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9085 SW EDGEWOOD ST
CITY OF T I G A,R p MASTER PERMIT _
PERMIT#: MST2000-00513
DEVELOPMENT SERVICES DATE ISSUED: 11/22/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 539-4171
SITE ADDRESS: 09085 SW EDGEWOOD ST PARCEL: 28102DC-00501
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK: LOT: 013 JURISDICTION: TIG
REMARKS: Garage and Utility room audition. GARAGE 792 SO FT-- STORAGE 492 SO FT AND UTILITY
ROOM 60 SO FT
BUILDING.,
REISSUE STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: t10 sf BASEMENT: sf LEFT in SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE. i1a, of FRONT: 07 PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT,
VALUE. 78;' �r
OCCUPANCY GRP: R3 BDRM: OATH: TOTAL N 4n sf REAR: =.y
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: i LAUNDRY TRAYS: RAIN DRAIN: TRAPS.
LAVATORIES DISHWASHEIS: FLOOR DRAINS: SEWER LINES. SF RAIN DRAINS: + CATCH BASINS.
TIIBISHOWERS. GARBAGE DISP: WATER HEATERS: WATER LINES: FCKFLW PREVNTR GREASE TRAPS.
OTHER FIXTURES
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 1 CLOTHES DRYER: I
FURN—100K: UNIT HEATERS. HOODS, OTHER UNITS:
MAX INP btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDEN11AL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPrCTIONS
1000 SF OR LESS 0 200 amp: 1 0 200 amp: WISVC OR FDR. I PUMP,IRRIGATIOW PER INSPECTION
EA ADD'L 500SF: 201 400 amp: 201 400 amp: 1st WIO SVC/FDR SIGNIOUT LIN LT. PER HOUR:
LIMITED ENERGY 401 600 amp: 401 000 amp: EA ADDL OR CIR: SIGNAL/PANEL: IN PLANT,
MANU HMISVCIFDR: 601 • 1000 amp: 601-amps-1000v: MINOR LABEL:
10004 aMPIVOlt:
PLAN REVIEW SECTION
Pecannact only: �-
-4 RES UNITS: SVCIFDR-225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
_ ELECTRICAL•RESTRIC TED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM. AUDIO B STEREO: FIRE ALARM. INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: IANDSCAPEIRRIG: PROTECTIVE S,GNL:
GARAGE OPENER: CLOCK. INSTRUMENTATION: MEDICAL- OTHR:
HVAC: DATAfIELE COMM: NURSE CALLS- TOTAL M SYSTEMS.
Owner: Contractor: TOTAL. FEES: $ 936.63
This parmlt is subject to the regulations contained in the
SULLIVAN, RICHARD A 4 SUZANNE OWNER Tigard Municipal Code.State of OR Specialty Codes and
9085 SW EDGEWOOD all other applicable laws All work will be done in
TIGARD,OR 9722.4
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: Phone Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Rte a forth in OAR 952-001-0010 through 952-001 0080 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED IWSPECTIONS
Erosion Control Insp 8, Crawl DrainlBackwalel Electrical Service Low Voltage Mechanical Final
Footing Insp Footing/Foundation Dr Eloctrical Rough In insulation Insp Plumb Final
Foundation Insp PLM/Underfloor Frai ling Insp Gyp Board Insp Final inspoctlon
Post/Beam Structural Mechanical Insp Shear 1"/all Insp Rain drain Insp Bullaing Final
Underfloor insulation PIUmb Top Out Exterior bheathing Insl Electrical Final
Issued By : ,� ;� J�__ ___._� Permittee Signature _
Call (5'03) 639-4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application
7Project/appi.
