12077 SW 95TH AVENUE i
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?age No. 1 CASE HISTORY FOR CASE NO.: MST57-0229
ROSE MANOR
12077 SV7 95TH AVE
06/19/5,
Action Description Req/ Schd/ End/ Action Notes Disp By Update UId
Code Sent Done Done Datu By
MSTA005 Application received / / / / 05/29/97 PASS JSD 06/17,'97 JD
MSTA008 Permit Created / / / / 06/16/97 PASS RT 06/16/ 7 BT2
MSTA010 Check for prcl, restrict. / / / / 06/10/97 PASS BON 16/17/97 JD
MSTA026 Plane approved by Pln Examiner / / / / 06/16/97 PASS RT 06/16/97 BT2
MSTA03l Reviewed plana routed to DSTS / / / / 06/16/97 PASS RT 06/16/97 BT2 �4
MSTA032 DST Pont-Review Completed / / / / 01,/17/97 PASS JSD 06/11,'97 JD
MSTA050 Hold for / / i / 06/17/97 Per Brian R, no permits to be issued due HOLD JSD 06/1.7/97 JD
te, issues with SUB. This can be made
re:,dy to issue an noon an Brian
indicates we can innue permits, jad
MSTA050 Hold for / / / / 04/01/98 sent building final inspection back to NOTE JT 04/01/98 JT
Kniholding c/o until case is completed
and confirmation from Ken.
MSTA092 (F) Ioeue combination permit / / / / 07/16/97 Brian R. released hold an oubdivioion on PASS GEO 07/16/97 GEO
7/16/97 ok to ioay.e.
MSTA095 Issue plumbing signature form / / i / 09/10/17 RECD SW 09/11/97 S+W
MSTA997 Isnue electric signature form / / / / Oe/15/97 P.ECD SW 09/15/97 S+W
MSTA700 Erosion Contol / / / i / / 06/16/97 BT2
KSTA705 Footing Insp / / / / 07/17/97 1. Need initial erosion control FAIL KS 09/17/97 BT2
approval.
2. Provide compaction report to bldg
dept. from soils engineer.
3. Post street address 6 permit no.
MSTA705 Footing Insp / / / / 07/18/97 1. Need initial erosion control PASS rS oe/21,'97 J•H
approved.
2. Pont street numbers m permit n+emLer.
3. Locate corner property line, property
corners and not string line for
reference.
v
H-- MSTA706 Foundation Inap / / / / .,724/97 Provide low point drain at interior PASS KS 09/17/97 BT2
footing.
c=
M.9TA710 Post/Beam Structural / / / / 07/30/97 Underfloor insulated prior to FAIL KS 06/01/97 J•H
tR
inspection.
MSTA710 post/Beam Structural 09/01/97 / / 07/30/97 2nd inspection this dat'9 PASS KS 08/01/97 J*H
MSTA711 Poet/Bram Mechanical / / / / 07/30/97 Underfloor insulated prior to FAIL KS 08/01/97 J'H
inspection.
NSTA711 Post/Beam Mechanical 08/01/97 / / 07/30/97 second inspection thin date PASS KS 08/01197 11
Page No. 2 CASE HISTORY BOE CASE NO.: MST97-0229
ROSE MANOR
12077 SW 95TH AVE
06/18/9P
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
code Sent Done Done Date Dy
------- ----------------- -------- -------- --------
MSTA713 Crawl Drain / / / / 03/27/9H SUMP PUMP HAS BEEN SIGNED OF.: PASS KS 05/05/98 :TT
MSTA717 PLM/Underfloor / / / / 07/30/97 PASS MS 08/27/97 J+H
MSTA720 Mechanical Inep / / / / 09/11/97 not ready FAIL RB 09/15/97 J•H
MSTA72.0 Mechanical Inep / / / / 01/29/98 1. Need final erosion control approved. FAIL KS 01/29/98 J+H
2. Strap water heater.
3. Adjust b-vent at horizontal to
maintain clearance.
4. Firelape and sprue nail at furnace.
5. Provide landings at patio door.
6. Extend quardrail 36-inches above
floor line.
7. Provide handrails at stairs.
8. Weather strip entry door.
9. Remove wood forms adjacent to crawl.
10. Insulate exposed water pipe at
crawl.
11. voids at under floor insulation.
