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9635 SW 74TH AVENUE 9635 SW 74th Avenue ELECTRICAL PERMIT CITY OF TIGARD \ PERMIT#: ELC2000-00575 DEVELOPMENT SERVICES DATE ISSUED: 9/29/00 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1S125DB-03900 SITE ADDRESS: 09635 SW 74TH AVE SUBDIVISION: BOULEVARD HFIGHTS ZONING: R-4.5 BLOCK: LOT : 027 JURISDICTION: TIG Proiect Description: Temporary power/service _—_ RESIDENTIAL UNIT _ _ TEMP SRVC/FEE_DERS _ — MISCELLANEOUS 1000 SF OR LESS: v 0 - 200 amp- 1 `PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL.: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL. (10): __—SE_RVICE/FEEDER _ BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: WISERVICE OR FEEDER: _ PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ PL_AIJ_R_REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS — > 600 VOLT NOMINAL: Reconner..only Y_ SVC/FDR >=_225 AMPS: _.•____ _CLASS AREA/SPEC OCC___ Owner: Contractor: KENNETH W. DAHME OWNER 9635 SW 74TH TIGARD, OR 9722.3 Phone: Phone: Reg#: --- —FEES - --_ _ _ Required Inspections YType By — Date Amount Receipt Elect'I Service PRMT CTR 9129/00 $66.85 272,0000000( 5PCT CTR 9/29/00 $5 35 2 720000000( Total — $72.20 --------- _ This Permit is issued subject to the regulations mntained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or If work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adupted Uy 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 ordirect questions to OUNC at(503) 246-1987. PERMITTEE'S SIGNATUREL , 'fly, ISSUED BY:'r� � _ OWNER INSTALLATION ONLY _ The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: -- —.. DATE: CONTRACTOR INSTALLATION 7NLY SIGNATURE. OF SUPR. ELEC'N: DATE:-- LICENSE NO: - Call 639-4175 by 7:00pm for an inspection the next business �.;y CITY-Or TIGARD Restricted Energy Electrical Application, Rec'd b 13125 SW HALL BLVD Date Re a TIGARD OR W223 Inc amplete or illegible applications Permit V-503-639-4171 X304 will not be accepted Cust.Call'd: F -503-598-1960 Name of Development Project TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Restricted Energy Fee........................................ E75.00 JOBt Address Ste# (FOR ALL SYSTEMS) ADDRESS / Check Type of Work Involved City/State 2 ~/`e# <y Audio and Stereo systems - -- N /� ❑ Burglar Alarm OWNER Mail'V73, Garage Door Opener' City/State Zlp Phone,# C7 Heating,Ventilation and Air Conditioning System' Name Vacuums Systems" 5,1ex, 5 IC71 Other Q- - CONTRACTOR Mailing Address �1 J (Prior to issuance a City/State Zip Phone# TYPE OF WORK INVOLVED -COMMERCIAL ONLY copy of all licenses _— ar,required if Orlagon Cc^lr.Brd Lic.N _xp.Date Fee for each system.............................................. $76.00 expired in C.O.T. (SEE OAR 91 13-260-260) database). E'ectrical Contr.Lic.0 Exp,Date Check Type of Work Involved. C.O.T.or Metro I.ic.0 Exp.Date r L.J Audio and Stereo Systems Ow Name ✓ /, ❑ Boiler Controls OWNER - Mailing Ad rless C Clock Systems APPLICANT `� J 5 7/ ���-` ❑ qty/Stated 6 �' a�# ❑ Data Telecommunication Installation 2:0 This permit is issued u i—ef OAE 18-320-370.This applicant agrees to ❑ Fire Alarm Installation make only restricted energy Installations(100 volt amps or less)under this permit and to do the following: ❑ HVAC