Fire Alarm
Susp'd Ceiling ---
Roof
Oth -- ---- —---
inal
t S� T 7 04375
Pos eam a
U-der Slab _
Rough-In
Water Service
Sanitary Sewer
Rain Drains --- ---
Catch Basin/Manhole
Storm Drain -- ---- --- ---
Shower Pan
Other: -
rna
FAIL — ------ — —
CHA L
Post&Beam
Rough-In -- -- -- --— --
Gas Line
Smoke Dampers — ---------_--�---- —
ii is
ECTRIC
Rough-In 5
UG/Slab r
Low Voltage li
Fire Alarm
Pinao Reinspection fee of$. —requirad before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
...P'_9AIL^
SITE L] Please call for reinspection RE:_ __ E] Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk �� 17�— — — InspectOf Ext
Other:
Final — ----- DO NOT REMOVE thins Inspection record from thro;oib site.
PASS PART FAIL
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT#: E:.C2002-00610
DEVELOPMENT SERVICES DATE ISSUED: 11/19102
13125 SW Hall Blvd.,Tistard, OR 97223 (503) 639-4171 PARCEL: 2S102AB-002.02
SITE ADDRESS 09455 SW CEI 11 ER ST
ZONING: R-4.5
SUBDIVISION:
BLOCK: LOT • OC2 JURISDICTION: TIG
Project Description: Install 1 branch circuit.
rRESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - ti00 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _ _PLAN REVIEW SECTION
1000+amp/volt: —4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: _ CLASS AREA/SPEC OCC:
Owner: Contractor:
LARK, HART KELSO ELECTRIC INC
9455 SW CENTER 545 SE 3RD
TIGARD,OR 97224 HILLSBORO,OR 97123
Phone: Phone: 503-648-6360
Reg #: I:l.l: 34-411,
FEES
Description Date Amount
Required Inspections
JFI.PRNIT] IiL('Permit 11 19102 $46.85 _—
AX)R'! State]ax 11 19102 $3,75
Elect'/ Final
Tota'. $50.60
This Permit is issued subject to the regulations oontained in the Tigard Municipal Code, State of 0< Specialty Codes and all other applicable laws.
All work will be dune in accordance with approved plans. This permit will expire if work is no#:3tarted within 1R0 days of issuance,or K work is
suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules ordire ct questions tri OUNC at(503)
246-6699 or 1-:Z3212344Issued By: ,am/^� },, (( +- Permit Signature:
_ _OWNER INSTALLATION ONLY
The installation is being made on In uperty I own which is not intended for sale, lease, or renr/
OWNER'S SIGNATURE: _ _ __ DATE:--_ _
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR ELEC'N: �� 1 Cc_ 2 I ' t `-- _ DATE:
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
Mel as
Electrical Permit-Application
ramut No..
City Of Tigardestorm PlxTniingApproval Sign
1 `1l l5 "A. Hill]Blvd. Plan Ravlew tv
Tagatd Urei,ou 97223 Data/by Permit No
Phctle: .103.639-4171 Fax: 503.598.1960 Pcal•Roview Land Uses
Data/B o No.:
Imemet orvw,ci.t;gud,M.us Contact Juris.: 1 0-3;i PaBa I for
14-bout Irsrectlon Request: 503-639-4175 Namo/Mcthod: Squoltmetall Infurtn•tlon.
r.'TYPE OF WORK "'I i;` �' a ,I. r U:IIPLIIy. VIEW' Ihtllfeh'ieh Q!'Pbat epplY)'^.l
New construction I LJ Demolition Service over 223 amp- Health-am f te{h!y
4
Add taon/aluration/replacement Other: 00,ra Orrasl Haw-doas locador,
F CON �' '� ❑Scrvmoc ova 320 amps-toting of ❑Buiidfij over 10,000 squam Icct,
i do 7 ratty dwelhngl four or awn nsldendU uric in
1 &2-FAMUY dweUins Commerci4l/Ixdu_8tri_al ❑system over 600 wits nondnel one stricauc
Acc-w Buildin Multi-F�BtAil 8 Building over three store, 8 Feeder 400 amps amort
r` �j_ rkeupont,oad over 99 persors MMUfactured sTucturM or RV park
Master Builder Other: ❑ irtWitrdng plan 1 O Other
JOB FUZ INFORN:ATION and LOCATION Submitteb of plane with any orthe above.