12. Need to locate low point drain.
13. Remove wood and debate at crawl and
recover with vapor barrier an needed.
14. Slope Zininh grade away from
structural at sides and rear.
15. Seal exterior penetrations.
MSTA722 Plumb Top Out / / / / 09/09/97 PASS MS 09/14/97 J-H
MSTA723 Electrical Service / % / / 09/23/97 service approved. PASS PRP Ov/24/97 J*H
MSTA724 Electrical Rough In ! / / / 09/23/97 Rough in approved. FYI: outlet boxes PASS BRP 09/24/91 J*H
are preferred to be 1/2-inch exteneded
from rough finish. Any box more than
1/4-inch backset will require an
1
extender at final.
Page No. 3 CASE HISTORY FOR CASE NO.: MST97-0229
ROSE MANOR
_2077 SW 95TH AVE
06/IR/9B
Action Description Peq/ Schd/ End/ Action Notes Disp By Update Upd
code Sent Done Done Date By
MSTA725 Framing Insp / / / / 09/23, 97 1. Provide TJI layout 2. Strap across PASS KS 09j25/97 J•H
plate above garage header. 3. Strap
trimmers to header at garage. 4. 9trar
ech side of wwll,g to glulam at garage.
5. Provide 3-in. of bearings at 4x12
beam (front of structure). 6. Provide
full bearing under glulam beam at living
room. 7. Strap beams to studs main
floor. R. Trona cl�ps missed at bedroom
also at front. 9. Fireblock at tube. In.
Extend save baffles 19 1D above bottom
of trues chord at blown insulation. 11.
Swav brace true an shown. 12. Mechanical
noffito at garage rot built.
MSTA726 Shear Wall Inap / / / / 09/12/97 PASS rS 09/14/97 J•H
MSTA727 Low Voltaqe / / / / / r 06/16/97 BT2
MSTA735 Can Line I!.ep / / / / 09/11/97 not ready FAIL RB 09/15/97 J•H
MSTA740 ?nnulation Innp / / / / 09/29/97 PASS KS 09/29/97 J•H
MSTA745 Gyp Board Insp / / / / 10/07/97 Approved an noted: PEND ISS 10/08/97 J•H
1. OK to mud 6 tape interior gypsum
(only).
2. Need clearance at b vert garage
ceiling.
3. goal around gan piping at ceiling
also plumbing at common wall.
4. Gypsum Joints need to occur an stud
Adjacent to furnace.
CALL FOR REINSPECTION TTFMS 2, 3 6 4.
DO NOT PEMOVR CARD UNTIL APPR'D
Q.
M.514055 Rain drain Inap / / / / 07/28/9 perimeter rain drains only PASS RAB 98/27/97 J•H
f!i
F-- MSTA760 Water Line Innp / r / / 09/2E/91 aresaure reducing valve at meter. PASS WA 08/29/97 J•H
J
.�
G7 M.9TA7E5 Appc/9dwlk Inap / / ! / 03/06/98 PAS.", MN 03/06/99 J•H
Vr MSTA797 Plumb Final / / / / 01/28/98 not ready FAIL MS 01/29/99 MRS
111
MSTA797 Plumb Final / / / / 05/05/98 PER KEN S. 3127/98, SUMP PUMP HAS BEEN PASS 05/05/98 ,T
SIGNED OFF
MSTA960 (F) Issue Cert. Of Occupancy / / / / 03/27/98 MAILED 6/11/99 MAIL VN 06/]1/98 VLN
Page No. 4 CASE HISTORY FOR CASE NO.: MST97-0229
ROSE MANOR
12077 SW 95TH AVE
06/18/98
Action Ltncr+pti,on _^.eq/ Schd/ End/ Action Noten Dinp By Update Upd
Code Sent Dong Done Date By
------- ----------------------------- -------- -------- -------- -----_-..---------—--—------`—-------- ---- --- -------- ---
MSTB705 Footing Inep / / / / 07/21/97 Approved an noted, pending corrections: PASS RB 08/21/97 J+H
1. USA Eronion required.
2. Provide an adequate keyway.
3. Provide 7,, depth footing.
4. Maintain bearing pad requirements.
5. Maintain seismic requirementn an per
alternate brace panels.