received: �� /S Permit n.,.:�!�T�p� - lS
City of Tigard --
Address: 13125 SW Hall Blvd,'I igard,OR 97223 no.: Expire date:
CitynfTigardphone: (503) 639-4171 issued: 13y: Receiptno.:
Fax: (503) 598-1960 Case file no.: Payment type:
— z,
Land use approval: I8r2 family:Simple ('nmpiex:
1 &2 family dwelling or accessory U Commercial/industrial J Multi-family U New construction U Demolition
U Addition/alteration/replacement J'fenant improvenirnt U Dirt-sprinkler/alarm U Other:
JOB SITE INFORMATION
Job address: C� S "-� C- (,) Q tAJQct�1 � Bldg.no.: Suite no.:
Lot: t z Block: Subdivision: E rjt w. Tax map/tax lot/uccount no.: adiCC- S
Project name: —01 C-)C,r- f,U 0,T t U A1 y,
Description and location of work on premises/special conditions:_
r—
Nume:
Mailing address: cl V ,4 Lo L cl v,;C h I do 2 family d"elling: v
City: I jState: 2 ZIP: c)'72Z Valuation of work........................................ $o"",
Phone:SCI 60 r Z v I Fax: E-mail: No.of bedrooms/baths.................................
Owner's representative: Total number of floors................................. _
Phone: IF= E-mail: New dwelling area(sq.ft.) ..........................
Garage/carport area(sq.ft,).........................
Name: Covered porch area(sq. ft.) .........................
Mailing address: Deck area(sq. ft.)..................l...................
- --- - --
-- Other structure arca(s . .�....City: __[State: ZIP: . U r Z
_
"-- �- Commercial/industrlalimulti-ffamily:
Phone: I ,i� I' nail y'
tt , Valuation of work........................................ $
Business name: I Existing bldg. amp(sq.ft.) ..........................
Address: New bldg.area(sq.ft.)................................
City: State: LIP: — - Number of stories........................................
Type of construction....................................
Phone: Fax E-mail:
— -- -- - Occupancy group(s): Existing: _
CCB no.: New:
City/metro lic.no.: 7Necontractors and subcontractors a,r-required to he
h the Oregon Construr"Wa Contractors Board under
Name: f ORS 701 and may be required to be licensed in the
Address: where work is being performed.If the applicant isCit ; 5talc: ZIP: licensing,the following reason applies:
Contact person. Plan no.:Phone: I:tx (� mail• — -- -
Name: _ Contact person: Fees due upon application ........................... :S
Address: Date received:
City: _ State: Z1 P: Amount received . ....................................... $
Phone: Fax: E-mail: J Please refer to fee schedule.
1 hereby certify I have read and lexam is application and the Not all jurtsdu ions accept credit canis,pleaw call jurisdiction fot m«e inrmmaiion.
attached checklist. All provisiohs of laws ank ordinances governing this U visa a Mastercard
work will be complied ith, tether s ifted herein cr not. Credit card number ._ _ _ / /
_ Expires
Authorized siggature: _ r^ te: New of cardholder as shown on credit card
4
Print name: Cardholder sipature Amount
Notice:This permit application expires if a permit is not obtained within IRO days after it has been accepted as complete. 4404611(60ari'oAo
One-and Two-Ilam ly Dwelling
Building Pernut Application Checklist Reference no.:
Associated permits:
('ilyu/7i�ur`� City of Tigard U EITctrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other: _
Phone: (503) 639-4171
Fax: (503) 598-1960
I Land vise actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verificatlon of approved platflot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit._—
1 Water district approval,
8 Soils report.Must carry original applicable stamp and signature on file or with application.
9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc. _T
10 _ 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 sep:uate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist. _.
I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a O4 elevation differential,plan must show contour lines at 2-ft.intervals);location of easements ano
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;di—lion indicator,lot
area;building coverage area;percentage of coverage;impervious area;existing structures on site;and sutface drainage. _
12 Fomdation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size AnI location.
I 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.
I4 Cross section(m)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,snb-floor..
wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sheat'ti w,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal it,.;ulation,etc. _is 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 analysi-.provide specifications and calculations to engineering standards.
