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CITY OF TIGARD BUILDING INSPECTION DIVISION MST of-0��_
24-Hour Inspection Line. 639-4175 Business Line: 639-4171
(, BLIP
,2-3110 ZF' Date Requested � -�-`>� ' �6 _AM PM —_ BLD —
Location1/11-_3�5 �.JI�V ��Tr`-� _`— Suite MEC
Contact Person ` _(� Ph �D.� - t� P,_M _
Contractor Ph _ SWR _
BUI�,piDl4"` Tenant/Owner _ —i` ELC
Retaining Wall ELP
Footing Access:
Foundation FPS _
Ftg Drain SGN
SlabT777 ^�
Crawl Drain Inspection Dotes: C !� // - ----
�1i_L_� SIT
Post&Beam _
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation
Drywall Nailin3 - - "tUCf-
Firewall
Fire Sprinkler .—_� � (�. Q�71,• �./ ��•��
Fire Alarm V
Susp'd Ceiling
Root 4 `- T
-
Final a ,l
PASS PART FAIL
PLUMBING `
Post&Beam
Under Slab
Top Out --
Water Service _
Sanitary Sewer
Rain Drains _
Final R
PASS PART FAIT_
MECHh.':ICAL
Post& Beam - -
Rough In
Gas Line - - - -- —
Smoke Darr pen
Final - -- - - - —-
PASS PART FAIL
ELECTRICAL `—"
Service
rr Rough In
UG/Slab
Low Voltage
�- Fire Alarm
Final
PASS PART FAIL
SITE -
Backfill/Grading - ----- -- ---_--- — -- --.__._ _-
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Bled
Catch Basin
Fire Supply Line l J Please call for reinspection RE: - _ _ _ [ J Unable to inspect-no access
ADA �� 1
Approach/SidewE ik �j -^ - 7 • //
Other D8t@ ! _ rnbNd4tor l _. Ext
Final
PASS PAR? FAIL 00 NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
(� (� r�, r• BUP
_._ -1�r t) Date Requested � +�� �� AM PM BLD
Location �� %� v C� 1.% �. ,� Suite MFC
Contact Person ft1 Ph PLM
Contractor Ph _ SWR _
UILDII�( —� Tenant/Owner _ ELC
Retaining Wall ELR
Footing
Foundation Access: FPS
Ftg Drain SGN `
Crawl Drain Inspection Notes: - —
Slab _ SIT
Post& Beam —
Ext Sheath/Shear I _—
Int eath/Shear "�-
ra _
Insulation
t Drywall Nailing -
Firewall
Fare Sprinkler
Fire Alarm
gfisp'd Ceiling
ick
PAS$ ' PART FAIL
PLUMBING
Post& Beam -
Under Slab
T,-.p O, t
Water Service
Sanitar, Sewer Y
Rain Drains
Final --�___------- --__ — .r_
PASS PART FAIL
!MECHANICAL
1Pust S BeamRough In
Gas L ne ---- - - --
S,no!,e Dampers
viral
FASS PART FAIL
ELECTRICAL
Service
Rough In .•.��—_��— _____ —`
UG/Slab
Low Voltage -
Fire Alarm
Final
PASS PART FAIL
SITE _
Backfill/Grarl,ng --- __--
Canitary Sewer
Storm Drain j )Reinspection fee of$ required before ne>,I inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Please call for reinspection RE.
Fire Supply Line j j p -- �a_ __ i )Unable to inspect- no access
ADA 1
Approach/Sideway
Other Date a Inspector_ Q1. ,Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
CITY OF TMp1GTr. R !'ERMT7
-A. DEVELO�'IVIENT' SE'�VICES PERMT,r #. . . . . . . : MST9S-0'7rF
13IY5 SW Nall Blvcr., Tigard,OR g7223 (503)6J-4171 DALE T S319MED: O6/17/9A
r TE r"D ,Ilk.TS. . , : 1.4.;t',`i 5W a0TI 1 I
1_1131)IVISI0I\1. . . :14AVEF2L_'(' re!E'r,I)F'11,rr 70NTI4'3: I-1- 7
. . . . . . . . . . :006 Tl!I IrnTCT InN: TIG
"emarks: Deck repair
---------------------------------- _- ---- BUILDING -------------------------------------------------------------
" ISSUE: STORIES.......: f FLOOR PREPS_.-. .--_-.._ BASEMENT,..: 0 s° REQUIRED SETBACKS---- RFQUIRED----------
'LASS LF WMY,:REP HEIGHT........: A 'IRST....: 112 sf GARAGE.....: 0 sf LEFT,.........: 0 SMOKE DETECTRS:
-YaE OF USE ..:SF rLOO1 LOAD....: 441 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES:
'YPE OF CONST.:SN DWELLING UNITS: 0 FINBSMENT: 0 sf RIGFr'T.........; 0
`CCUPANCY GRP.A3 BDRM: 0 BATH: 0 TOTAL------: 112 sf VALUE..1: 0 REAR.....;..... 0
-------------- ----------------------------------------------- PLUMBING
'INKS.........; 0 WATER CLOSETS.: 0 WASHING MACH..: 0 1_41,01DRY TRAYS,: 0 RAIN DRAIN ft: 0 TRA-�.........: ?