Job site address' _ The above are trot applicable toamrrerory construction"Mice.
ti. 2 >RtE�scae=,at
Suite#. Bld ./Apt.M: Number of inspections ucr permit allowed !
Project Name: Dascrl to Iin Q� Fu w, Tata1
Cross S7eetm'reCt10R5 CO Oh £t',C Nvw resid•ntlaHingie or multi-Nmay pit I i
dwelling unit.Inetudut itaaehod garage.
Service Irtttttled
1000%Gfc.Rot Ilea 145.11 4
r— -" — Llmked ere. teals o2a _ '5,00 2
o f J3 40
$ubdlVlStOn' Lot#_ mile spear rwn re identill _'5.00
r
Tax ma parcel# Eich manufarnued home or nodular d%vlling
',9 C 1P ON F.WOA}C tarviceanb'orleader
Serviceb or reader-iwtullUan,
alteration or rolocatloa:
200 LMC1 or lets I SOJG 2
m4
401 am to 00 etas 160.66
PROPERTVOW[NER =TEhANI't:' " 4 2
Name ser loon amsn or volt' -– —— 454.61
i nn t I 66.t5 2
AddrewTcmponry services or Icederi•Installatloo.
-------��. ------— -- arteraUoq or rclocatlon:
�Cih'/StatdZip: !_ 200 1.Ma er let,
>'llonc: 1~ax: 7Q am.�to4T-ra 2
i APPLICANT aGl to 6U�un�a 137.7J
-- _ — - Breach elre•ite•new,alterat(oa,er
Nart:e: extension per panel: 1
AddPesS:
A.Fcc to,Drenrh clrru,p with purchme of
� —. r,ri_len ar feeder fie nth'cartel+c,r,uh � I 6.tS 2
CayItate/zlp: a I've for branch Mcuin without purchase of I
Phlxlc: Fax. }_ui fads f•a rpt br��h circuit
r� 2
_--._ FAch addltbna,branch Or= 6.65
E-mail: Mtac(Service m feeder not included.
COhTRAC>COR Pea+OWD or 1,TlAAWn circ:• 52 40
"'—" F�oh s. or euehne G ht S3 40 2
Job No: �,. alraah(a,o<. t rrd en.rTy p.n.l,
Business Name: r' / Ad
' I1e.ctT,Non
Address: .S a c �_. �'✓ L57-
City/StatGLlp: '&A L /Z PEI
ad/idonal Inspection ever the afiowsbic In any afthe abow
Phone: r 3 FaX: t �� PrP rpt , it hour•,.aui. I hour) ,-- 4 6250
tfc+al.� r,,_.tu'�— � /„ C'// ,-,.a�ady�tioo 0
CCH Llc. t+: !/L c } I Llc. : ;s'/ �r3d c Otho:
I— FJtsctrtcal'Pu rdkv*60 -,
Supet-Osing elec7tc'.an --- -
st stature re _*etl: mi Fee) $
._$. _--�_ _ _�i���7 Plan Atvfeua•(2Sv.of Permit Fee): S
print Name: 41 LiC.0: `/Z rJ State Surdw • 8%of Permit Fee' S -Tc
r<ttdtorlted TCT.kL PERMIT FEE S
Notleet This remit application tVirs if a permit Is not ebtalaed t
Sigrtuure: Due:� IV drys agar It has boon amsp.•d U oompl•ts.
*Foe naethodoloV set by Tri-Counh Building lndustry Sam cc Beard
(Pitta P^nt naw)
100(A VV911 At) .111.; 009198SC09 TF•d hT tT Z002-19 90
i
MASTER PERMIT
CITY OF TIGARD PERMIT#: MST97-00336
DEVELOPMENT SERVICES DATE ISSUED: 8128197
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRERS: 09455 SW CENTER ST PARCEL: 2S102AB-00202
SUBDIVISION: MARIELL ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: 116
REMARKS: Addition to existing single family dwelling.
