11180 SW 106TH AVENUE SW
1
ArDRESS:
H
J
H
\J
�i
J ..
1:'V-C-Mtfslmlcrotlrnitargetslbultdifig.doc
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639.4171
Footing Rain Drain Cover/Service FIN8.1).
Fou dation Water Line Ceiling -Plumb
Post/Beam Mech. Shear/Sheath Framing -Meeh.
PIbg.Und/F!r/Slab I'Ibg, Top Out Insulation -'lect.
Post/Beam Struct. Mech Rough-in Gyp. Bd.
San. Sewer Gas Line Appr/Sdwlk en
Other: -- � Q
Date: 2, A.M/.—P.M. Entry: -V. L"
Address:
Tenant: _ _. Ste:—__ MST: d
SUP: _
Con/Own: S (o Z �: _ MEC:
PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED EI_R:
a
H
V)
y
~ I
Inspector: _ Date:
ROVED _DISi.PPROVEt,�CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line 539-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service
Fo,,ndation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. £ t3idg.
San. Sewer Gas Line Appr/Sdwlk fle+ns
Other:
Date: � �:�� A.M. P.M. Entry:
Address: J,.U_0 /DG r
Tenant: ;'te: MST: Q _Q szd
BLIP: _
Con/Ow��u GJc=a MEC: _
6,6 c/ �J'G Z. PLM:
ELC:
THE CL.LOWING CORRECTIONS ARE REQUIRED: ELR:
��--.�/�7U�rt
r
a
H
J
r.
Inspector: _—_._ Date:/
_APPROVED %%APP @V&WGALL FOR S . CF CO
CITY OF TIGAPr) BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Fcoti g Rain Drain Cover/Service FINAL:
Founuation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plug. Top Out ;;p
ul ' n -Elect.
Post/Beam Struct. Mech. Ro,aah-in . B -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: CC
Date: t1 IS
I �P A.M. P.M. Entry: __-__---
Address:
Tenant: ---- _. Ste:_._._ MST
BLIP: _
Con/Own: MEC:
PLM: --- -- I
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
F-
u7
J
Cil
CD
LL1
I�nsp�tor:
—APPROVED —DISAPPROVE DICALL r-OR REINSP. CF GO ,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/ServiceFINAL
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/ heath Framing -Mecr .
Plbg.Una/Flr/Sleb Plug. Top Out Insulation Elect. II
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:AAd.,,-& o�
Date: _l_�( v A.M. E
� ��1 _
Address: LJ � )-6 laia
Tenant: _ Ste: _ MST:
Con/Own: _ MEC: _
17.-4 PLM: -.��yy���.�
p"G ELM ��,��3
THE FOLLOWING CORP1CTIONS ARE REQUIRED: ELR: .___ -
--
F 2cc>
vi
i—
J -'
C,7
lil
J --
Inspector. �' � D ate•
APPROVED _—DISAPPROVED/TALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639.4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath ram -Mech.
PIbg.UncUFir/Slab Plbg. Top Out Insulation Elect.
Post/Beam Struct. Mech. Rough in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: __ (0 A.M. Pr Entry: ---
Address: r! b 6 116 A '0"� _
Tenant: Ste: _ MST: T�F 0320
BUP: _
Con/Own: __ MEC:
PLM:
ELC: _
THc FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _
J
r-�
5-,0,4 C` Cr�YA c/L tMMp
J" Ori�iL j���c,'�X..�%CJs�I��/r 7►�iG�`'i' S.11r17S
Inspector 7Date_APPROVEb t-14H9A'PPROVED/CALL FOR REINSCF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Meeh.
Plbg.Und/Flr,'-,lab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mech, Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: ---� C 1 �i �L_—_ A.M. P -----
Address: �Ph
Tenant: Ste: - MST:C?S-43 7/
�Con/Own: [� �� �- MEC ".=J—.��12�. MEC: —
PLM:
ELC
THE FOLLOWING CORRECTIONS ARE REQUIRED ELR:
LD
z �
W
Ins ctor: — ate:
APPROVED —DISAPPROVED/CALL FOR REINSP. CF CO
- - --
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phona: 639-4171
Footing Rain Drain Cever/Se; lice FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath raRtllTtr -Mech.
