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10880 SW DERRY DELL COURT
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Lin--: 639-4175 Business Line: 639-4171
SUP _
Date R,quested C3 AM Z PM BLD
Location i D Suiite� MEC
_
Contact Person Ph ,l[�L PLM — -
ContractQr_ — Ph !Y(2; Z- SWR --
NUR—D& Tenant/Owner `— — ELC
Retaining Well ELR
Footing Access: FPS
Foundation I _ - -�---
Ftp Drain �� SGN
Crawl Drain Wispection Notes: '"`--� ----
Slab —_ - SIT_
Post&Beam '
Ext Sheath/Shear
InaSheath/Shear
mma
Drywall N ,ding C Q S � G�� -- -�-"
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof _
Misc:
FinASS PARI'
P. MBING
Post Beam
Under
Slab V 0 -- --
Top Out 71
Water Service --
Sanitary Sewer
Rain Drains
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
i
Fire Alarm
Final
PASS PART FAIL --
SITE --
Backfill/Grading —
Sanitary Sa..er
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW a.' '{Ivd
Catch.ResinUnable to inspeLi- no access
i-ire Supply Line I 1 Please call for reinspection RE: _ l �
ADA
Approach/Sidewalk Date I�!�? �I --Inspector -Ext
Other ,—
Final
PASS PART FAIL DO NOT REMOVE this inspection rs�cord from the job site.
� S' I sui`i -
FRAForm N..=t(g
(Revised Au",t IgGA) FEDERAL HOUSING ADMINISTRATION Fvrm approved.
11 New installation. REPORT {7F INSPECTION budget Bureau Na.
__l11-100207__
® Existing installation- INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
To Be Headed in by FHA OfficeRecsipt 1/7087
Pacific First Federal. Savings
Portland, Oregon find Loan Association Conditional
-................_.... .-----.--..._......--__... -
_..... --(Insuring office) _..... ........
_
(Mortgagee) (Mortemmr or sponsor)
Property address __10880_S.W. Derry Dell Court, Lot 2�s Der Pell Plat 12
--- ---__--------- -- --Tigard------------�..__------Washington--
ic)tyl -------
—
(County) (state) -
Totai number: Living units __..__1Bedrooms_._�_ _ Baths ___ Basement: ❑ Yes L1 No.
Water supply by: [79 Public system. ❑ Community system. [] Individual system on site.
Is system to be installed to accommodate: Garbage grinder? ❑ Yes ❑ Noo.Automatic washing machine? 0 Yes ❑ No.
Part I—s.—FOR USE OF INSPECTING OFFICIAL
(Fill in below information applicable to subject installation)
INSTRUCTIONS: If new installation, inspect for compliance with approved exhibits arl record any observed information not
shown on, or which varies from, the approved exhibits. If existing installation, furnish ag much of the information aE may be
available. ,
PRIMARY TREATMENT consists of$tSeptic tank. ❑ Cesspool.
Septic Tank:
Distance from well, Y.W. feet. Material,. --------Qol1A
zqt4--------- ---•- --------- ------ Number of compartments---
Total liquid liquid capacity, ---_--------750 _____________•-_ --_ gall(as. Capacity inlet compartment Q--_
Inside len P gallons.
- feet. Inside. width, _.___ ''•• --'---`--`-
�• - ---- ---- -• -���_ feet. Liquid depth, --___.N__-_--- feet.
Cexspool
Distanc, from: Well,___-_-__ feet; foundation _ feet; nearest lot line at ❑ front,❑ aide
f ,------------ - , El rear,-•------------feet.
Inside dinmeter- --------.- feet. Depth, ---------- feet. Liquid capacity,q P Y, .... gallons.gallons. Lining material
SECONDARY TREATMENT consists of in Pistribution box and XXTile disposal field. Cl Seepage Pits. Other____-.___..�_________
Tile Disposal Field:
Distance from: Well, __F,.X.___ feet; foundation, ______10__ feet; nearest lot line at a front, ® side, EJ rear
Total length of the lines, ____2110_________ _ f t. Number of linea-----------------
_ - --� .._.-feet.
_ � - - Distance between lines, _____.�.� __
� --•-----� -- - -- feet.
Total effective absorption area in bottom of trenches, ________ square feet. Trench width 36-----------
Length of each line, 1("9-71--------------------- feet. D^pth, top of tile to finish grade, _______
Type of filter material:EXGravel. ❑ Broken stone. EJ Cinders. Other__---------,..__
�•�" - -------- -- ----- inches.
------------------------ - ----
Depth of filter material beneath tile, .....4--------- 6 ------
Depth
inches. Depth of filter material over tile,_____....�.. __
Seepage Pile: ------------- inches.
Number of pits _ Outside diameter_____________feet. Depth, ------------ feet. Lining material _________.____
Distance from: Well --------------- -•------
________.___- feet; foundation, ______._____ feet; nearest lot line at❑ front, ❑ side, ❑ rear,
_. feet.
If Fainting Installation, give all the following additional information available:
Distance to nearest: Public sewer, ________ _______ feet. Communitysystem
,...............feet.
Approximate direction of surface drainage of lot, ------------------------------------ Approximate sloe feet per 100 feet.
