10330 SW 70TH AVENUE t
ADDRESS :
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INS
IR ERMII
CITY OF T I GARD 17-1ERINI IT MASTE. V-!
' . I . . . . - *
COMMUNITY DEVELOPMENT DEPARTMENT DATE IISG"UED. 04/Z'7/'.1
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)839.4171
PARCEL. 1313GAA- OL,10 1-7i I
ITC ADnRESS. . 11"41330 SW "'ITIS AVU
JSDIVI53ION. . — ZONING. r-4. 5
LOCK. . . . . . . . . .. LOI.. . . . . . . . . . . . .
BUILDING
DWELLING UNITS:0 BASEMENT. . . . . . . . :0
LAS;~ OF WORK. -AD.0 3CDRmS:0 DATHS:0 GARAGE. . . . . . . — :121
YPE CC USE. . . .–JF r`LOOR AREAS—— REQUIRED5r2TZACI-',S _-._ _-..-
Y.:-"'E Ji` CONST. :5N FIRST. . . . 1 C2'9 e.f LEFT-0 ft RIGHT. .0 f
'CCUr'nNCY 0"nP'. . IR SECOND. . . 0 s f F-RONT. :0 ft; REAR. . g 0 ft
:TORIr-S. . . . . . . : 1 F I WS)MENT:0 f REQUI RED–
LE I G I IT. . . . . . . . .. I ft TOTA=L •. _'.-_.r: 1;.:'D a r SMOVE OCTECTORS.
_0OR LOAD. . . . :40 psf VALUE. . . . . $: 831(11 PARKING. S P A C E E. 0
K11"CHEN PEIVGDEL
LUM11ING
0 17LOOR DRAINC. %3 BAC) CLOW P*r%EVN1_RS. . :0
AVATORIEG'. . . . cO WATER HEATERS. . . :0 TRAF'S. . ,. . . . . . . . . . . . . . :{*c
'~'.'1 7 H 0 W C:R 73. . . . 0 LAUNDPY TRAY S. . . :0 C A7IC1 I L -; 71 1 W',. . . ID
-'ATER CLOSETS. . 0 SEWER LINE (ft ) . .0 GREASE TRnP5. . . . . . . :0
te WATCR LINE (ft ) . :0 OTHrR 17IXTURC",. . . . . ..IZI
APBAGE D I rr,. Ot RAIN DRAIN (ft ) . :0
ASHING M.(""H. . . 40 SF RAIN DRAIN — :0
MCCHANICnL. FCES
-"I :L 7il 717 i UNIT I IT W.3. . .0 t y P am(Sunt by datc
VENT15 . . . . . :0 BP RT f 74. 50 rA 04/27/95
SPLC $ =i t3. 43 ZON 4'14/. k/95 5–
.AX INPU"1'.0 r.-T'J VENT PAN,13. :0
JPN 10OR . . .,Z HOODS. . . . . 10 PrI-XIC 3. 73 D 04/Z'7/95
U['�N w. 10 V1 V, . .0 woor�,'[JVUS. Lo
uiu rupNt. . . . .o CLO DRYERS. 1 0
OTI !CR UNTTS;O
rjA;:� OUTLETC, :0
LRRY (.00HRAN
0"
SW 70TI-1
1GARD OR 97211i'21131
R
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C, TOTAL
it pc-lit is issued tubject to the regulation` contained in the RI-OUIRED INE31',ECTInNS
;ar4 M�mkipsl Code, State of C,-e. Specialty 16odts and all other r-ocltiog Irjg+p) Bmildil-qj Final
piCaL'Af laws. AIA work will bs dolt in accordance with approved roumiation IuF-,p -------—
arii, This Pei-Bit will u 00
__�'Avtfd within I' V'01"t"'BeAm
C-D iY5 of isivanct, or if oo. , days. Crawl Drain
!'riming Intp
is 1.)-u 1�x t 10 11 1 v,"P
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17,Aill L11-AiO
i an " CA 3 94 17
WIN
Residential Building Permit Application V
City of Tigard \,, \�
13125 SW Hall Blvo. ►�\
Tigard, OR 97223
(503) 639-4171
/Jobsite Address: 10330 -S -2�
Subdivision: Lot# Office Use Only
_
i7D �,�� PlancklRec # f
Valuation: b//-/ L
Corner Lot? Y O Permit # tKI 51 (?-5 -017
Flag Lot? N Reissue of
Map & TL # 51 w PI 100
Owner: ' C�-�, �� Approvals Required
Address: y 's c)7* Planning
Engineering _
Phone: _��� -���� Othe
Contractor: -(L)5��-� Items Re^uired
\ddress Subcontractors
-- Truss Details
Phone: Other
Contractor's License #
(attach copy of currant Oregon license)
Contact Name & Phone:
Subcontractors: ArchitecVEngineer:
Plumbing: Address -a-----— ----- ------ ---
Mechanical
Ln (attach copy of current CR Contractors license)
y Phone:
JOB DESCRIPTION: `\�C� (-*evJ VIEAPA 0 Z, Zy 3 �.