1V'rTORIES,,..: 0 DISHWOVS...; 0 FLOOR DRAINS.,: 0 SEWER LINE ft: 0 SF RAIN DRAINS; 0 CATCH BASINS..: 0
-UB/SHOWERS... : P GARBAGE DISP..: 0 Wi:TER HEATERS,: 0 WATER L'I"rE ft: 0 nrLW PREVNTR: @ GREASE TRAD5_: 0
OTHER FIXTURES: 0
--- MECHANICAL ---------------------------------------.__-------------------
µ'1EL TYPES----------- FURN t INK ..: 0 B011./CMP ( 3HP: 0 VENT FANS.....: 2 CLOTHES DRYERS: 0
FURN )=100K ..: 0 UNIT HEATERS..: 0 !GOODS.........: 0 OTHER UNITS...: 0
"AX IV.: 0 BTU FLOOR FURNACES: 0 VENTS'..,......: 0 WOODSTOVES....; 0 VAS OUTLETS ..: 0
_--- 'CCT91CAL -------.------------------ .--------------- .----------- - ---
-RESIDENTIAL UNIT--- ---SEAVICE/'EEDER---- —Tri.+ SRVC FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS----- --ADD'L INSPECTION'
iVP OR LESS: 0 0 - 200 asp... 0 0 - 200+ asp.., 0 W/SVC OR FLR-, 0 MIMPIIRRIGATION: 0 PER INSPECTION: 0
I;WSF,: 0 20' - 400 amp..: 0 201 - 400 asp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR....... 0
727.: 0 401 - 600 asp..: 0 40' - COO Pap..: 0 EA ADDL BR CIF: 0 SIGNAL/PANEL...: 0 IN PLANT,...,.:
'IN- HM/SVC/FDR: 0 601 - 1000 ay.: 0 601+amps-1*0 V: 0 MINOR LABEL -L0: 0
10.'"+ amp/volt.: 0 -__..___.._....._..- ---.____.____-._ PLAN REVIEW SEETIC"! ..-.__.-_.____..__. ...._.._.___.___....__.
Rerinnect only.: 0 1-4 RES 'JUTS,.: SVC/FDR?=225 A.: 1 600 V NOMINAL: CLS AREP/SPC OCC:
------------------.-------____-----------_---__.._ ELECIFICw; _ RESTRICTED ENERGY .-____._
SrRESIDENTIAL------------------------- B, CONNERCIAL------------..----------------._-------------------------_--.__.------------__.
".UDIO 8 STEREO.: VACUUM SYSTEM..: AUDIO A STEREO.: r1hE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
'1'?R;LAR ALARM..: OTH; BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGN.:
"AR40E OrE47R.,: CLOCK......,...:. 1N5TRUNFNTPTION: MEDICA1........... OTHR:
VAC........,..: DATA!TELE COMM.: NURSE CALLS..... TOTAL A SYSTEMS: 0
--------- -- Cnrtrac+,or; __...___.._.. - _.._..... TOTAL PFS:1 422,50
?INEY, ROBERT 8 ,'IRGINAP OWNER This permit is subject to the regulations contained in tM,t
165 SW 110TH AVE 'i;ard Municipal Code, State of Ore. Sper'dity Codes and all
'PRD OR 57224 other applicable laws. All work will 4e done in accordance
with appy-oved plans. This permit will expire if work is
ore tkr not started within 180 days of issuanv, or if the work
Reg m..: 00000(` suspended for mare than 180 days. ATTENTION: Oregon law
requires yoti tc follow rules adopted by the Oregon Ut
"ification Center, Those rules are set forth i:. OAR 552-N14010 through OAR 952-001-0080. You may obtain copies of these rale
rect questions tr,, r3UNC by calling ''.5031246-1997,
------------------------—-------------—-----------------
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CITY OF TIGARD Residential Building Permit Application Red By
i 13125 SW HALL BLVD. Alteration - Interior Remodel Only Date Recd io '
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. k&'
V 503-639 4171Date to DST9F 503-684-7297 Permit# M`.7 -
�--
Frint or Type
Incompi,ete or illegible applications w0l not be accepted
Name of ect (� Name
Job �C,K f-ei' .'k y-
Adc+ress Sit Address - I Architect Mailing Address
I �36a .s I. y?o
Name '— City/Slate ZipPh-ne
Owner Mai'ngAddressName
1 :?b-. Ski/ 9Q{A, 7t
Cit�r/State zip Phone Engineer Mailing Address
TL el.v%u , (,)rZ- 117za1
General Na City/State Zip Phonr:
Contractor c1WV1�'V Descnbe work New O Addition O Alteration O Repai.