Soil is: ❑ Loam. ❑ Sandy loam. ❑Clay. ❑ Sandy clay. ❑ Coarse sand or gravel ❑ Hardpan. ❑Rock, Other___-.________________
Number of bathrooms, In there a basement? ❑ Yes, ❑ No. Basement drains to ____—______
Fixtures in basement: ❑ Laundrytray. �" •""--""-'-�-'----'--------
y C] Toilet. ❑ Bathtub. ❑ Shower. ❑ None. ❑ Floor drain. ❑ Sump pump,
Laundry waste disposal: Direct to ❑ Seepage pit. Other __--------------- Through sump pit to:U Septic tank. ❑ Seepage pits.
Is footing drain provided? ❑ Yes. Cl No. Drains to: ❑ Surface. ❑ Dry well. ❑ Sump in basement. Other_._.______._
Downspouts or areaway drain to: 0 Surface discharge. -----
e ❑ Dry well. Other
Depth of house sewer below finish rade at foundation `
g �------------.._feet.
Inspection made by: ❑ State, ® County. ❑ Local Health Authority,
(Signed)
Date of inspection___..__ «. 26 _ 19 56
uperviteilag Pnbli 1 ea1tl�_-9�nitaria-
- (rivet --------------
Part
--- - -----•---
Part 1—b.See reverse aide
Part IL—F'OR USE OF THE HEALTH DEPARTMENT OFFICIAL REVIEWING REPORT —
Based on the information reported hereon and other available information, It is the opinion of the 1_7 State 2 County ❑ Local
INSPECTION -REPORT _ SR Ar-E DISPOSAL SYS'TEm
PROPERTY C"MER NO. BEDROOMS
ADDRESS and LEG DESCRIPTION
CONTRACTOT?
PT'IMAPY TRFATVENT consists of soptic tank.
SEPTIC TANK=
Distance frim well,
compartments,, � feet. Material,, �„c.w.d,1.c; .Number of
j �
�atal liquid capacity S" `- allons. Capacity inlet compartment
7 _gallons. Inside lengthfeet. Inside width jl
-feet. Liquid depth feet. — `
SECONDARY TREATMENT consists of ✓ Distribution box and �.-
Tile Disposal field, seepage pits, other �'-'�
Tile Disposal field:
Distance from: '.;ell feet; f0andation_117 feet; nearest lot
line at front, _ . side, rear, feet.
Total length of the lines, d feet. Number of lint:.-
Distance between lines, feet.
Total effective I4orption area in bottom of trenches, _ �sq. ft.
trench width _ _ inches. Ler.oth of each line
feet. Depth, top of the to ini. •h grade J;,c hes. Typo of
filter material beneath the �, �� ^inches. Depth off
filter material over the inches.
� 1
Ila /
DATE OF INSPECTION i O
'Sanitarian
RECEIVED -
FOR DEO USE ONLY
APR 13 1999
Dept.of Health&Human Services
Environmental Health
LAND USE COMPATIBILITY STATEMENT
FOR ON—SITE SEWAGE DISPOSAL SYSTEMS
APPLICANT'S NAME NAILING ADDRESS PHONE
'K�t_.1, cd3w kk3 C &,I A-At t--- SO 3-')oy- S9
Cui 4-1ar � � _ �-TZ-��_ S� 5 - �3g -38 ,'18
CITY STAT ZIP
TOWNSHIP .1 RANGE %4,\l
/ SECTION �� TAX LOT OR ACCT NG
v,\V _Sk JY
P A SUBDIVISICN/PROJECT LOT BLOCK COUNTY
E T
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T 0
PROPERTY IS A LAT OF RECORD CREATED BEFORE AUGUST 1, 1981.
PROPOSED LAND USE – ----
E- r[s►,�r C Cyf eW' ,`tic, srr(4 LC
STATEMENT OF COMPATIBILITY iROM APPROPRIATE LAND USE AUTHORITY
(An equivalent statement may be provided in lieu of this form)
PROPERTY'S ZONA DESIGNATION —
1 �3�5
THE ABOVE: PROPOSAL HAS BEEN REVIEIED AND FOUND TO BE:
COMPREHENSIVE LCDC ACKNOWLEDGED ❑ CONSISTENT WITH THE
10
STATEWIDE PLANNING GOALS
OR
NOT COMPATIBLE W17H THE I.CDC NOT CONSISTENT WITH THE
ACKNOWLEDGED COMPREHENSIVE PLAN ❑ STATEWIDE PLANNING GOALS
REASON FOR FINDING OF COMPATIBILITY / INCW1ATf8.L1T_Y n --
` kt,tw_ ;:�VhSt S dF (�t',RI�A t:t� ��tP►,� �N - (`�—�•� 7 �
PRODLATY IS LOCATED: (check one) –
INSIDE URBAN GROWTH BOUNDARY OUTSIDE URBAN
INSIDE CITY ❑ OUTSIDE CITY LIMITS ❑
GROWTH O(XRWARY
LAUD USE AUTHORITY ------ – ._ — _ -- —
G�
SIGNED TITLE DATE
cr
El CITY/CC.MTT CONCURRENCE IF INSIDE URBAN GROWTH BOUNDARY A
SiGNED 1ITLE ` �I
(3/21/90)
('Y;�4a•yF1w\y4�"rlM�i�P..� �-.�P�IMY�Yf}I�!�1��ww,1 ...rte. .+.+..•, nw ,
/f(f 1. y"'"*"""."�„W�=�'lr3G<'Wt`rr,..-.. .,..-r,"..,?;.�fr•�:.'.]�'.bvli.W7�r�•,:,ww,,.
WASHINGTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH AND SANITATION
155 N. First Avenue
Hillsboro, Oregon 97124
(503) 648-8722
CR. #:
Tax Map #: L Li7c.`
Road Name:
.MIT
New Construction PE
Repair ( Major, Minor)
Alteration
An On-Site Sewage Disposal Permit is issued to :
fora period c f onevear from the date issued.
(This Permit is NOT transferable)
All septic systems must be installed as indicated on the approved plot plan. If any changes are
anticipated, a revised plot plan must be submitted to the Washington County Department of
Health and Human Services ;or approval. The plot plan is part of the permit.
Before a drainfield can be backfilled, a pre-cover inspection must be made. The inspection will
be made within 7 working c�a�s after it is requested. t
,
Date Issued:
Ei.vironmental Health Specialist ^
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_ WASHINGTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH AND SANITATION
155 N. First Avenue
Hillsboro, Oregon 97124
r., (503) 648-8722
CR. #: 1 i U
Tax Map #: _D
Road Name: P rN
PERMIT
New CoDstruction
Repair ; Majork_Minor.)—D
Alteration M
An On-Site Sewage Disposal Permit is issued to : rI I G (-W{c /�►.,--
tbr a period of ane vear from the date issued.
(This Permit is NOT transferable)
All septic systems must be installed as indicated on the approved plot plan. If any changes are
anticipated, a revised plot plan must be submitted to the Washington County Department of
Health and Human Services for approval. The plo plan is part of the permit.
Before a drginfield can be backfilled, a pre-cover inspection must be made. The inspection will
be made within 7 working days after it is requested.
- -- - --
Date IsFaed: - I ' `1`7 • i
Environmental Health Specialist
to
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06-23 99 10:20 RICHMCM CONST I -S41 3137 4339 P:02
PROPOSAL
Eastside West-side I Proposal Na
253-7567 2415-138715
Sheet No.
Date
SEPTIC AND SEWER SPECIALISS" 'UN CITY
0 Mo"ome Million 656 2632
Proposal Submitted To Work To ne Periforivwd At
Name (;treat felfe9e)
r —J'
-P.I,-I 4-4�- (:it ".k —-
Y—4-
Date of PI ns
slate. Architect
Telephone Number 7A29�M25� 30 1-3
We hereby propose to furnish the rn-.ieriats and I mrloirm the tabor necessary lot the curilliulehui i ul
OL
7.
4
Per, V
-4 k e— 1.ejW79--LL--
All material l5 9uaranlegd to bP as ape J,ea alt cith, iv�lh Wwork 1; 44 pArtotmed in accordancewililli III*- (111evvinga
n p�
and sperifical ions submilled lot abov _Meled in a Tslariliai workmarthi(e mannor lot the sum ul
'/
,(200
",III waymelits to be made as follows'. Soo
1; d�o c4,b% perly A" c-A4 cz --tk 4-1t �e
6, 4.e 'Afo— 00�' i-II4.3-C-4
'4
iteration or devisitoi, Iro- above spor'lirrill in�in.,olving Respectfully submitieci GU1
will bO executed only upon-1111011 orders, And
agreements contingent upon strikes actrimiti,sit -i trioyi i-yo-i
our control Owner lu,.a ,y lite, tvii*eW and oth Or necessary
nsurilince upon amovo work WorKmen s Lamp -'enuan and Note This proposal may be withdrawn
PUUIIL L-til.,#Wy lollwlllrncft 0-1 atx')Vo irionirk In be Ken cut by
by us if not accepted within"7p days
ACCEPTAME OF PnQPr)SA1
The above prices, spacifications and conk ions, are satisfactory and hureby accepted You are AtilhorizPci to dr) the wnrk as
Spe';Iflad Payment will be mane as outlintia above
Signature
Signature -----
2.S 3d4 - 2 300 Alk✓.•tlswti
Al McCutchan (owner) Map#S2103DA-02.300
0880 SW Derry-Dell Ct. Oleo )ell 6f Plat: Derry-Dell Plat #2 Lot 25
Tigard OR. 97223 / Zone: R-3.5
Site Size: 16401 sq. ft.
Jeff Floyd Excavation (installer) No Basement
20040 S. White Ln,
Oregon City, OR. Scale 1" _ ?.0'
:iO3-656-5815
� 2 2
PEQ:` 3147316
228
–�
------- 100' — 10'
99'-1" --
Rq•,� gq.to cy.q qQ— `� �—pro 1011-01,
. -
40'
32' 40' 40'
S
�P1�3 ,,p 4`0' OS V,q 40`t� ��.
40' a — 10'
test hole
40'
Proposed new
99'-1" OR code steel tank
/or
10, — ` qC0 1000 gal. cap.