17 Floor/roof framing.Prov?Je plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic venlilafion.
18 Basement and refolning walls.Provide cross sections and details showing placement of rehar.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 fce:long and/or any beam/joist carrying a non-unifonn load.
20 Manufactured floortroof truss desln 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 he stamped by an engineer or
architect licensed in Oregon and shall be shown to he applicable to the project undoi rrcir++
23 Five(5)site plans are required for Item I 1 above.
24
25
26 _
27 _ --
28 — -- — -- —
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. 410-4614(nma'COM)
Plumbing Permit Application
Date received: Permit no.:
City Of TigardM L7 � Sewer permit no.: building permit no.:
Address: 13125 SW I tall Blvd,Tigard,OR 97223
CitvnfTigard Phone: (503) 639-4171 Woject/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: by: Receipt no.:
Land use approval: _ _ rase File no.: Payment Type:
TVPE OF PERMIT
0 I &2 family dwelling or accessory U Comtncicial/industrial U Multi-family U Tenant improvement
U New construction U Arhlition/alteration/replacement U Food service U Other:
1 ' SITF INFORKATION1linformadbu use checklist)
Joh address: c- �' +_ j 3T ' ae e D O.t.
Desert tion Qty. Fee(ea.) Total
�� New I-and 2-farnily dnellints Only;
J- Bldg.no.: Suite no.:
r Tax ma /tax lot/account no.: (includes IOOfl.for each utility connection)
p — SFR(1)bath
Lot: t ock: Subdivision: Ed ,,,k•c a 'SFR(2)bath
Bl
Project name: Cn aAe,t- ndd�he->-t _ SFR(3)bath
City/county: 'i 0 W,%, I ZIP: 9'1223 Each additional bath/kitchen
Description and location of work on premises: Siteutilitles:
_ Catch basirt/area drain
Est.date of completion/inspection: Drywells/leach line/trench('.rain
Footing drain(no.lin. ft.)
Manufactured home utilities _
Business name: 0 013 t\l t:}Vq- Manholes
Address: Rain drain connector
City: ISI Sanitary sewer(no.lin.ft.)
Phone: _ Fax: E-mail: Storm sewer(no.lin.ft.)
CCB no.: Plumb.bus.reg.no: Water service( -).lin.ft.)
City/metro lic.no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: Date: Backwater valve _
1111111110m, RX 0 MUNI Basins/lavatory
Name: Clothes washer _
_- -- - ----- Dishwasher
Address: --- Drinking fountain(s)_ _
City: State: 'LIP-- Ejectors/sum
Phone: Fax: E-mail: Expansion tank
Fixturelsewer cap
Name(print): Floor drains/noor sinks/hub _
Mailing address: Garbage disposal
Hose bibb
City: State: ZIP: - Ice maker _
Phone: I Fax: E-mail: Interceptor/grease trap
owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),basira(s),lays(s) _
Owner's si nature: Date:_ Sum _
Tubs/shower/shower pan _
Urinal
Name: i_ Water closet
Address: Water heater
City: _ _ State: ZIP: _ Other:
Phone: 1 Fax: Email: Total
Not an jurisdictions wcepl credit earth,please cell jurisdiction for more information. Notice:~'is permit application Minimum fee................$
U Visa i]Mastercard expires permit is not obtained Plan review(at _ %) $ _
Credit card numtwr: within 180 days after it has been State surcharge(8%) ....$
E
- —cardholder u shown on ctedia card zplrca---- accepted as complete. TO'T'AL .......................$
Nome of
S
— Cardholder signature ------ Amount 440•1616(60t)a+COM)
PLUMBING PERMIT FEES:
-- — PRICE TOTAL New 1 and 2-family dwellings only: -
FIXTURES individual QTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 - for each utility connection J_
One 1 bath $249.20
Tub or Tub/Shower Comb, 16.60 Two 2 bath $3---,0.00