BUILDING
STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
REISSUE: i ,
CLASS OF WORK: ADD HEIGHT: ... FIRST: 440 sf BASEMENT OAO sf I EFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 440 sf GARAGE: 0 sf FRONT. 20 PARKING SPACES: 2
U Sf RIGHT: h
TYPE.OF CONST: SN DWELLING UNITS: 1 FINBSMENI VALUE
OCCUPANCY GRP: N7 BDRM. t BATH.
I TOTAL. HHO 91' � 58 87200 gEAR. t5
PLUMBING
SINKS:
q WATER CLOSETS: t WASHING MACH. LAUNDRY TRAYS: '� RAIN DRAIN: hili TRAPS: 0
LAVATORIES: I DISHWASHERS: t t-LOOR DRAINS SEWER LINES: tnn SF RAIN DRAINS. 1 CATCH BASINS: 0
TUBISHOWERS. 1 GARBAGE DISP: 0 WATER HEATERS: o WATER LINES: 100 BCKFLW PREVNTR. a GREASE TRAPS: 0
OTHER FIXTURES: 0
MECHANICAL _
FUEL TYPES
FURN<100K: 0 BOILICMP<3HP: VENT FANS: n CLOTHES DRYER: o
FURN—100K: 0 UNIT HEATERS: o HOODS OTHER UNITS: 0
MAX INP.
0 blu FLOORFURNANCES: 0 VENTS. n WOODSTOVES: GAS OUTLETS: 0
ELECTRICAL --
RESIDENTIAL UNIT — SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTION
I PUMPIIRRIGATION: 0 PER INSPECTIONU
1000 SF OR LESS. 1 0 200 amp: 0 0 200 a no " WISVC OR FOR: :
EA ADD'L SOOSF. 1 201 400 amp: 0
201 400 amp. ' 1st WIO SVCIFUR: 00 SIGNIOUT LIN LT: 0 PER HOUR: 0
LIMITED ENERGY. 9
<D1 - 100 amp: 0 401 - 600 omP. EA ADDL BR CIR-. 0 SIGNA.LIPANEL: 0 IN PLANT: n
MANU HMISVCIFOR-
601 - 1000 amp: 0 601-amps-'1000V MINOR LABEL: 0
1000•amp/volt: 0 PLAN REVIEW SECTION
Roconnect only: 0 >800 V NOMINAL: CLS AREA/SPC OCC'.
>-4 RES UNITS: SVC/FDR-225 A..
ELECTRICAL-RESTRICTED ENERGY
0.COMMERCIAL
A.SF RFSIDENTIAI. —, '--
AUDIO&STEREO. VACUUM SYSTEM. AUDIO&STEREO: FIRE A'ARM INTERCOM/PAGING OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: `iVAC. LANDSCAPEARRIG+ PROTECTIVE 31GNL:
GARAGE OPENER:
CLOCK: INSTRUMEW ATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM
NURSE CALLS TOTAL M SYSTEMS: n
TOTAL FEES: $ 816.55
Owner: Contractor This permit is subject to the regulations contained In the
LARRY HART OWNER Tigard Municipal Code. State of OR Specialty Codes and
9455 SW CENTER STRLET all other applicable laws All work will be done in
TIGARD.OF. 97223 accordance with approved plans This permit will expire if
work is no' started within 180 days of issuance,or if the
work Is suspended for more than 180 days ATTENTION
Oregon law requires you to follow ruses adopted by the
Phomt Oregon Utility Notification Center Those rules are set
Phone: forth In OAR 952-001-0010 through 952-001-0080 You
Reg M. may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
F
osion Control Insp 8' Crawl Drain Mechanical Insp Plumb Top Out Framing Insp Gyp Board Insp
r- Rain drain Insp
ooting Insp CtawI Drain Mechanical Insp Plumb Tap Out rarning Insp
nsp Rain drain Insp
Foundation Insp Plln/undslab Insp
Plumb Top Out Electrical Service Framing I
Post/Beam Structural PLM/Underfloor Plumb Top Out Electrical Rough In Shear Wall Insp Electrical Final
Underfloc insulation Mechanical Insp Plumb Top Out Electrical Rough In I]ns tion Insp Plumb Final
CU, 641, fiL `')('Z'
Issued B i 1 r , _/ _ 1, . f t Permittee Signature --�—�
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day