99 -4
1 Tt-
i top of ground 100'-0'� I r'
4" pvc at enols 5' _-__Li Won' 3 �CLt
of infiltrator for _
contlnous system
I I
I I
J 311_' of infiltrator 6 I I L
1 I
�u l n c0e s-2/'/&1 7 5'/
S'GA p ,< f Cr+�/ A/`r1v_<1 1
it
.,�-.1 y
1 S ►� ------
"y 10'
I� � +
�OI N
15011m// o/ VAv4/ concrete
coverers 11 SU,1 �rj
water
area serviceai rnary 30'
line
1i
100'
228 _ �— "� I��P✓v�I 1.�l� ct --� 230
N (F�1�r /✓v SNc✓tou i
f/ / t � �7 f {. d tr rl Ht l
y4erl Sof
'� C.1 ) 1,Alar .\ v r sp r 4
re 1, K)��oZs1�= 7Y" ,h - 3G6M IM L )l
"
...�. ,
32' 40' 40'
40' 1 114S 00 40' koo
40' test hole
40'
l Proposed new
`-�" 1 93'-1'b OR code steel tank
!D�
10, q 1000 gal. cap.
41.
99'-4 �� .� �y/
'1 �► T1-
top
of ground 100'-0'I I to-
4"
4" pvc at ends 3 �oU
of infiltrator for
40
T continous system I -- I
I g'3�
I �
312' of infi;I:tater f1f' i 77—
/f/0
—/flu mCV[vt-¢- rit 7.5'
r 4� �J.,��. f/l�l-N• rr1 pVrhr� ._.....-......_.............. � P��� I
k�
(itfk __—_— ----
►� Ok �ff, t��r� J >. Dt <;r:t; taco ' t.
s 1'
ov "/VAta-'/ concrete 3 I
cove,,ed '. watar
area servicernA30'
line
?YAG 100' #
228 le✓'..4I Oea Of. ,� 230
'It* — NV —TN C'/It's u /Loll
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T�, S�Vr �Iprvr /1�(� 11A A - T1
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--�-� 7 l � qV ern h� S�t/N�{G�I:•�., A'rr l
/PINE �1010
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009
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CZ� C 4u w 51,11 f—tP �. C f t k— LLk—
Itr1�� S t�rt.�e bta.,` b,c/f.C'�/�✓ s�' (�.rtrh1.�
2 S / - 3 d - 1300
Al McCutchan (owner) Map#S2103DA-02300
10880 SW Derry-Dell Ct. (JP✓vim i�l'�C C� Plat: Derry-Dell Plat #2 Lot 25
Tigard OR. 97223 Zone: R-3.5
Site Size: 16401 sq. ft.
Jeff Floyd Excavation (installer) No Basement
20040 S. White Ln.
Oregon City, OR, Scale 1" 20'
Tt; Z5DD
503-656-5815
P"- p 31473 + 228z
'— 10'
100'4 tA �o
�n 99'-1" �q•2 q
f• 1 .
32' 40' '10,
pp.�
CA
ao' test hole
1' I t�;'k-e1'5
tt-- ia' 10' I aq.q 1000 gal.
vDL �-� T(-
L4 1�A � I top of ground 100" 1
4" pvc at ends 5' �_` �,;, 3 )00
�r��A ? .�►�t. \ (1 of infiltrator for _____ ♦ __
continous system
� I ! 8'j-n
is
A 312' of infiltrter 'r4
T L
A 'fS !'It►[•�• ✓!hl OK!♦I If I 6� 1 ji l
I u WCvtvr-¢. „j 75'
r , SUN COJ 1
>t A A r c/OIw i'l
w./1r � _ : I S Q ,°
! Artane. system les
• pet"- tn`
�. etIL-A wioVIh/�
..i>,'. I,;Ir�A nar� l µna'thgaOAFelwI
vo '.'„a�L3
I 1„s't'ella1r V01net d
t
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-501 f,i� �/ C)VAV�I cc ncretf xtl' stint 1
I
Govt l ed
.< ,' a �lwner
r\A 1 ��✓ 3 0'
Yt'JGII r^
line
T!_
1 YvU 100' ------> I
228 ---'' r Jr'r. �� r J� Ct
I l Yi7 A �`^.. �'bl GM! r,✓tJ -�N C✓ W JA /'
115/-AGl i Y df IrprI'rl /It•L 1 L a
S�NP4r.'� wrn.� S y�_
! 1'�Nl�� �V,wr')�� � �y�v���1. ll� nµ+Gl g//YOkt^.�J T`/I.f_✓,F/Gem n. .�7
228 � I
_ ,
-- 100'
• 99' 1„ 2 qq.(o 0g.4 qq.q W.F,
40'
32' 40, 40'
test hole
40 ly UprP rJNo ae�•c
41
6,.h"
vo
99'-1" �v;-y TuNt�
*r !°' �` 10' 1000 gal.