-«----
Shower Only — 16.60 Three abath - $393.00
Water Closet 16.60 _ SUBTOTAL _
Urinal 1660 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL. 4 -_
Garbage Disposal - 1680 _ TOTAL _
Laundry 7ray 16.60
Washing Machine 16.60 —
Floor Drain/Floor Sink 2" 16.60
3.. - 16.60 PLEASE COMPLETE:
4•• — 16s�� ------
Water Heater O conversion O like kind 16.60 Quankit b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removedl
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 4640 Lavatory - - --
___— Tub or Tub/Shower
Hose Bibs 16.60 Combination_
Roof Drains 16.60 Shower Only
Drinking Fountain - 16.60 Water Closet
-_
Urinal
Other Fixtures(Specify) 1660 -^ _ _-
_ _ Dishwasher
Garbage Disposal
- LaundMRoom Tra -
--- - - -
Washing Machine _
Floor Drain/Sink: 2"
Sewer-1st 100' 5:.00 3- -
Sewer-each additional 100' -' 46.40 4" _
Water Service-1st 100' 55.00 Water Heater -_ -
Other Fixtures
Water Service-each additional 200'- 46.40
s ec fy)
Storm&Rain Drain-1st 100' 55.00
Storm&Rain Drain-each additio•lal 100' 46.40 -- -_
Commercial Back Flow Prevention Device 46.40 - --
Residential Backflow Prevention Device' - 27.55
Catch Basin 16.60 J1
Inspection of L-xistillg Plumbing or Specially 72.50
Re uested Ins actions !-_ per/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 �—
Grease Traps 1660 --
- QUANTITY TOTAL
Isometric or riser diagram Is required if - - —
Quantity Total Is >9
*SUBTOTAL —
8%STATE SURCHARGE --- -- --- -----
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty total is>9 _
TOTAL $
"Minimum permit fee Is$72 50+8%slate surcharge,except Residential Backflow
Prevention Device,which Is$36 25+Ft%stale surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review
i:\dsts\forrns\pim-fees.doc 10/10100
Electrical PermiitApplication
bate received: Permit no.:
City of Tigard Project/appl.no.: Expire date:
City nfTigar'd Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Recciptno.:
-
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
7❑ 1 &2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant ifnprovcnient
U New conslrut-tion U Addition/alteration/replacement U Other: U Partial
1 f
Job address: 131dg. uu.: �Ullc m): Tax rnaphax )ot/accnunt 110,:
Lot: 13 Block: Subdivision: _ "c we c�
Project name: need, , Description and location of work on premises:
[Estimated date of com letion/ins ction
-SCREDUILE
Job no: rix Max
Business name: (")W (L — - - Description Qty. Hca.) Total no.Inc
Address: New resifivatial-single or mulls-fami.y per
dwelling unit.Includes altached garage.
C;:y Stnte ZIP_ Serviceincluded:
Phone: Fax: E-mail: 1000 sq.u.or less _ 4
Each additional 500 sq.ft.or portion thereof
CCB o.: Elec.bus.Tic.no: Limited energy,residential 2
Cil /m4tro liC.: Limited energy,non-residential 2
C. ' 1 1 1 D D Fach manufactured home or modular dwelling
Slilmiture of supervising el&9cian(required) Date- Service and/or feeder 2
Sup.elect.name(print): License no: Services or feeders-Installation,
■� alteration0 unamor relocation:
20
20ps or less _ 2
Name(print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: State: ZIP: _ Over 1000 amps or volts 2
Phone: Fax: I E-mail: Reconnect only I
Owner installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alterallon,orrelocation:
ORS 447,455,479,670,701. 200 amps or less --`__ _ 2
201 amps to 400 amps 2
owner's si nature: Date: 401 to 600 amps - 2
AN 101 a 0 Bench circuits-new,alteration,
or extension per panel:
Nome: A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit ?