I Only use electrical licensed persons to do installations where required. Certain residential and other transactions are exempt from licensing. E] instrumentation These have asterisks(') All others need licensing; ❑ Intercom and Paging Systems 2 Cull for inspections when installation under this permit are ready for ❑ Landscape Irrigation Control' inspection at 603-639-5175; 3 Purchase separate permits for all Installations that are not ready for an ❑ Medial inspection when the inspector Is out to inspect under this permit; F-1 Nurse Calls 4 Assume responsibility for assuring that all corrections required by the Inspector are done,and; L-1 out Jc •Landscape Lighting' 5 Assume responsibility for calling for a final inspection when all of I'm f---1 Protective Signaling corrections are completed. L� Permits are non-transferable and non-refundable and expire if work is not ❑ Other_ started within 180 days of issuance o.if work Is suspended for 180 days r _Number of Systems The person signing for this permit must be the applicant or a person No licenses are required licenses are required for all other Installations authorized to hind the applicant FEES:� 0S,7L ENTER FEES f — S gnature 8%SURCHARGE(.08 X TOTAL ABOVE) f TOTAL $- ? (. ct) Authority If ether than Applicant I srlslsvormsvesele doc 8/00 CITY CF TIGARDPlan ChecK# Electrical Permit Ap�►licatioll 13125 SW HALL BLVD. Recd 4y --� Date Recd _ TIGARD OR 97223 Date to P.E. Phone,(503)639-4171, x304 Print of Type Date to DST Inspection (503)639-4175 Incomplete or illegible will not be accepted Permit# Fax(503) 598-1960 Called 1. Job Address: - 4. Complete Fee Schedule Below: _ Number of Inspections per permit allowed Name of Development A Sa rvice Included: Items Cost Dotal Name(or name of business) 4a. Residential-per unit Address 1000 sq.ft.or less $147.15 4 City/State/Zip __ _ - Each additional 500 sq.ft.or portion thereof $33.40 __ t Commercial❑ Residential ❑ Limited Ene•gy _ $7500 Each Manurd Home or Modular Dwellina Service or Feeder _ $90.90 2a. Contractor installation only: 4b.Suivices or Feeders (Prior to permit Issuance,applicants must provide contractor license Instr,110on,alteration,or relocation Information for COT data base). _00 amrs or less __ $80.30 _ 2 Electrical Contractor 201 amps io 400 amps $106.85 2 Address_ - 401 amps to 600 amps $160.60 2 City State -zip-_ 601 amps 10 1001?amps _ _ $240.60 2 Phone No. _-__�-___ M�-_ Over 1000 amps of volts $ .65 2 $66 _�- Reconnect only _ $60.85 2 Job No. _ - -- - 4c.Temporary Services or Feeders Elec.Cont. Lice. No. _Exp.Date installation,alteration,or relocation OR Slate CCB Reg. No._ _Exp.Date_.�_-- 2uo amps or less _�_ $66.85._� 7. COT Business Tax or Metro No. Exp.Date_-_` 201 amps to 400 amps _ $100.30 2 401 amps to 600 amps _ $133.75 2 Signature of Supr. Elec'n _ Over 600 amps 10 1000 volts. see"b"above. License No. _ _ Exp.Date 4d.Branch circuits Phone No. New,alteration or extension per panel ---- a)The fee for branch circuits with purchase of service or 2b. For owner installations. feeder fee Each branch circuit $6 65 _- Print Owner's Name _ b)The fee for branch ni Address _ without purchase of service City _ State_ p ZI or feeder fee. -` First branch circuit _ $tiG.85 Phone No._ - - -�-- Each additional branch