ti,lh. 99'-4
top of growid 100'-U'�
f 15. 7v0
4" pvc at ends • 5' �`
rr1l� .�m- \ of infiltrator for ____ ~ __
continous system I I
_ 5)t1 I 813„P pow
A 312' of Infiltr ter i i I C-
Vito" OWW/
•!1 fj i a
161
�rClt�,rr Sln�it SC<�a .< ��✓ c����'�..�� W
n 0,/o j sNy 1MAW Qct
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y S
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„' +u4 1i voids u, 0
I D►' �Jfc��i 1�1� �� c..l �� �,,�3se �fl uva�d �'
Ct(gH c,1r/� t�/ 6vlfvt.l con7retea{ 5 ,
covered ` K Sti` l n'rS q/P,oa
.� yyllla��t �,,,�pwn°r
area ., ! '�`nr(ce 30'
�✓ rna r
line
1i
�10,'0 m�-.� �m�M 100'
�;I ,,; I,�F✓v�l 1Jr!( ct --j 230
I
�Fel� r-� �>-�►�I r 4 N� rel�✓c.�� ,h � c_ _/_�i•..�
04 r4 y trr/► C1 /11�f' ^ 1 S p rr 7�► �;�...�
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CZ r 1 l�^� fr+� C F'! /� -�r t✓+ ' -
4
k1n.Ns
(i.�t /�v �,�.. .•��( gall r ,
CZ} t.t(� �d,r A•� INS:toeu G+At4,\., L�
11 v S �i� �it,a+�. 6•c.lll'i14.� s� "Ll...'1`";n l
228 4
100' 10
• 99'-1' �? 101'-01,
MQ r' 40'
32' 40'
,10\Up
41
/. 'Ot1 l qol 3 (� S 4iaq `�
I -- 10,
I, 1 40test hole
N 4�P
C W&
99'-1" ,� t�F%meg TGwX
qq,q 1000 gal.
els? 991-4
r�ih. 101 G �i cfq ry
b�drr u � I / topof round 100'-0'l ��� TL
�h 9 I
4" pvc at ends 51 ` oD
of infiltrator for
contlnous system
_ I I 81311
'rX1SS' �l I I
• � 312' of infiltrd ter I N^ I le—
Cow
I � I
61' /(�� IrrC✓gas 2- ,h 75' \
6 hav��r•,h !t � /� _ () _� �all DN1
_b.n�nppuv -
rah!- 5;stem
1013-1
•�I t ,iU�n u11• ,> hula th oru" I
eIL� IYIoVIhI µee�lh Uep F�1W I
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m 0
rtrmaut 1DVr
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r;LIkN ��r/fl fN G VAv�/
concrete �14 �0.�# m•
I covered
ar(a '�4rvlce ((' 30'
line
2yUU -- 100'117
�-
-- 228 � Orvvkl Jeer G^ri _� 230
/rgre� wrn� 5541`' /
7 r u 3 n / SIV�NIN� sLfV tC�u (•� .I
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�ivlGJ(IDHH � 5 �9� r�f�v = lw9a�,
�I� IIAY`�1' 0` �Ir41�•llt�% N�eatil� �+ R� �I� Ah ,U�jSrvVwll'�,IM �10✓i 61►�.Ns�
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CITY OF TIGARn BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - ---
BUR
Date Requested_ AM PM BLD
Location.__._. ' ' �� Z Suite G MEC
Contact Persin Ph (G' �� Q 7o PLM
Contractor Ph �`� Z �� SWR ^�
BUILDING Tenant/Owner _ ELC
Retaining Wall ELR
Footing Access: -
Foundation FPS
Ftg Drain SGN -
Crawl Drain Inspection Notes: --- ----.--
Slab — SIT
Post& Beam --- --- -
Ext Sheath/Shear
Int Sheath/Shear ---- --
Framing _— - -- -- -----
Insulation — -
Drywall Nailing
Firewall
Fire Sprinkler - 14
Fire Alarm
Susp'd Ceiling
Roof -_.—.----- ----------------
Misc:
Final - -- -�-- -
PASS PART FAIL ---- -- ,�K — � i-CJe - = .
PLUMBING _ ZAJ -_�� �� � � - l:, 1, r
Post& Beam /5,' rI_�-.--
Under Slab ��
Top Out ----- -- --- �_. �1''- � '- -
Water Service
Sanitary Sewer -
Rain DrainE
Final --
PASS PART FAIL
'HANK
Post&Beam
Rough In �� �
Gas line
Snake Damper:;
PART FAIL.
ELECTRICAL__ - _. ----- --- --- -
Service
Rough In
UG/Slab
Low Voltage ---
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Urading - - -
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supple Line [ j Please call for reinspectic [ ]U cable to inspect-no access
ADA
Approach/Sidewalk /f i
Other Date (�f /> ��3- _ Inspector _ Ext
Final
PASS PART FAIL_ DO NOT REMOVE this inspection record from the job site.
CITY O F T I G A R D _ MASTER PERMIT
PERMIT#: MST99-00071
DEVELOPMENT SERVICES DATE ISSUED: 4/9/99
13125 SW Hall Blvd., Tigard, OR 9722.3 (503) 639-4171
SITE ADDRESS: 10880 SW DERRY DELL CT PARCEL: 2S103DA-02300
SUBDIVISION: DERRY DELL. PLAT 2 ZONING: R-3.5
BLOCK: LOT: 025 JURISDICTION: TIG
REMARKS: Addition and remodel of existing single family residence, Path 1.
_ BUILDING
REISSUE. STORIES: i _ FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK ADD HEIGHT. 1;r FIRST: 471 St BASEMENT'. 000 sf LEFT: n SMOKE DETECTORS.