City: Stale: ZIP: - 13. Fee for branch circuits without purchase
Phone: 1 • r trail _ of service or feeder fee,first branch circuit:
Each additional branch circuit.
Misc.(Service or feeder not included):
U Service over 225 amps-commercial U Hen]di-carefacility Foch pump or irrigation circle 2
U Scivice over 320 amps-rating of 1&2 O ifamrdous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel.
•System over 60x1 volts nominal more residential units in one structure alteration,or exlensinn•
•Building over three stories U Feeders,400 amps or more "Description: _
❑Occupant load over 99 persons U Manufactured structures or RV park Each addhimul Inspection over the allowable In any of the above-
U Fgress/lightingplan U Other: . Per impection
Submit__ -_sets of plans with any of the above. Investigation fee _
11re above are not applicable to temporary construction service. Other
-— — --- Permit fee.....................$
Not all jurisdictions amept credit ciuch.pleaµcall jurisdiction for more information. notice:This permit applicatioll
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number:._ __ --1-1_._ within 180 days after it has been State surcharge(8%)....$
Name randholr as shown on credit cor�—
Expires accepted as complete. TOTAL .......................$
S
— Cardholder 7iltrteture -- Amount 4404615(6A"M)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
p Restricted Energy Fee.... .__
Number of Inspections per ermit allowed """""""""""""""""" 575.00
„�� (FOR ALL SYSTEMS)
Service included: Iters Cost Total
Check Type of Work Involved:
Residential-per unit
1000 sq it or less $145 15 4 ❑ Audio and Stereo Systems
Fach addilional 500 sq If or
portion thereof $3340 _ 1 El 3,,rglar Alarm
Limited Energy $75.00
Cacti Manuf d Home or Modular
Dwelling Service or Feeder $90.90 2 El Garage Door Opener'
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 F1201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 6fr0 amps $160.60 2 _
—� - Other
amps $240
_ .60 _ 2
601 amps to 1000 a
Over 1000 amps or volts $454.65
Reconnect only $66.85 __ 2
Temporary Services or Feeders V TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fes for each system.......................................................... $75.00
200 amps or less $66,85 _ 2 (SEE OAR 918-260.260)
201 amps to 400 amps _ $100.30 2
401 amps to 600 amps $13375 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, _
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits ❑
Now,alteration or extension per panel Boiler Controls
a)The fee for branch circuits
with purchase of service or E] Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b)I tie fee for branch cirruits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit �— $46.85
Each additional branch circuit $6.65 ❑ HVAC
Mt.;cellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle _ $53.40 intercom and Paging Systems
❑
Each sign or outline lighting $53.40 _
Signal circuit(s)or a limited energy
panel,alteration or extension $75.00 ❑ Landscape Irrigation Control*
Minor Labels(10) _ $125.00_
Each additional Inspection over ❑ Medical
the allowable In any of the above
Per inspection $62,50 ❑ Nurse Calls
Per hour $6250
In P1,30 _ $73.75 El Outdoor Landscape Lighting'
Fees: ❑ Prolect;ve Signaling
Enter total of above fees $ ❑ Other
8%State Surcharge $ _Number of Systems
2511.Plan Review Fee
See"Plan Review"section on $ No licenses are required Licenses are required for all other Installations
front of application -
-- Fees:
Tofa/Balance Due $
--��_�- Enter total of above foes
EJTrust Account#
- -- 8%State Surcharge 5
Total Balance Due
i Wsts\forms\cic-fccs.duc 10/09/00
Permit#:
/�. Address: -57
Issued
h . 'z
j� Issued by: _ Date: L
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 1 and 2, and either box 3A or 313:
ki1. I own, reside in,or will reside in the completed structure.
fa2. I understar That I inust register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
J
L3A. My general contractor is
l� (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
5313. 1 will be my own general contractor.