circuit $6.65 The installation is being made on property I own which is not 4e.Miscellaneous (Service or feeder not Included) intended for sale,lease or rent Each pump or Irrigation circle _ $53.40 Each sign or outline lighting _ $53.40 Ownei s Signature -^_ Signal circult(s)or a limited energy panel,alteration or extension $75.00 3. Plan Review section (if required):* Minor Labels(10) $12.5.00 4f.Each additional Inspection over Please check appropriate Item and enter fee in section 5B. the allowable In any of the above 4 or more residential units in one structure Per Inspection $62.50 _ Service and feeder 225 amps or more Per hour $62.50 In Plant $73,75 System over 600 volts nominal __Classified area or structure containing spedal occupancy as 5. Fees: f described In N.E.C.Chapter 5 iia.Enter total of above fees $ -� 8%Surcharge(OD X total Tees) $ ' Submit 2 sets of Flans with application where any of the above apply. Subtotal $ Not required for temporary construction services. 6b.Enter 25%of line So for NOTICE Plan Review If requlred(Sec 3) $ _ ) Subtotal $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR ❑ Trust Account 0 WORK IS SUSPENDED OR A13ANDONED FOR A PERIOD OF 180 DAYS Total balance Due $ AT ANY TIME AFTER WORK IS COMMENCED. f?� -2- i:\dstsllorrnskleclric_rev.doc-E/00 C,zar CITY OF TIGARD PI III-DING INSPECTION DIVISION MST 24-Hour Inspection Line: . .9-4175 Business Line: 631. .171 �- BUP .__Date Requested_,!z _ANA PM _ BL Loci. ,i— _3 5 `� �' Suite _ _ MEC G _ - Contact Person --_ _ �►�_ Ph 27U lr —_ PLM Contractor Ph SWR _ BUILDING Tenant/Owner ELC �_— Retaining Wali ---- -- -_-- — -d--� EI_k Footing . ------_.._-_ Access: Foundation FPS Fly Drain — �. SGA Crawl Drain Inspection Notes: - - Slab _ SIT Post& Beam ____----_ ---- ---------- -- --- ----- ------ Ext Sheath/Shear Int SheathiSheaf Framing Insulation Drywall Nailing Firewall Fire Sprinkler ----------------------- Fire Alarm Susp'd Ceiling Roof Mise -- - --- - - -- - Finta, PASS PART FAIL Post& Beam -- -- - - Under Slab Top Out ------ Water Service Sanitary Sewer - Drains F' PART FAIL i ost& Beam Rough In Gas Line ----- -- - - - - - ----- ---- - -- SrEke Dampers nr ---- _._._. --- - - - — S PART FAIL CTRICAL ---- - --- - -- - - - Service Rough In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL - - - --------- ------- -- --- -- SITE Bac n ra rng -------------- Sanitary Sewer Storm Drain ( )Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line f l Please call for reinspection RE:, [ )Unable to Inspect-no access ADA Approach/Sidewalk ' Other - Date _ InSpsctor_ (_ Ext Final PASS PART FAIL 00 NOT REMOVE this Inspection record from the jots site. CITY OF TIGARD BUILDING INSPECTION DIVE )N MST ��,G � -� �J3 z 24-Hour inspection Line. 39-4175 Business Line: 639-4171 — --- euP --____—Date Reques'ed `� _ /J_ —AM PM _ BLD --- Location -� -s c✓ �"'� Suite — MEC _-- Contact Person Ph PLM —_ R Contractor l � / Ph SW — EtUI� LDING--- Tenant/Owner l� a ELC ----,�--�-- Retaining Wall l� �,r r-u 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 — — ---- --- - - Fire Alarm Susp'd Ceiling ---- Roof Misc:Final PASS PASS PART FAIL --- --- PLUMBING _ Post&Beam — Under Slab Top Out Water Service Sanitary Sewer Rain Drains — Final PASS PART FAIL — MECHANICAL