Plbg.Und/Flr/Slab Plbg, Top Out Insulation -Elect.
Post/Beam Struct. Mech Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: _
Date: ` A.M. ,�P.M. Entry: -_
Address
Tenant: Ste: MST: Q1
BLIP:
Cone*: --- ----- MEC: -- - ---
�� PLM:
ELC:
THE FOLLOWING CORRECTION'S ARE REQUIRED: EL9:
rL
in
M
Ln
LLl
Inspector - _ Date: 7 /
_ VED _DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line, Appr/Sdwlk Roins.
Other: �a'"_Q --
Date: .2 — 9(..,, .m. P.M.__ Entry:
Address: ____�f_�—�61 x
Tenant: — ____ Ste:-- _ MST: ���— O 3 7.
BLIP:
Con/Own: ' _1�_—_ MEC:_
PLM: —
ELC:
T FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
rL
J -
07
CO --
W
J
Inspector: . Date: C
APPROVED -DISAPPROVED/CALL FOR nEINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: _
v
sooting _ 1 —Sup. Ceiling Sprink. Rough-in Appr/Sdwlk
Loden P!bg. Underslab Mech. Rouyh-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested._ -l< < — Time: AM PM
Address: �I -
�iJ
Builder: (. �, (�� �- Permit #: -i-L
THE FOLLOWING CORRECTIONS ARE REQUIRED:
�,Y��i��i�
CL
Cr
N - - -- —�
J
LD
Inspectors — _— Date.:���^-�Z
__APPROVED '00--T7l PP90`JED —APPROVED SUBJECT TO ABOVE
`—Call o AeinCp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam PA,ch. Shear/Sheath Framing -Mach.
Plbg.Und/Fir/Slab Plbg. Top Out Insulation _Elacb
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line �Ap�ppr�/Sdwlk Reins.
Other: 31LJ Q_ _�
Date: _ 'I—�/ 'L T A.M. P.M. Entry:
Address: // U S(4-) / y 4 C-1,
Tenant: _ Ste: – MST: 'J'03 70_
11 BUP:
Con/Own: ,odU)l 4 -!fV S Z - MEC:—
PLM:
ELC: V*Ze_153
THE FOLLOWING CORRECTIONS ARE rIEQUIRED: ELR
J
G7 ,
if
Ur
LLJ
_J
Inspector:�477 e Date:7
APPROVED __DISAPPROVED/CALL FOR REINSP. CF GO
CITY OF TiGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Pione: 639-4171
Footing Rain Drain Cover/Service FINAL.
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech, Shear/Sheath Framing -Meeh.
PIbg.Und/Flr/Slab Plbg. Top Out Insulation) -Elect.
Post/Beam Struct. Mech. Rough-in Gyp Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: - ( 6) �(' Gi ' A.M. _: Entry:
Tenant: --_._ _,— Ste: MST: _
BUP:
Con/Own: --- -- ----- - MEC: --
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED ELR: -_-
v
F—
c7
Lil
Inspector: --- — Date: .
APPROVED —DISAPPROVED/CALL FOR REINSP. CF CO
C;TY OF TIGARD BUILDING INSPECTION NOTICE
!nspection Line (Rec-O-Phone): 639-4175 Business Phone: 639 4171
Inspection:_
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
i Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam A tech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. Elect.
Date Requested: ( '" l Z Cf 5— Time: AM PM
Address
Builder: _ Permit #: 17C)
THE FOLLOWING CORRECTIONS ARE REQUIRED:
v'.
J I
Inspector: \. - Date::,:?
__APPROVED DISAPPROVED _APPROVED SI-19 IECT TO ABOVE
1l C- —Call For Reinsp.
MAS'F-R PERMIT V
. 70
CITY CSF TIGARD DATEIISSUED: . 11/09/95"
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 87223.8199 (503)839-4171 1='A RCEI-: 1 S 1 34DA-IZ1031ZIO
Il L i-)1)DRLL35. . . i i .10411 W 1061 I-1 AVE
_SUBDIVISION. . . . : NORTHERN FINE ZONING: R--4. 5
ial_CJCI;. . . . . . . . . . . i_OT. . . . . . . . . . . . .