6. Remove vegitation from footing.
MSTB711 Post/Beam Mechanical / j / / 07/31/97 PASS KS 08/21/97 J•H
MSTB713 Crawl Drain/Backw:,ter valve / / / / 03/06/98 Can't locate. FAIL WA 03/09/98 J•H
MSTB725 Mechanical Innp / / / / 09/15/97 1. Secure collar at b-vent (fireplace FAIL KS 09/17/97 J'H
and secure fireplace to framing
members) .
2. Insulate exposed wyes at heat ducts
(attic).
3. Provide inaulation shield at b-vent
(attic) ane scure.
4. Straps sulnor"ng heat ducts at attic
too tight freducin3 air flow) .
MSTB725 Mechanical. Insp / / / / 09/17/97 PASS KS 09/17/97 J•H
MSTB730 Framing Inep / / / / 09/26/97 PASS TLP 09/26/97 J•H
M3TB740 Gan Line Inn: / / / / 09/15/97 25 psi PASS KS 09/17/97 J•H
MSTB750 Shear 'Nall tnnp / / / / 09/10/7 1. arage wing walls snow triple FAIL KS 09/15/97 J•11
trimmern, nail 3/12-in. oc. 2. Plan
nh,wn HDSA holddownn at garage wing
walls. 3. HD2A holddown not installed at
bedroom #1, FTAS, straps not installed
at (ABP) . 4. Nail braced panels at
it 6/12-in. oc. S. This inspection does not
f.2 include generic paneln.
N
> MSTB751 Exterior Sheathing Tnsp / / / / 08/29/97 Nails sunk too deep, do not penetrate FAIL 09 09/01,/97 J•H
F—
sheathing surface.
J
Ci]
MSTB760 Gyp Board Inep / / / / 10/13/97 1. Provide clearance at b-vent FAIL KS 10/13/97 J+H
LD
ti) penetrating ceiling at garage las
J
indicated at prior inspection) .
2. Tape gypsum joi.its behind furnace.
Page No. 5 U SE HISTORY FOR CASE NO.: MST97-0229
ROSE MANOR
12077 SW 95TH. AVE
06/18/98
Action Description Req/ Schd/ End/ Action Nctes Cisp By Update Upd
Code Sent Dome Done Date By
---"-- ------- ------- -------- --------------------------------------- ----- --- ------- ---
MSTB796 Electrical Final / / / 12/30/97 1. Plate-kitchen, GFCI not flat on wall. PASS BRP 01/01/98 J-H
ART 380-9
2. Rr.-ept. 6 cord for disposal subject
to physical damage, SECT. 422-8(1)(b)
3. 3-9.ang plate dining room does not
cover wall opening, ART 380-9.
4. Smoke detector', dining room does not
cover opening.
5. Entry 3-gang plate does not lie flat
an wall, ART 380-9.
T1,E ITEMS ARE NON-COMPLIANCE ISSUES, BUT
REFLECT ftiiRF AS A COSMRTIC FLAW. I AM
P79SING THIS BLDG WITH THESE BEING NOTED
FOR THE RECORD. LOW VOLTAGE PASSED.
MSTB797 Plumb sinal / / / / 03/06/98 Final okay except could not find low PART WA 03/09/99 J•H
point drain - contractor will locate.
MST8798 Mechanical Final 03/09/98 / / 03/06/98 PASS GS 03/09/98 J•H
MSTB799 Building Final 03/09/91 / / 03/06/98 1. Strip forms off all underfloor FAIL GS o3/09;9B J•H
footings.
1. Insulate exposed water pipe at crawl.
3. Still can't find underfloor drain
(exposo).
4. Complete finish grade to slope away
from structural (6-inch fall).
MSTB799 Building Final / / / / 03/27/99 1 ved pe. GS correction list dated PASS KS 04/27/99 KBS
030998.
sump pump installed for, crawl drainage
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CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171
CERTIFICATE OF
OCCUPANCY
PERMIT #. . . . . . .
MSTcl'7 -020:Y'l
DATE I SS1
EDP03,"27/98
PARCEI-P iZS1&:,.BA -033500
c')ITE ADDRESS. . . : le077 SW 95TH AVE
SUBDIVISION. . . . : DUBLIN PARK ZONING sR---25 PI)
BLOCK. . . . . . . . . : LrIT. . . . . . . . . . . . . 1003 JURISDICTIONiTIG
CLASS OF WORK. :NEW
TYPE OF IJSE. . . :SF
TYPE_ OF' v.'.ONSTRsfN
OCCUPANCY GRP. tR3
OCCUPANCY LOnDc2
Remarks PATH I
Owner:
ROSE MANOR
CISI NW CONST.