LLI
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,cerhat tZZs
rmation is correct and that I have read and do understand the Information
Notice to P ope ty Ubout Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
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EMPLOYER RESPONSIBILITIES:
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ti,llll illl'e µll i V i1„
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Wrkers'corn lx"rlstition irmsdrance: .AS an em I!>yt'; �tnt urt vt!hjr rc tll th; (?te}rtrn l�trtlel!, i.'i'n11
t,l�lanl \sr,�kerti't"nn,Irt IlSatltltl�n,ttrtnLe fyt�uui ecll.luvtt s. Il �trl) 11111 ll1 llhtitiit worker CUrnik;11J1llIkII I I o iI:irji"., f 1)
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cull iht Worker, G',rnpensatkin Diviwion at,t)*,Dep;Iltnu0lit t, mi'l.1mer ulit l
l',.S.internal Revenue Service; As an employer, vOU I'lust"vithh(rlcl flALlit) illWrTle CIA,f0#1114M1ntdb;y#04'"Os
hulilc rOr tilt-tax potmAt even if ymi didn't actually l ithitoill tli t[ix. F=t+r ttttlr;'information,+Nall the inttwrial Revenue.Servrc�,
Al 1-8011) i`?4t••11!�(I.
OTHER RESPONSIBILITIES AND AREA r, OF CONCERN:
(�IICIt.'r'Onrl)lN�llll'l': •� ,1ht'pl'rtr111 ht�1tlt'i ft�t'thlipt'1tjt: 1 �,Vt,. ,•r't'tit,t+l,'.1i�1�' I,� �•"j1I^ 1iI�,;rr�, Y,,'1!1,••Ire 11tt°t•t,'r��i1'!rrlt,Ir1 � °.�.�:tl"
thus rl,ny he hrolight It, your attention throtigh mm,,
1,ialbility and pruperty damage insurance: Grt1t,1,.1 wol lic hall e agclit to•,ec: it rt•l!ha\t :dcquaix ul.ul wo
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tl»thc,�rrk of rl,t[tth n I!it11 finicl}
:uul it)liolifv huildirtg ijffleirrla At thi+ so they crm perfonil the 1'rg1l1retl infpectititle.
11 > !1 II,Iyc 1Jtlriolt11)quettlons. ritt? 11r c,►II the construction contra,tors Ilollrtl(F'C1 flctit l4i til, `tiulem,t)F�ta;3t lis ;;+�`
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CITY OF TIGARD 24-Haar
BUILDING
Inspection Line: (503)639-4175�+
INSPECTION DIVISION Business Line: (503)639-4171 �- P _
HeceivedZ date Requested 4S AM PM— BUP
Location " " - — Suite— MEC
Contact Person Z--_ PLM
Corir t
Ph 1 -) SWR
-- -
ILDI iena40wner�'—__.--- _- -- ELC -
q ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT _-
Post& Boarn --
Shear Anchors �.•
Ext Sheath/Shear
Int Sheath/Shear
raming
Insulation (, ---
Drywall Nailing - -— -- —
Firewall
Fire Sprinkler - --
Fire Alarm
Susp'd Ceiling -- - — --- — -�
Roof
Fi
PAR r FAIL
SL
BIN�t y < ---- ----
Post e-am
Under Slab - -- '-
Rough-In
Water Service - ---- - - -- L- -- -
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain - -- — -
Shower Pan
Other: -
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 1__� Reinspection fee of s-.----required before next inspection. Pay� H 13125 SyV Hall Blvd
PASS PART FAIL /
SITE - I Please call for reinspection RE: _� — -_-__._ to in -no access
Fire Supply Lint;
ADA ,
Data Inspector
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspoction record from the Job site.
PASS PART FAIL
ADDRESS:
QA "fWag
i:\records\microflm\targets\bu iIdiny.doc
i
IIfSPECTIOB iKYI'TCE ��,I
City of Tigard Building Departnsnt �.