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sl GARAGE. n st FRONT: 1) PARKIN,SPACES �
TYPE OF CONST: :N DWELLING UNITS: FINBSMENT of RIGHT: 6
.12n��0
OCCUPANCY ORP: R3 BDRM: 1 BATH: TOTAL- 4'1 an VALUE: S 1',
sf REAR: 70
PLUMBING
SINKS: 0 WATER CLOCETS, WASHING MACH: 0 LAUNDRY TRAYS: 0 RAIN DRAIN: n TRAPS,
LAVATORIES: 2 DISHWASHERS: n FLOOR DRAINS: 0 SEWER LINES: 0 SF RAIN DRA:NS: I CATCH BASINS
1UBISHOWERS: 2 GARBAGE DISP: n WATER HEATERS: 0 WATER LINES: 0 BCKFLW PRE.VNTR: 0 GREASE TRAPS
MECHANICAL OTHER FIXTURES:
FUEL TYPES FURN<100K: 0 BOILICMP<3AP. U VENT FANS: 2 CLOTHES DRYER 9
G,15 FURN—100K: 0 UNIT HEATr RS'. 0 HOODS: 0 OTHER UNITS: 0
MAX INP. bhlu FLOOR FURNANCES: 0 VENTS: 5 WOODSTOVES: 0 GAS OUTLETS: n
ELECTRICAL.
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRr ITS _MISCELLANEOUS ADD'L INSPEC IIONS
1000 EF OR LESS: I 0 200 amp. 0 200 amp: C W/SVC OR I is 1 PUMP/IRRIGATION: 0 PFR INSPECTION 9
FA AOD'L 500Sr - 201 400 amp: 0 201 400 amp' 1st WIO SVCIFUR: SIGNInU1 LIN LT o PER HOUR 0
LIMITED ENERGY- a 401 600 amp: 0 401 600 amp: EA ADDL SR CIR. a SIGNALIPANEL. 0 IN PLANT U
601 1000 amp: 0 601.amp5-1000r MINOH LABEL: 0
1000.amplvoll: 0
Reronna[t only: 0
PLAN REVIEW SECTION
—�
—4 RES UNITS SVC/FDR-225 A.. 600 V NOMINAL. f•LS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL _ _ _ B COMMERCIAL. _
A11DIU&STEREO VACUUM SYSTEPA ` AUDIO&STEREO FIRE ALARM. INTERCON.IPAGIN OUTDOOR LNDSC LT
BURGLAR ALARM: OTH. BOILER: HVAC: LANDSCAPE T^u: PROTECTIVE SIGNL:
G,-RAGE OPENER CLOCK: INSTRUMENTATION: MEDILAL 07HR.
HVAC, DATA/IELE COMM: NURSE CALLS. TOTAL 0 SYSTEMS-
Owner: Contractor: TOTAL FEES: $ 658.13
This permit is subject to the regulations contained in the
I,I I: tQ.r Ne 7 Q_M rt �` R D DESIGN &CONSTRUCTION CO
,e. , 1436 SW PARK AVE#501 Tigard Municipal Code.State of OR Specialty Codes and
rq-y0.r7W V f Q -�( LL ( T all other applicable laws All work will be done In
!'s2 PORTLAND OR 97201 accordance with approved plans This pe�Tlit will expire 0
-T R t? (-7 lir, work is not started within 180 days of Issuance,or,f the
work is suspended for more than 180 days ATTENTION
Phone G _ .� PI 1Q Oregon law requires you to follow rules adopted by the
i Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-00101hrough 952-001-0080 You
Rep 0 may obtain copies of these rules or direct questions to
OUNC by calling 15031 246-1987
REQUIRED INSPECTIONS
Erasion 844-844-1 Cr awl Drain/Backe Electrical Rough Ir Rain drain Insp
Footing Insp Pt M/Underfloor Framing Insp Electrical Final
Foundation Insp N. �hanical Insp Shear Wall Insp Mechanical Final
Post/Beare StructL Plumb Top Out Low Voltage Plumb Final
Post/Beam yecha Elertrical Service Insulation Insp Building Final
._..;�;, ii.. l /�, •. - L�C . 1�� r L 17.Qom;
�--� f, �; 1 i qL t TOO�'Ili �I Ltl��i;�.1,�.�.` l/ �.�tE• 't' G.vG.r�i.-� �4
0 C�
C!TY-OF TIGARD Residential Building Permit Application Plan Check#
-13125 SW HALL BLVD. Additions or Alterations Rec'd Byzi-
-rlGARD, OR 97223 Single Family Detached or Attached (Duplex) Date Recd_;R
Date to P E
V 503-639-4171 Date to DST .9 Z 3 s 9
F 503-684-7297 r i /�_ Permit#1 I11�T ' _,6-7
Print or Type Called"- e/ r/ - 9%9(/Oft
Incomplete or illegible applications will not be accepted GFFr VN Ia41?`AWL
Name of Project r Name
Job Ci uq A LTM A tv kA
I —_—__
Architect Mailing Address
Address Site Address T1Qr�� / �� rinpx'FfO
- - — 18$0 SW DEMI•DSU.. CT_ 4_1223 City/State -�zi� Phone
Name �Rf�,ArNY Q�0�`
AL$ERj MC C_JTLH<lrJ - --
- ------ Name
Owner Mailing Address
10896_ 5 W peRartes-Cr. ----- -----
Cit /Stale Zip Phone Engineer Mailing Address
_ � 9"IZz3 (0311.38?_8
- -
- ---- -- /State Zip hone
Genem Name, , , , , C't ,Y, t>w NSR Y p P-
--