10E,20 SW LUCAS DR
TUNLATIN OR 97060"
Phone #: 452-81.73
Contractors
ROSE MnNOR HOMES 114C
10620 SW LUCAS DR
mpt-ATIN OR 97062
Phonp #1 452-8133
F?eg 0. . : 1098613
ihis Lertificat:e grants UCCL(PanCy Of the above referenced building ur portion
� het-paf and confirms that the building has boon inspected for cumpliance with
' fie State of Oregon Specialty Codes for the group, ocr.,,.tppncv, and use under
)hich the refeavenced jzer•mit was isoiued.
LiRIAL(./
R INSPECT I N SUPERVISOR
POST IN CONSPICUnUS PLACE
3'
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171 -
Date Requested: -7�.�? A P.M. MST:
Location: -V 7 1 �� J _ B(JP:�- —
Tenant: Suite: Bldg: MEC:_
Contractor: �. � Phone: '- - i, 14-- PLM: —
Owner: P4wnc: LC:
0 01
Site 1NG LDG3.(ron't) P MBING CN LAICAL E- A, SITE
SitePow r,earu Post/Beani Post/Bemn Cover/Service Sewer/Stonn
FooGag Roof UndFl/Slab Rough-ht Ceiling Water Line
Slab Framing Top the Gas Linc Rough-In UG Sprinkler
Foundation Insulation S,!wer flood/Duct Reconnect Vault
Bsmt Damp llr}wall Ston) Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C tJ(;Sial)
Shcnr/Sheath Fire Spklr/Ahn Crawl/Found lh l leat Pump I ow Volt
Approved .Approved Approved Approved
Appr/Sdwlk tj LApgL 1ved Not Approved Nct Approved Not Approved Not Approved
/FINAL `> FINAL FINAL FINAL FINAh
Call for rein. 1i r,,C/�►/\• 4 Reinspection fee of S_ required beforerrext inspection C7 I Inahle to inspect
1r1 ctor: , '\ Date. 3- .Z 7_ / 0
---�– - __. ----- ----___. -- l age—...-. —of
u
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 63379-4175 Business Phone: 6394171
Date Reycx•0,,d: _�"!' / A.M. _ ^ P.M. MST: 7— D 9
Location: BIJF:
1'r:r><1nt:_ Suite: _ Bldg: MEC:
Contractor: P-) . /t_Q�0 rYLG>'�-d iL-�-/ Phone: PLM: _
Gruner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/13carn PostlBearn Post/Beam Cover/Service Sewer/Storni
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab FramiuF To ut Gas Linc Rough-In UG Sprinkler
Foundation htsuldhon t Sewer flood/Duct Reconnect Vault
I3smt D unp Drywall Stonn Furn rce Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alin Crawl/Found Lr I teat Pump Low Volt
Approved ppro Approved Approved Approved
Appr'Cdwlk Not Approved aA44,roved Not Approved Not Approvrd Not Approved
FINAL NAV FINAL FINAL FINAL
a
N
i—
C]
W
J
C1 Cell for rcinspec C1 Reinspection fee of Srequired before next inspection C1 I Inable to inspect
Inspector_ /c�/`� -- — — Datc: _2 —' 7� Page-- �--of
CITY OF TMASTER PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : MST97l 0;'29
� 1312°SW Hall Blvd., Tigard,OR 97223 (503)639.4171
DATE: ISSUED: 07/16/97
P,ARCEL-: 2S1O2BA-033700
SITE ADDRESS. . . : 120-77 SW 95TH AVE
SUBDIVISION. . . . :DUBLIN PARI; ZONING.- R-25 PID
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :OOS JURISDICTION: TIG
Remarks: PATH I
-------_-_—----------------------------------------------- BUILDING --------------------------------------
REISSUF: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS----- REQUIRED--------------
'-LASS OF WORN.:NEW HEIGHT........: 20 Fi.RST....; 814 sf GARAGE.....: 448 sf LEFT..........: 5 S"c DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 863 sf FRONT.........; 20 PARKING SPACES: 2
TYPE OF CONST.:SN DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT........... 5
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 1677 sf VALUE..f: 119970 REAR..........: 20
------------------------------------------•------------------------- PLUMBING --------------------------------
SINKS.........: 1 WATER CLOSETS.: 3 WASHING MACH..: 1 '_RLINDRI TRAYS.: 0 RAIN DRAIN ft: 100 TRAPS.........: 0
LAVATORIES....: 4 DI`3HWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 100 SF RAIN DRAINS: I CATCH BASINS..: 0
TUB/SHOWERS...: 2 GARBAGE DISP..: i WATER HEATERS.: 1 WATER LINE ft: 100 ACKFLW PREVNTR: 1 GREASE TRAPS..: 0