13125 6W Ball. Blvd. Tigard, Oregon 97223
Inspection Line (Re�-A3-Phona)3 639-4175 Business Phone] 639-4171
Inspa tionr__V1�
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Pound. Plbq. Top out
Cas Line lIlfALt
Post/Baam Struc.. San. Sewer Framing -Bldg.
Post/Beam Mann• Rain Drain Insulation
-Plumb.
Plbg. Underfloor Nater Line Grp. Bd. -Meeh.
Gate Requested: `� � C�
Timet _.__AM ,_PM j
Addressr� e
�0 k -"> ;d� ��+����c� d -�.
mit
Buildwrr
TON MLLCOIBG COMMMIOMS ARE RMUl"Dr y
i
SOG
� 1
I
, I
Inspector: \' �.._- y �f✓ ��•�------ �_
Dater_1 -- ��,_�
DISAPPl1ovan "pWWRD SUBJRC! TO ABOVZ
call Por Reinsp.
■
INBFECTION NOTICE I /
City of Tigas_d Building Departsent
131.25 BM Ball Blvd. Tigard, Oregon 97223
Inspection Lina (Rec-C-Phone) t 639-4175 Businoss Phone: 639-4171
Inspection:_
Footing Plbg. Underslab Hach. Rough-in Appr/Sdwlk
Fcnand• Plbg. Top Out gas Line FINALt
Post/3aam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -Meeh.
Data Roquestoda�.S �— --Times �' AN Pit
Addresses Permit to MO(- -CA45 i
Builder:
THE FOLLOWING COECTION3 ARB RFQItIRF.Dt
,,
7 L�Ld,lj�
Inspectors Data,
11PPROVED V DISAPPROVED APPROVED SUBJECT TO ABOVE
V Call For Reinep.
CITY OF T MECHANICAL
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT'
13125 SW Hail Blvd. f!gard,Orogon 97223.8199 (503)839 4171 PERMIT #. . . . . . . .. MEC94-0004
6,:9-4171 DATE ISSUED: 01/04/94
PARCEL: 2S102DC-00501
SITE ADDRESS. . . : 09085 SSW EDGEWOOD ST
SUBDIVISION. . . . - EDGEWOOD ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 13
CLASS OF WORK. . sADD FLOOR FURN. . . . a EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . : VENA FANS. . . :
OCCUPANCY GRP. :R3 VENTS W/O ADPL: VENT SYSTEMSs
STORIES. . . . . . . . :2 BOILERS/COh,PRESSORS HOODS. . . . . . . :
FUEL 'TYPES------------ 0-3 HP. . . . : DOMES. I NC I N:
s/WUO/D / / 3-15 HP. . . . : COMML. INCIN:
MAX INPUTS BTU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS?. . s 30--50 HP. . . . s WOODSTOVES. . : i
GAS PRESSURE. . . : 50+ HP. . . . : CLO DRYL:RS„ . :
NO. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. -
FURN ( 100K BTU: <- 10000 cfm: GAS OUTLETF . s
FURN )-100K BTU: > 10000 cfms
Remarks - INSTALL NEW WOOD STOVE
Owners -----------------•-----------------------------------• FEES --------------•-
RICK SULLIVAN type amount by date rec-pt
09085 SW EDGEWOOD PRMT $ 25. 00 BLT 01/04/94 .
5PCT t 1. 25 BLT 01/04/94 .
TIGARD OR 97223
Phone Ms
Contractor: ---______-------•------------•_----
CONTRACTOR NOT ON FILE
----------------------------------------
$ 26. 25 TOTAL.
-------- REWUIRED INSPECTIONS
This pereit is issued subject to the regulations contained in the Final Inspection
Tigard Nunicipai Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
appvnved plans. This pereit will expire if work is net started
within 188 days of issuance, or if work is suspended for more
than 188 days.