Post&Beam — — Rough In Gas Line — --- Smoke Dampers Final PASS PART FAIL — E EGTRI Service Rough In UG/Slab - Low Voltage rite ALKw — — -- FAS ' PART FAQ _ E Backfill Grading Sanitary Sewer 6torrn Drain ( (Rnlnspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd hatch Basin We;,opply Line ( ]Please call for relnaper!lon RE' ( able to Inerect•no access )A pproach/Sidewalk Date ? U Inspector '� Ext Nher - n PARI' FAIL J 00 NOT REIMOVE this Inspection record from the jots site. CITY OF TIGARD 24-How BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4,;71 SUP _ Received Date Requested �� ' AM __ PM _.—_`_ BUP Location 2L2 zi Suite-_. __ MEC Contact Person Ph( ) _ _^ PI-M Contractor Ph SWR __- BUILDING Tenantner lka-ll, L �r -3 -2 y 70 6, 77 ELC Footing Foundation ELC Ft Drain Access: Ft 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 Susp'd Ceiling - Roof Other: -- - - --_ - p�S�) PART FAIL — -- PLUM8144 -- -- Post&Beam Under Slab Rough-In Water Service - - Sanitary Sewer Rain Drains Catch Basin 41annole Storm 0. 1 Shower Pan Ott ,r: - FinalPASS PART PART FAIL MECHANICAL Post&Beam Rough-In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service - - Rough-In UG/Slab Low Voltage -ire Alarm -•-- ----.--_...________. Final l I Reinspection fee of$. __ required before next inspection. Pay at City Hall, 13125 SW Hall B vd. PASS PART_ FAIL SITE — Please call for reinspection RE:------ Unable to inspect-no access Fire Supply Line ADA 7 Approach/Side.alk 6 '-- Inspector . _ � Ext Other Final _ DO NOT REfMGVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 635-4171 -- / BUP _—Date Requested__ ! AM --PM BLD — Location Suite --t— __ MFC Cortact Person __-- — Ph —_ PLM — — Contractor Ph SYJR BUILDING Tenant/Owner --- -,---- - -- ELC Retaininy Wall EI R Footing — Foundation Access: FPS Ftg Drain _ Crawl Drain Inspection Notes: SGN _ Slab Po":t& Beam --------- — — - ----- SIT --- Ext Sheath/Shear I Int Sheath/Shear - ----- ---� Framing Insulation Drywall Nailing Firewall Fire Sprinkler _ Fire Alarm Susp'd Ceiling -- --- Roof Misc ------- Final PASS PART FAIL - - -- - ---.- _ --------- PLUMBING Post& Beam Under Slab Top Out Water Service -- ---- - --- ------------ Sanitary Sewer - - - Rain Drains Final PASS PART FAIL MECHANICAL _ - Post& Beam Rough In GasLine ------------------ - --- -------- --- ----- - — -- Smoke Dampers --.-__- - T FAIL Rough In - -- UG/Slab _ -------------- - Low Voltage imer PART f AIL --- — --- - --- — - ------- - - —.. ---SITE Backf;11Grading ---- -- --- Sanitary Sewer Storni Drain [ J Reinspection fee of$-� required before next inspection. Pay at City Hall, 13126,;.11 Hall Blvd Catch Basin Fire Supply Line I )Please call for reinspection RE _.,--- __ -- J Unable to inspect no access ADA Appc oo--h/Sidewalk ��1_1 _ Date G Inspectar. _ Ext Other - _-- _ Final PASS- PART FAIL- DO NOT REMOVE this inspection record from the job site. Kenneth W. Dahme 9635 S.W. 74`h Tigard. Oregon 97223 January 8, 2002 FILE COPY City of Tigard Attn: Hap Watkins Re: Permit No. MST2000-397 9635 S.W. 74'h Tigard, Oregon 97223 Dear Mr. Watkins: This letter is to request that the above permit be extended for one year beyond its original expiration date. I am requesting this extension because the cost of the remodel was higher