OTHER FIXTURES: 0
------------------------------------------------------------- MECHiNICAL ----------------
FUEL TYPES----------- FURN ( INK .,; 1 BOIL/CMP ( 3HPt 0 ENT FANS..... : 4 CLOTHES DRYERS: 1 ,
GAS - r-iRN )=100;; ,.: 0 UNIT HEATERS..: 0 'OODS.........: 1 OTHER UNITS...: I '
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....; 0 GAS OUTLETS...: 1
------------------ -------------------------------------------- ELECIRICAL ---- - -----
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1080 SF OR LESS: 1 0 - 200 alp .: 8 0 - 200 asap..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 508SF.: 3 201 - 400 amp..: 0 2^01 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN Ls: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PA'-L...: 0 IN PLANT......: 0
NANF 4M/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0
1002+ amp/volt.: 0 ----------------------------- PLAN REVIEW SECTION -___._------------.___------------__---_-.
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)-225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
---------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY --------------------------------—
SFPESIDENTIAL--------------------------- B. COMMERCIAL-------------------------------- ---------------------------------------------
AUDIO I STEREO. : VACUUM SYSTEM..: AUDIO d STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURPA R ALARM..: 0TH: :: X ROILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GIRNE OPENER..: CLOCK........... INSTRUMENTATION: MEDICAL........ : OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMf-, 0
Owner: -------------------------------- Contr•actcr: ------------------------------ TDTAL FEES:! 4515.76
ROSE MANOR ROSE RINOR HOMES INC This permit is subject to the regulations contained in the
I GSI NW CONST. 10620 SW LUCAS DR Tigard Munir-ipai Code, State of Ore. Specialty Codes and all
106;.0 SW LUCAS DR TUAL.ATIN OR 970C? other applicable laws. All work will be done in accordance
TUALATIN OR 97062 with approved plans. This permit will expire if work is
Phone #: 452-8133 Phone E 452-8133 not started within 180 days of issuance, or if the work is
Reg L.: 109868 suspended for more than 188 days. ATTENTION: Oregon law
y —-------------------------------------—_____.-------- requires you to follow rules adopted by the Oregon Utility
~ Notification Center. Those rules are set forth in OAS 952-001-0010 through DAR 952-001-0084. You may obtain copies of t',ese rules or
direct questions to OUNC by calling (503)246-1997.
- ------------------------- REQUIRED INSPECTIONS ---------_---__-------------------------------------------
Erosion Contol Post/Beam Mechan Electrical Servi Gas Line Insp Water Line Insp Building Final
Grading Inspecti Crawl Drain Electrical Rough Gas Fireplace Appr/Sdwlk Insp
Footing Irsp PLM/Underfloor Framing Insp Insulation Insp Electrical Final
Foundation Insp `lechanical Insp Shear Wall Insp Cyp Board Insp Mechanical F,nal
post!Beam Struct
1 r umb a_ Out Low Low.. Voltage Rain
ain drain
i Insp
ePlumb Final
Issi_sed � y: P + + "'ar•mittee
+++i ++ 1 i+4- 4 ++ 1-+-1 + +++++++++++
+4-4-+ 1-4 1 ++++++++++i +f 4-++1-+++++
Cal. 1 6.39-4175, by 6:00 p. m. for an inspection needer_I the next bs-rsi-ness day
CITY OF TIGARD
DEVELOPMENT SERVICES SEWER PERM ITCONNECTION
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . : SWR 97-02;?'I
DATE ISSUED: 0713G197
PARCEL: 2S102BA-03300
SITE ADDRESS. . . : 1 ='077 SW 95TH AVE
SUBDIVISION. . . . :DUBLIN r,,)RK ZONING: R--25 FID
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :003 ,.JURISDICTION: TIG
-------------
TENANT NAME. . . . . :
USA 1\10. . . . . . . . . . : FIXTURE UNITS. . . 0
CLASS OF WORK. . . :NEW DWELLING UNITS. . : t
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1.