111
J
Applicant Signat & Pho/n'e1 number _
Received by: (y<< i` Date Received
Permit# Account Description Amount Amt. Pd. Bal. DuQ-
hl5f�S -ol 7j Bldg. Permit (BUILD) . 'U
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX) j
Bldg:
Plumb:
Mech:
Plan Check (PLANCK) ,/
Bldg: '
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-1) �^ —
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
c.
v`- Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT ;EROSN) _
TOTALS:
#: N1`-JT qS 0
F-
`''�
e: Address: to?7-30
ry l Issued by: k'CW 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:
,i 1. I own, reside in,or will reside in the completed structure.
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.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
y Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
z registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct acrd that 1 have read and do understand the 1 nfornratiim
Notice to Prope -Owners about Construction Responsibilities on the reverse side of this form.
J
-
ignature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # _ l (
Phone (503) 639-4171
Date Issued r r
CITY OF TIGARD FAX (503) 684-7297 Issued by
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Address 10 ;o JrC.0 --7 0 T,* _ Service included' Items Cost(ea) sum
City/State/Zip � 'L'1Q -277Z, 4a. Residential-per unit 4
1000 aq It or lose ` $110 00 r
Name (or name of business) Each t eeleq It or $25 00
tion
poron tit
1
_
Commercial❑ Residential Limited Energy $2500
Each Manutd Home or Modular 2
Dwelling Service or Feeder $6800
2a. Contractor installation only: 4b.Services or Feeders
Installation,alteration,or relocation 2
Electrical Contractor 260 amps or lose $8000 2
Address 201 amps to 100 amps $8000 2
401amps to 800 amps $12000 2
City __._ State_ Zip 001 amps to 1000 amps s1e0')0 2
Phone No. Over 1000 amps or volts $34000 2
Contractor's License No. Reconnect only a:^0o
Contractor's Board Reg. No. 4c. Temporary Services or Feeders
Installation,allaration,or relocation 2
Signature of Supr. Elec'n 200 amps or lees $5000 _ 2
License No. Phone NO 201 amps to 400 amps $7500
401 amps to 800 amps $10000
Over 800 amps to 1000 volts
?b. For owner installations: see V above
4d. Branch Circuits
Print Owner's Name I20,!!MzAP"1New,alteration or extension per panel
Address a)The fee for branch circuits wfrh
City State Zi f1� Eachpurchase or circuits or As d r f1N.
Each branch circuit $500 _
Phone rJo. Q 2A,0- 4 j:1 b)The toe for branch circuits wffhouf
The installation is beinglm4e on property I own which is purchase or senrlae or feeder fee.
not intended for ease Or rent. Fust branch circuit $3500 /
Each additional brans,circul $500
Owner's S gnature L 4e.Miscellaneous
(Service or feeder not included)
3. Plan Review se on (i/required): Each pump or irrigation circle $4000
Each sign or outline lighting $4000
Signal cimuit(s)or a timded energy
Please check appropriate Item and enter fee In section 50. panel,alter,dion or extension $4000
4 or more residential units in one structure Minot Labera(10) $10000
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
_Classified area or structure containing special occupancy the allowable In any of the above
as described in N E C. Chapter 5 Per inspection $3600
Per hour $5500
N In Plant $5500
Submit 2 sets of plans with application where any of the above
►— apply. Not required for temporary construction services. §. Fees:
—' 5a. Enter total of above fees
NOTICE
n? 5%Surcharge(05 X total fees) $ z;-C',
lUi PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal s r r ,t
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b.Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $ _
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account N $
t Balance Due $ 1,