than the original budget and 1 found it necessary to arrange further financing. I would now like the additional year so that I can finish the project properly. Please let me know if you have any questions. Thank you for your consideration of this matter. Sincerfly, "o( Kenneth W. Dahme 503 Pys• yl`� Gvv�� 3'0 WV- 7&W fir,Y- Ms T 2 00 0-00 7q 7 I 7 CITY �� ��G��� _ MASTER PERMIT PERMIT#: MST2000-00397 DEVELOPMENT SERVICES DP.TE ISSUED: 9/12/00 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 09635 SW 74TH AVE PARCEL: 1 S125DB-03900 SUBDIVISION: BOULEVARD HEIGHTS ZONING: R-4.5 BLOCK: LOT:027 JURISDICTION: FIG REMARKS: INTERIOR REMODEL adding second floor 900 sq ft BUILDING _ REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS_ REQUIRED CLASS OF WORK: 4DD HEIGHT: FIRST: %I BASEMENT. Sf LEFT. 31, SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAC: 40 SECOND: 900 at GARAGE: 5f FRONT: 7; PARKING SPACES: TYPE OF CONST: SN DWELLING UNITS: FINBSMENT: of VALUE: RIGHT: S��'�a2J 4t+ OCCUPANCY GRP: R3 BDRM: BATH. 3 TOTAL: 900.00 at REAR: PLUMBING _ SINKS: WATER CLOSETS. WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS-. FLOOR DRAINS: SEWER LINES: S-RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: GARBAGE USP WATER HEATERS: WATER LINES: BCItF1 YJ PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUFL TYPES FURN<100K. BOILICMP-3HP: VENT FANS 3 CLOTHES Ok1 1 FURN>•100K: I UNIT HEATERS: HOODS: OTHER 11M+S: MAX INP: btu ;LOOR FURNANCES VENTS: WOODSTOVES. GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL.UNIT SERVICE FEEDER _ TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 at— 0 - 200 amp: WISVC OR rDR: I PUMP/IRRIGATION! 'ER INSPECTION: EA ADD'L 5005F: 201 - 400 amp. 201 400 amp: 1st W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 $00 atop: EA ADDL SIR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFDR: 801 • 1000 amp: $01+Ampa-1oU0v: MINOR LABEL: 1000+amplvolt: PLAN REVIEW SECTION Reconnect only: >*A RES UNITS SVC/FDR>='225 A. >600 V NOMINAL: CLS AREA/SPC OCC: . ELECTRICAL•RESTRICTED ENERGY S.COMMERCIAL A.SF RESIDENTIAL _ AUDIO d STEREO: VACUUM SYSTEM: AUDIO 6 9TERFn: FIRE ALARM INYERCOMIPAGINO: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC. LANDSCAPEJIRRIO: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATArtELE COMM NURSE CALLS: TOTAL N SYSTEMS. TOTAL FEES: $ 1,267.45 Owner: Contractor: This permit is subject to :he regulations contained in the KENNETH W.DAHME OWNER Tigard Municipal Cede,State of OR Specialty Codes and 9635 SW 74TH all other applicable laws. All work will be done in TIGARD,OR 97223 accordance with approved plans. This permit will expire If work is rot 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 Get Res it: 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)248-1967. REWIRED INSPECTIONS PLM/Underfloor Framing Insp Electrical Final Bui!ding Final Mechanical Insp Shear Wall Insp Mechanical Final Plumb Top Out Gas Line Insp ' Lumb Final Electrical Set/ice Insulation Insp Final Inspection Electrical Roup in Rain drain Insp Building Final Issued�y : H. Permittee Signature : --- gall (503) 639-4175 by 7.00 p.m. for an inspection needed the next business day ✓__ ,,iTZ" OF TIGARD Residential Building Permit Application Plan Ch� ZZ 131.25 SW HALL BLVD Alteration - Interior Only Recd By TIGARD, OR 9722: Sing!