Mailing Address - tc be done:
Prior to permit _ _ Additional Des:ription of Work. �
issuance, a copy City/State Zip Phone tV+-O\A 4 Per`s p�n�e�
of all licenses - - --
are required if Cregon Const.Cont. Board Exp Date PROJECT
expired in CUT Lic.# VALUATION S00
database
Mechanical Name_. NEW CONSTRUCTION ONLY:
Sub- — So. Ft. House: Sq. Ft. Garage
Contractor Mailing Address
Prior to permit Corner LotYES NO Flag Lot YES NO
issuance, a copy City/State Zip Phone (check one) (check one)
of all licenses Restricted Audio/Stereo Burglar
are required d Oregon Const.Cont. Boers' Exp. Date � Ener
expired in CVT Lic.# gy System Alarm
database _ Installdiiuri Garage Door HVAC
Plumbing Name Opener Systems
Sub- (check all that Other:
Contractor Mailing Address - ate)
Will the electrical subcontractor wire for all I YES NO
restricted energy installations?
Prior to permit City/State ` zip mono
issuance, a copy Has the Subdivision Plat recorded? N/A YES NO
of all licenses are Oregon Const.Cont. 0oard Exp. Date
required if Lic.# Solar Compliance
expired ie COT (Calculation Attached)
database Plumbing Lic.# Exp Date I hearby acknowledge that 1 have read this application, that the
information given is correct, that I am the owner or authorized
Name - agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Electrical Si ria ure f O ner/A�nt
Sub- Mailing Address � � te'
m Contractor CQnt�ct Person Name Phc.ieAl
City/State — Zip Phone ffw a Lam. lzc\ vl ie �,z-t_8�9�'
Prior.-"rmit FOR OFFICE USE ONLY:
issuartce. a ;opy PI t#: - 1 i Mapl1 L#:
of all licenses are Oregon Const. Cont. Board Exp Date ( ,3 l /
required if Lic# d1cZLL1; ( <(
expired in COT _ S1) aptetbacks: kR Zone:, Solar:
database Electrical Lic.# Exp. Date _
r L:ngiq ng Approval: Planning provai. TIF:
- ; _ ,'ci'�>/',✓ .�'E t,�iE G,) - d /(, ?r ��� �c� /CtEA/_�d►.vs
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I:SFREM.DOC(DST)5/1198
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CITY OF TIGARD Date Rez'd:
SINGLE FAMILY ALTERATION jttMRIOR/REMODEL) Recd By:
APPLICATION/PLANS SUBMITTAL REQUIREMENTS Plan Check #:
Applicants: Please complete
1. APPLICANT NAME: 1 0o 6,e ft PHONE #:-6 -14-8 9 R
2. SITE ADDRESS: 14 3 tS SLL) WtU c�> l 111 \JJ FAX #
1. 3 VICINITY MAPS (fully dimensio^al, drawn to scale) labeled witl1;
n North arrow, ❑Street names, d Subdivision name, 0 Subdivision iot#, 0;;ite address,
❑ Applicant name. ❑ Rione number.
Size requirements: 8 1/2" x 11" to be a maximum of 11" x 17" and NOT attached to budding plans.
2. THREE(3) FULL SETS OF BUILDING PIANS (No red line revision or tape-ons).
Size requirements: 4' x 36", folded into eighths (9" x 12") with the plans inside.
(No rolled, reversed or mirrored plans will be accepted).
ALL DETAILS LISTED B LOW SHALL BE INCORPORATED INTO THE PLANS
A. FLOOR PLAN(S).
B. FLOOR FRAMING (when creating new habitable space).
C. ROOF FRAMING PLAN (when creating n9 v habitable space in the attic).
D. CROSS SECTIONS. Every set of plans s 1,)!I contain tw . cross sections at mid point of
each direction.
E. BEAM ENGINEERING CALCULATION (submit two copies of engineering calculations for
beam exceeding 10 feet in length or any beam that supports a point load).
F. IDENTIF`! THE E=NERGY CODE PATH. (CABO, Appendix E, Table 401.1 a)
_ G. WALL BRACING (indicate '`le braced and alternate braced p.nets of the foundation and
.L floor plans. Bracing shall meet design standards of CABO. Section 602.9 the alternate
r
Itr_thod 97-1, or an alternate engineered).
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ANY CORRECTIONS MADE IN RED INK WILL ONLY CAUSE DELAYS.
I:SFREM.DOC(DST)50/98
Permit#: AIS /o �� � P
.Address: AL
1 Z:
�..;. ItiSIIc d. ry� Date:
Igg9
Statement: information Notice to Proper}y Owners
About Construction Responsibilities
Note: Oregon Law, URS 701.055(4), requires resid',nttial construction permit appli-
cants who are not registered with *? Construction Contractors Board to sign the
following statement before a building pet mit 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 3B:
FA1. 1 own, reside in, or will reside in the complete:structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
(�1 3A. My general contractor is
1L�-J1 (Name) Conte.--tor regis. #
1 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.
111 hire subcontractors, I will hire a. .1y subcontractors registered with the Construction Contractors
NBoard. 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.
J
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I hereby certify that the above information is correct and that 1 have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit a li+ccant) V (Date)
g 1 PF
(White copy to issuing agency permi(,rle,
pink copy to applicant)
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CITY OF TIGARD
Approved.............................................. :[ l
Conditionally Approved.........................
For only the work as described in:
PERMIT NO._Q 'f��p�Q—
�I See Letter to: Follow.: .... .
�............... ...... [
Attach. .
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