Oermittee Signatures
issued Bye
.all for inspection — 639-4173
City o1 Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit #ZZ 4- 000 <.
Tigard, GR 97�_23
(503) 639-4171
-;rte ----- Description
W l.d uJ0 Table 3A Mechanical Code QTY PRICE ANIT
Job f QQ� '7223 1) Permit Fee -� -0- -0- 10.06
Address cMill
---- - - -"
-> f 2) Supplemental Permit 3.40
-Fumwe to-lW713WITIV -
�- 1) incl.duds&vents 6.00
Furnace
_ +
Owner } '�'' t., e8 woo 2) incl.ducts 6 vents 750
-Noorur-F mance - __ - ---
27- 3) incl.vent 6.00
Suspended eTer,wailheater-
4)
iea er
4) or floor mounted heater 6.00
men I'd in I °_
Occupant > 5) appliance permit V _ 300-79- _
parr c ea ng,re rig.
6) cooling,absorption unit 6.00
--%Ti er or mrip,heat pump,air-or O. - ----
7)
-7) to 3 HP absorp unit to 100K 87 L 6.00 i
"• - i er`or comp, a pump,air co ---- '-"--
(-ontractor f� 8) 3-15 HP absorp unit to 500K BTU 11.00
icer or`comp, heatpump,ars
9) 15-30 HP absorp unit.5-1 mil BTU 15.00
. •• Boiler or comp, 5-1 pump,air con -
10) 3050 HP absorp unit 1-1.75 mil BTU 22.50
reoy acMowI4QW tfiat I have read this applcalKm,that the ler or cort�ie7i np pump,air cor -
information given is cc rect,that I am thra owner or authorized agent 11) >60 HP absorp unit 1.75 mil BTU 31.50
o1 the owner,that plans submitted are in compliance with State it an rng un-RTo -'
lawn,that I am registered with Mho Gonstruction Contnac tur't Soard, 12) 10,0b0 CFM 4,50
that tt:e number giver;is oorrw_ (Of exempt from State registration,
Akrhing urn
please give mason below.) 13) 10,000 CTM + 7.50
- ------ - on porta _-.
_ 14) evaporate coder 4.50
_79-7n an connected
_ 15) to a single duct 3.00
-� en a on sys em no --
16) included in appliance permit 4.50
Hood serve_
17) mechanical exhaust 4.50
iiscn'6a w«Tc-naw a r ron a cera n reps r ____UFM_rMrdal or hn s ri __
to be done residendW non-residential Q 181' type incinerator 30.00
Existing use of Other:.e., s ove Hva er
WkIiing or prop" N 0 0.LE _ 19) heater,sdar,aWoa dryers,etc. 4.5n
Proposed use of 20) Gas piping one to four oudet5 2.00
lwikfing or pmporty —
21) More than 4-per outlet
Type of fuel oil 0natural gas(2) LPG Q elrrctric Q _.
Minimum FPe$25.04 SUBTOTAL G(/
PERMITS BECOME"D IF WORK OR CONSTRUCTION -" - --- -
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR S9f.SURCHARGE a
IF CONSTRUCTION OR WORK IS SUSPENDED OR ---
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED.
TOTAL Z �
Special Conditions - "--
--�_ Date issued by
rl�plrMr
Cll*y 017 RECU"IPT OF PAYMENT' RFCEIPT NO. 04-247262
CHIRCK AMOUNT a 26. 25
AME c SULLIVAN, SUZANNE' CASH AMOUNT' a 0. 00
14635 SW BOTH PAYMI-N'T DRIE a 01/04/94
TWARD, OR SUBDIVISION
9','e84--
'UNPOSE OF PAYMF NI OWIINI PRID PURPL*J: (It- PAf4YMf7'-Nl' AMOUNT, PAID
ECHANICAL PL MEC-44-00V.64—------- 6' CUT FaIIILD -T.-4
OJAI— AlloCII1I'41' PAID