INSTALL TYPE. . . . iDUSWR IMPERV SURFACE: 0 sf
Remarks : PATH I
Owner: FEES --
ROSE MANOR Lype amoi-tnt by date recpt
GSI NW CONST. PRMT $ L2,200. 00 GEO 07/16/97 97-297225
10620 SW LUCAS DR INSr-, $ 35. 00 GEO 07/1.6/97 97-297225
TUALATIN OR 97062
Phone #:
Cont t-ac+--ot':
OWNER
Phone #: $ `235. 00 TOTAL
Reg #.
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
permit expires The Agency does not guarant-- the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952--001-0010 through OAR You say obtain copies of
these rules or direct questions to OUNC by calling (503)246-1987.
Tssi-ted by : Permittee Signat1.tv-e :4r'-A-
LAJ
-j
++-f.........4+4-4 .. ......4......4++4.......4.++4.......................4•...........
Call 639-41.73 by 6:00 p. m. for, an inspection needed the ne>(t bi.isiness day
4..................I.......4-++++-1-+++4...........1-+++4-1-++++.+-4.++++++++++++4 4-+4+++4.4.+-1-
Plan Check a
! 0-= TIGARD Residential Building Permit Application Recd By
Z5 SW HAIL BLVD. New Construction Additions or Alterations Date Recd
"GARU. 0- 97223 Singie Fin nly Detached or Attached (Duplex) 0 totoPE.L2 -0-7
iO3-639-1171 Oate to OST
E03-584-7297 Permitil b7Stl7-U 2t�
Print or Type called
Incomplete or illegible applications will not be accepted
Name if Protect I Name
J O b /aha'/(
Address S+re Address — Architect Mailing Address
L , . - 3 u, -� 5(,�1 F. 0. /3 u 3 0 2.
Name City/State Zip Phone
r, /y D TryivfST Tit.Ct �� 1�� /W 150 v c[E o o v GAP
Owner Mailing Address 7�s Name
C+tyistate ZipPhone Engineer Mailing ss
74(411 477A.�',P1,1 Ty- .
Name C+tv'State Z.o Phone
General ¢>Cii.[ ( Gescnbe work New Addition O Ai'era•on O Pepa+r O
::ontractor Mailing Addrs to be done
e
c A _ Additional Description of'Nork:
C"' IState Zip Phone
- .3
11i
regon Const.Lo-nt. Board Lic.M Exp. Date
Attach Copy of
Current COT Business or Metro$ Exp.Date tALLIATION
ROJECT
Narge
Licenses Cr $Mechanical NEW CONSTRUCTION ONLY:
� `�� ���;
Sub- maamg Address Sq. Ft. House: Sq. Ft. Garage
' -lb'l I 'V
Contractor 3 / 5'Sa.+,. Corner Lot YES NO Flag Lot YES NO
C,'rSta
Zip - Pone
74� Z (check one) (check one) Fk
Cregon rd`o,st.ccnt. BoaL+c.s Exp.Oat , ti Restricted Audio/Stereo Burglar
attecl,Copy or ,I,V / t Energy System Alarm
Current COT Business Tax or Metro M Exp. Dae Installation Garage Door HVAC
Licenses
Name t t' Opener " Systems
Plumbin 9 (check all that' Other.