Contractor -J�j.-'�IZt . Describe work -Nev O Addition)' Alteration O .epair O -
-- -
Marlto be done
Prior
Address _ - � _----- - ---...--.---
Prior to permitAdditional Description of Work
issuance,a copy City/State V Zip Phone ADA T31-K M&4�c_ �� 1
of all licenses
are required if Oregon Const Cont 3o4-dExp. Date _ PROJECT 31 J�2 (�
expired in COT Lic#
database VALUATION
Mechanical Name--- _.- -- -- NEW CONSTRUCTION ONLY: i 2 3 Z
Sub- At-%TaMC_ Ci>TCkA,J Sq. Ft House - Sq Ft Garage
Contractor Mailing Address
Prior to permit Indicate the restricted energy installation by the electrical
issuance,n copy City/Sta
-le Phone-- ------- -- - subcontractor in the follow;n areas
�ip —-
of all licenses Restricted Audio/Stereo
are required if Oregon Const Cont Board Exp Date Energy _1--- System Alarms_
expired in COT Lic# Installations Vacuum Irrigation
database _ System _ _�_ System
Plumbing Name (check a!I that Other -
Sub- ALe4T Me-CJ?CNAN app/ ) _
"— ---- — Corner Lot YES NO Fla
f:OntfaCtOr Mailing Address 9 Lot YES NO
(check one) ✓ (check one)
Prior to permit City/State lip Phone
Lias the Subdivision Plat recorded'? NIA YES NO
_
,nuance,a copy --- - ---- -- -- --
of all licenses are Oregon Const Cont Board Exp Date
required if Lic# _.
expired in COT I hearby acknowledge that I have read this application,that the
database Plumbing Lic # Exp Date - information given is correct,that I am the owner or authorized agent
of the owner, and that plans s,,bmitted are in compliance with
Oregon State laws.
Name �1 t� SiQn�ture of OwnerhA ent v la
Electrical �l6ei-T 1v t L�113TC4F#tel W 1LLIA A KD BAIL__-
Sub_ Mailing Ad rens "-�- Contact Person Name - Phone#
Contractor BtL - Roe — _----�__— 704-8q1�
City/State Zip F'hone
Prior to permit
issuance.a copy FOR OFFICE USE ONLY: _
of all licenses are Oregon Const Cont-Bo.,rd Exp Date Plat#
required if Lic#
expired in COT
database Electrical Lic # Exp. Date ;etb?cks Zone om"r-
Electrical Supervisor Lica Fxp Date Engineering Approval: Planning Approval TIF
i\dsts\forms\sf.,,idalt doc 11/20/99
Al McCutchan 639-3878
10880 SW Derry-Dell Ct.
Tigard OR. 97223
Map#52103DA-02300
Plat: Derry-Dell Plat #2 Lot 25 Scale 120'
20' �T�1
Zone: R-3.5 1 V
Site Size: 16401 sq. ft.
Actual Addition Size 470 sq. ft.
No erosion control required L37'
228'
100'
Setbacks: Front - 20'
Side - 5'
Back - 15'
Stcin to hook to existing
Septic to hook to new tank
and fend per Health Dept.
6'3" from house to lot line
Two bedroom house
new areas outlined
by dotted lines
161'
New Construction
10'3"
.concrete
covered
area
30'
100' —
228' 230'
SW Derry-Dell Coui t i
I
CITY OF 'rIGARD BUILDING INSPECTION DIVISIOi _ `__
24-Hour
Insoection Line: 639-4175 Business Line: 71
Date Requested Ile' AM F'M _ BLD
Location_-16 Suite 1 - MEC
,. Ph ci; `� �% -� 7, PLM
Contact Person - ' `� —
Contractor — — Ph _— SWR -- -- —
UILDING Tenant/Owner
ELG
Retaining Wall ELR
Footing Access.- "i y i f y�y _ FPS
Foundation
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab __ =�� '':�f: SIT —
Post& Beam
Ext Sheath/Shear --
Int Sheath/Shear A ,
Framing — -- —�
Insulation
Drywall NaiCng4'
Firewall
Fire Sprinkler — -- --
Fire Alarm
Susp'd Ceiling _�--
Roof
RT FAIL -- -- --"---- — '
UMBING
Post&Bearn
Under Slab —
Top Out
Water Service _ _—
Sanitary Sewer
Rain Drains _ —
F'
T FAIL —
NIC
Pos eam ---
Rough In _ —
Gas Line -
e Dampers
Fii
P RT FAIL
Service - ------- - — ---- �'�.
Rough In
UG/Slab - - --
Low Voltage
Fire Alarm -— - — --
PART FAIL
Backfill/Grading -- —
Sanitary Sewer
Storm Drain f ]Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin r 1 P'sase call fo4r.einsp
ction RE: _ [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Z _Inspector
_ _Ext
Other
Final
PASS PART FAIL DO NOT OtEMOVE this Inspection record from the job site.