- F=amily Detached or Attached (Duplex) DDateRecd Date R P E ;: zs- 00 V 503-639-4171 Date to DST C'o F 503-6$4-7297 rt t Permit#M- i?OQO 003 " Print or Type called r<cr vaOt el Incomplete or illegible applications will -hot re accepted � � ; a . mzi Name of�roiect Job Architect Mailing Address �d � Address crie ''J55t�" 971= .1 ♦'XJO CnrSfcrPtE 4.��� Nam f 'eem- ity/State Zip T Pone 4(41, hi 1,/A i- ... ----- --- -- 5a-c�Cu_;: Or DIC' 1 S�O Name Owner M jng- Address d 35 5 4� -7410Avc'x" Mailing Ad Ci State Zi Phone Engineer g dress City/State ZipTPhone General NaMe I Contractor (41,1,6.^ Describe work New G Addition O Alteration IX Repair O Mailing Address to be done Prior to permit Additional Description of Work: �] issuance,a copy City/State Zip Phone _ �/✓ifje0/2- of all licenses �� 4- '� are required if Oregon Const Cont.Board Exp. Date PROJECT expired in COT Lic.# VALUATION $ _ database -- Mechanical- Name— NEW CONSTRUC_TIOi1 ONLY: Sub 4� qh ��„ r Sq. Ft. House: — Sq. Ft. Garage Mailing Address — -- — Prior to permit j21 i' ,2� Indicate the restricted energy installation by the electrical Contractor subcontractor in the followin areas issuance,a copy ty S to Zip Z n — f� Restricted Audio/Stento of all licenses _ r/l,'/-q A e j��' �9 Ener System Alarms are require)if Oregon Cunst nt Board Exp.Date Energy _— _ expired in COT Lic.# Jam, installations Vacuum Irrigation _database_ 't7 C� �(�� ( - y 'o System S stem Plumbing Namen 7 ii (check all that Other: Sub- 7O'� 0—'440416,r Ldl� apply) Contractor Mailing Address �— Corner Lot YES �C3 Flag Lot YES WYO- .5� � _,,,1� Lheck one) i`� check one _ � Cfj /�ye _ Has the Subdivision Plat recorded? YES NO Prior tr,permit y/'tate C,zl Phone I 31k Issuance, a copy (XI 561"W27M Solar Compliance of all licenses are Oregon Const.Cont.Hoard Exp. Date (Calculation Attached _ required If Lic.# expired In COT �[ L4 I hearby acknowledge that I have read this application,that the database Plumbing Lic # 7 iL Q Exp.Date information given is correct, that I am the owner or authorized agent of the owner,and that plans submitted are in compliance with Z f Ll � U / Oregon State laws. Name Signa r f Own /A' rLg1eDate L� Electrical VG n c. r� h �nt — Sub., Mailing Address — Contac P rson Na a Phone# Z , zly nv62 Contractor (7 y U %j A),.A bu _ FOR OFFICE USE ONLY: City/State Zip Phone C Plat#. Maprrt-W: Prior to permit issuance,a copy f T 1 -1. Gil, 4 1-2 3 — — tT of all IrcPnses are Ora on Const Cont.B rQ ' Exp. DateSetbacks: Zone: olar.required if Lie.# � p ` ' 6 e,/exoired in COT l - V Engineering Approval: Planning Approval: IF: database Elect[Ical Lic.N Exp Date Electrical Supervisor Lic # Exp.Date f>a�Pl N I:formsbfintaft.doc(DST)10/23/98 Permit #: : 0 ltiIICcc Date: - Statement: Information Notice to Property owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires res%dential 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: FX1. I own, reside in, or will reside in the completed structure. (� 2. I undr,rctand that I must register as a construction contractor if the structure is sold or offered for sale �1 before or ipon completion. El- 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 F-ubcontractors, I will hire only subcontractors registered with the Construction Contractors Board. h T 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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property wners about Construction,/Responsibilities on the reverse side of this form. (Signature of permit apps+cant) (Date) (White cope to issuing agency permit file, pink copy to applicant) 1hfbimation Notice to Property Owners Akout Constw.uc.tion Responsibilities ic. > ,. :r,; rr,.rj�, it ;�'„!t�r..