- ILC .� . a,0 y)
Sub- ,Hailing Acores$,� Will the electrical subcontractor wire for all YES NO
ContractorGt /`�n.t restricted energy installations? ✓
ovate Z.p Phone Has the Subdivision Plat recorded NIA YES I NO
(JA 17,'S 3 41.73 _
Crrgon GkKst. Cont. Board L+c♦ E'o Date
attach cony of Reissue 0(M 'i 4
•-
S Solar Ccmohance
ti Current Plumbing Lie s Exp.Datt► r ((Calculation Attached)
N Licensee + I;�,i� I hearby acknowledge that I have read this application. that the
COT Sus+cess Tox or Metro s Exp. Dar information given is correct. that I am the owner or authorized
r . ` - agent of the owner. and that,plans submitted are in compliance
Nace ;., . ; ,,r with Oregon State laws.
m Sign Ure of Owner/Ag nt Dat
Electrical ;,t ,,f, ; �( r ' ft' /,
Sub- Mailing Address -' "
-� Contact Person Name Phone#
Contrar.,'or 4)10 ) -) 41u 1t,- 444" 51561.0174.1 .-y
y J3
CaySta:e Zip Phone FOR O, FICE USE ONLY:
',l J G 17.3Plat�
I MapITL#:
cregon an Cont Board L,c# a. D e t- Z 0 •e)-;)C'
v
alta' :opy of i 1101 7 7 J yl / SE be 3' zan
(, ) —~ Solar:
L +i-Tent cl�tnra +CC ; exp.Coln
Lcenses C - Engin sting
C T usiness Tax or Metro 9 Cate
-c t� 9 9 PP�ov I: Ptennrng Approval: ( TIF
Icy
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kj-10' I
FlarmiL Account Descri i n ,m n Amt. Pd
&1 � MST. Permit (BUILD)
Plumb. Permit (PLUMB) :2.2
Mech ermit (MECH) _ o v,
ELC/ELR Permit (ELPRMT) ;ct� Z
State Tax (TAX) �- ✓ _
Bldg:
Plumb:
N1ech: �.
ELC/ELR:
Plan Check
M; T: (BUPPLN) �.3/3, 9� C , Cv� t6'
PIunib: (PLMPLN) /
Mech: N(MECPLN) 1 t, f-r V a �b
CDC Review C,Y (LANDUZ) —,54 Ve
_Sc� y7aZ2FSewer Connection (SWUSA) �210u V/ uU
Sewer Inspection (SWINSP) _33-, _t/
Parks Dev Charge (PKSDC) /DSV G/
Residential TIF (TIF-R) l 5_7 D r/ S 7p
Mass Transit TIF (TIF-MT) 2,0 V / Z�
Water Quality (WQUAL) 7,7 (," /S tV
N Water Quantity (WQUANT) l u d c /UGC
Erosion Control Permit (ERPRMT) `�
tr
w Erosion Planck/USA (ERPLAN)LD
Erosion Planck/COT (EROSN) 1L� '
e
Fire Life Safety (FLS)
TOTALS:
c, faPO Qoc (cury
97 ATey ltd 17:47:37 RaLTiLT3DP SATURN(G4.^.RJ
1677
acto N14 BY :
ROSF MANOR HOMES. LTD.
b Z bit - IPH.► 452-8133
CITY OF TIGARD
DUBLIN PARK
T 3
�l 5'T:N 14 -55
12077 S.W. 95TH AVE.
4-4F ,H DlZ�1'f►uS T� (J,44J S0. FT.)
tfb L Os N_c:
LOT EXEMPT FROM SOLAR CODE
DUE TO LESS THAN 20 S0. FT 4 145<
ON THE HOME TO THE NORTH
'� ��• NC TE
�k/.� / e IFp6 GRAVEL DRIVEWAY ENTRANCE
PER EROSION CONTROL
�( �, � ��tiny` / / `'�. 8559 8`F �'•p.
/ o \
MAIN FLOOR
EL -185.5'40
�.
►. huh `` ti.
GA AG6`- / Nlb
90sy8. / e' CDNC
0 DRIVEWAY O
13500 PSI)
4g 01.
t, .
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AZ�
7g.s �6�6
a C�.
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J
05/28/97 MRR
AN MASCORD DESIGN ASSOCIATES.W O
IS NOT LIABLE FOR THE ACCURACY OF THE
'OGRAPHv INFORMAINNI 11 IS THE SOUS
RI? ,OQNSIBII Ifr OF THE BUILDER i0 vERKr
Al SITE CONOIHONS MCLIMO ANY FILL
PL "FDON THE SHE AND WORM OWNERS
OF ANY POTENTIAL FIELD MODIFICAItJNS
ALAI1 11A / CORD DC / IQfI AIIOCIATF ! In
1;05 N W 1A .H AIIFNUE, PORI LAND, OREGON 97209 (503) 225-9161 S C A L E 1 " 2 0 ' - 0 "