CITYOF T I GA R D _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2000-00173
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 05/09/2000
PARCEL: 2S 103DA-02300
SITE ADDRESS: 10880 SW DERRY DELL CT
SUBDIVISION: DERRY DELL PLAT 2 ZONING: R-3.5
BLOCK: LOT: 025 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILERS/COMPRESSORS HOODS:
_ _FUEL T_Y_P_ES 0 3 HP: DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 -__AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: — 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Replace existing P!ectric furnace with new gas furnace and add gas piping.
Owner: FEES
MCCUTCHAN, ALBERT Type By Date Amount Receipt
10880 SW DERRY DELL PRMT GEO 05/09/20( $50.00 0002012
TIGARD, OR 97223 5PCT GEO 05/09/20( $4.00 0002012
Total $54.00
Phone: -- ---
Contractor:
OWNER
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Heating Unt Insp
Reg #: Final Inspection
lov
\N Alt-
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire it is
riot started within 180 days of issuance, or if work is suspended for more than 180 days ATTENTION Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNr;by
calling (503)246-918,,9.
Issue B .��� ��- Permittee Signature:�• , �_ _
Call (503 39-4175 by 7:00 P.M. for inspections needed the next business day
CITY OF TIGARD Mechanical Permit Application Plzri Check a _
p� R;,:;d By_
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 �j ( "` Date to DST
Print or Type Permit# *,Fe��"�T�z
_ Incomplete or illegible a plications will not !,e accepted_ cooed
Name of Development/Project Description
,�_k_e C �-%.��it,, ,,` Table 1A Mechanical Code Qt Price Amt
Job Street Address Suite# A) Permit Fee 16.00
A ddress ;c—g?ldSG" 1) Furnace to 100,00( 7TU
Bldg# city/State Zip ncludin (ducts&vents 9.65
d+J 2) Furnace 100,000 BTU F
including duras&vents _ 12.00
Name(or name of business) 3) Floor Furnace
Owner ''e including vent 9.65
Mailing Address 4) Suspended heater,wall heater
or floor mounted heater 9.65
1 Citylstate zip Pltone 5) Vent not included in appliance ermll _ 4.75 _
-- Check all that apply: 'Boiler Heat Air
For Items 6-10,see or Pump Cond Qty Price Arnt
Name(or name of business) footnotes 1,2 Com"
6)Repair units
--
Occupant Mailing Address — –
P 7)<3HP;absorb unit to 8.40
_ 100K BTU _ 9.65
Cltyl5lale v lip Phone 8)3-15 HP;absorb unit
100k to 500k BTU 17.65
Contractor Name � 9)1.5-30 HP;absorb
J
�� r4,Yr ✓ vnil.5-1 mil BTU _ 2415
Prior to permit Mailing Address 10)30-50 HP,absorb
unit 1-1.75 mil BTU _ _ _ 36.00
issuance,atopy /l'3'I�',SL�'.l�.,�i%��` e Z 11)�50Hp;absorb unit>1.75 mil BTU of all licenses City/State Zip Phone 60.15
are required if i• �J (JS'- 12)Air handling unit to 10,000 CFM
expired in COT Oregdn Const Cont Board Llc# Exp Date
%.00 _
database 13)Air handling unit 10,000 CFM+
Architect Name 11.85 _
14)Non-portable evaporate cooler
or Mailing Address 7.00
15)Vent fan connected to a single duct
Engineer City/State Zip Phone _ 4.75
16)Ventilation system not included in
appliance permit7.00
I)—;crihe work to be done: 17)Hood served by mechanical exhaust
_ 700
`4e*A,,. Re�O Replace with like kind: Yes O No O 18)Domestic Incinerators
Residential P Commercial O Modification O 12.00
19)Commercial or industrial type incinerator
Additional Information or description of work: � �f^�^ f-��<y 48.25
CC �c / , fr" ,e l/L 0 rr.:� 20) Other units,including wood stoves
NOTE: 1 or Commercial projects Only;Units over 400 lbs.,located on the _ _ 7.00
roof,require structural calcs..re aced tjy licensed engineer. 21)Gas piping one to four outlets _ 3,75----
Type
.75 _Type of fuel: oil O natural gar LPG O electric O 22)More than 4-per outlet(each) .75
I hereby acknowledge that I have read this application,that the information Minimum Permit Fee$50_.00 SUBTOTAL /
given is correct,that I am the owner or authorized agent of — 8910 SURCHARGE _
the owner,that plans submitted are in compliance with Oregon State laws. PLAN REVIEW 25%OF SUBTOTAL
Required for ALL commercial permits only
Signet ner ABQnt s 1 Date TOTAL
Lz
Contact Person Name / Phone Other Inspections and Fees
1 Inspections outside of normal business hours(minimum charge-two hours) $50 00 per hour
2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
Foonotes for commercial projects only: $50 00perhour
1. Provide full schematic of existing and proposed gas line and pressure. 3 Additional plan review required by changes,additions or revisions to plans(minimum
2. Provide drawings to scale showing existing and proposed mechanical charge-one-half hour)$50 00 per hour
units. 'Slate Contractor Boiler Certification required
- "Residential A/C requires site plan showing placement of unit
C\mechperm,doc rev 1111/99