�l'1�' u;'iv� ±.its ,,.�r• ,, , %�'. , .,r% �?llir;) I• ! L.. ., L ,.,II �, ,', .� ,,.!II,• r; ISI; M)l'L:Ilk,1�.� ti1{,,'U:� JW-i L JI ..Y.:.�OIS�i -iiH' `�i,41`,:L:'�li.:.... .a'1C% ,:i'f' .'1 ��'iI• �.a. EMPLOYER ktlESPONSIE3iHTIES: S%{� 9•. 1%,i�i�-� {, %f,, I;,v ��%•.ti, ,I1- r,�, .I _ •.r,, ir:;{{, %r X711, til, !,�� Irn�li :I�•r�,r , , ,r�>7i { 7,;�1 1�!'1:�•�r%17n` It�1.1c..};1W1 • ,;.(� ,.%'.. ,.j I , �.!{, _ ,'.j% I_. ilk ; "N-,I(4% „' in, ! t % { is � ti1�i1lt41 i'tlit9 ;;)1�1C{• i t� lls!{r�..yyi,'1\t,,'yt1:U1{a: �... .. _ ! r., ..�, I, , ,i, � � '� i a 'i,l,_ . �%.t.”, . I!I ('4 °V'�?f"�.`1S`: ��;1�'" :%h'�,.�,,,,1{�1'. : 1�1(`I�"L�ll,'lY1t,'{!':1. ;:1= �-f!711'r,��,ly,r.�l�;•r,l{ �:hf�'If'{�,r �;,��%,ftl';�171�.11%�f��,t.� ; �t`r,l:-�nl•-{"i I ,!71�{(i;�j,I, f,ttlyl;, nllli'ittte ,!i IMI(. ;Ipp,I'iort(1tr timf, c.t itit Clan ���rin177:tI7,• t'o�,�tllr, �� I7��•%V�.tifq, I "I scale: 1 = y0 - i 1 i F� 2/6a 3�6" 444, ui _ i z 5O. 70 -rev L of 3 90O, my I S 1 .uo8 I., ., '.,rA On 4,,L. 967; 1�w 7y"< 4r.' 7?ld7l Or. 9:7 2 3 CITY OF TIGARD 13125 S.W. HALL. BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE J + R PLUMBING 34308 SW 209TH AVE ALOHA, OR 97007 Plumbing Signature Form ^�'ffltdf: 14Y MIM 00397 Site Address: 09635 SW 74TH AVE Subdivision: BOULEVARD HEIGHTS Block: Lot: 027 Jurisdiction: TIG Zoning: R-4.5 Remarks: iNTERIOR REMODEL adding second floor 900 sq ft Your curnpany has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid. please have the appropriate individual from your company sign below and return this Plumbing signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will oe authorized until this completed form is received OWNER: PLUMBIN'j CONTRACTOR: KENNETH W. DAHME J + R PLU10BING 9635 SW 74TH 3430B SW 20TH AVE TIGARD, OR 97223 ALOHA, OR 97007 Phone #: Phone #: 642-7776 Reg #: I I(' 00072680 PI M 34-214PB AN INK SIGNATURE IS REQUIRED ON THIS FORM x LV�') Signature of Author i e Plumber If you have any questions, please call (503) 639.4171 , ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE EVANS ELECTRIC INC 10150 SW NIMBUS AVE E-6 TIGARD, OR 97223 Electrical Signature Form Permit #: MST2000-00397 Date Issued: 9/12/00 Parcel: 1 S125DI3-03900 Site Address: 09635 SW 74TH AVE Subdivision. BOULEVARD HEIGHT:3 Block: Lot: 027 ,Jurisdiction: TIG Zoning: R-4.5 Remarks: INTERIOR REMODEL adding second floor 900 sq ft our company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN.- Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: KENNETH 111,x. DAWNI.E EVANS ELECTRIC INC 9635 SW 74TH 10150 SW NIMBUS AVE TIGARD, OR 97223 TTE-6GR pR 97223 Phone #: Phone#:- 5572 Req #: Lic 001048 SUP 42255 ELE 34405(' AN INK SIGNATURE IS REQUIRED ON THIS FORM X =� Z/44 Signature �f Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310