Remarks: adding bed room and car oort PATH I
--------------------------------------------------------------- :UILDING ----------------------------------------------------------------
REISSUEs STORIES.......: i FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SE?BACKS---- REQUIRED-------------
CLASS OF WORK.:ADD HEIGHT........: 15 FIRST ...: 165 sf GARAGE.....: 240 sr LEFT..........: 5 SMOKE DETECTRS:
TYPE OF USE,..:DUP FLOOP IOAD,. .: 40 SECOND...: 0 sf FRONT.........: 20 PARKING SPACES: 0
n•c'E OF CONST.:5N DWELL14G UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 5
OCCUPANCY GRP.:R3 BDRM: i OATH: 0 TOTAL------: 165 sf VALUE-1: 12961 REAR..........: 15
--------------------------------------------------------------- PLUMBING ----------------------------------------------------------------
SINKS.......... 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS. : 0 RAIN DRAIN ft: 0 I 10S..I......: 0
LAVATORIES....: U DISHWASHERS...: 0 FLOOR DRAINS..: 0 gEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: C BCKFLW PREVNTR: 0 GREASE TRAPS..! 0
OTHER FIXTURES: 0
----- ----------------------------------------- MECHANICAL -------------------
FUEL TYPES----------- FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: 0
FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP. : 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OU'fLETS...: 0
_---------------------------------------------------------- ELECTRICAL -------------------------------------•--------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECT!ONS--
AN SF OR LESS: 0 0 - 200 ago..: 0 0 - 200 amp..: 0 W/SVC ON FDR..: 0 PUMP/IRP,IGATION: 0 PER INSPECTION: 0
EA ALD'L 500SF.: 0 201 - 400 amp..: 0 201 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
i-iMITED ENERGY.: 0 401 600 amp..: 0 401 - 600 amp..: 0 EA ADDL SR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MANF HM/SVC/Fbn: 0 601 - 1000 ago.: 0 601+a1ps-1000 v: 0 MINOR LABEL -10: 0
1000+ asp/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 --------------------------------------------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL---------------------------------------------------------------------------
AUDIO I STEREO. : VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM..... : INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC:...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNI_:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL M SYSTEMS: 0
1wner: -------------------------------------Contractor: ---------------------------- TOTAL FEES:: 167.46
BRAD WEIS OWNER
:1180 SW 106TH AVE
11GARD OR 97223
,hone #: 684-6562 Phone 1!:
Rey C. ; 000000
N This permit is issued subject to the regulations contained in the Tiga.d Municipal Code, St;te of Ore. Specialty Codes and all other
y apP1J1L;ble laws. All work will be done to accordance with approved plans. This permit will expire if work is not started within 186
►- days of issuance. or if work is suspended for more than 180 days.
-+ --------------------------------------------------------- REQUIRED IN£oECTIONS -----•-----------------------------------------------
Erosion Contol Electrical Servi Rain drain Insp
Footino Inso Electrica! Rouoh Electrical FinalLJ
-� Foundation Inst' Framing Inso Building Final ^�
Post/Seas Struct Insulation In Erosion Control
Underfloor insul Gvp Board In
F,er-mittE,e t�on'Fit 1_1t. ,, TsSrleLi R y
Call for inspection - 639-4175
ft
' Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171 ) ` C ,t
Jobsite Address: 11!�It7 �/� zl,2Iy/
Subdivision: _ Lot# Otflce Use Only
: � � d 11�It9���YI�� Contact Date I ! Initials
Valuation
Result
New Construction Only: ,Square Footage) Planck/Rec #
/
( 17K O?
'
I Permit # m51 yS -v.1
House: !U Garage: a �� l Reissue of
Map & TL
Corner Lot? Y N Flag Lot? Y N Zone
C�. '' �,1� 0� ,�/S Plat # ;
Owner: I��I;l�1pp�--�4 �'/s�) 1 /} ��
Address: %11Q7 Approvals Re aired
T1 2b Planning Setbacks N _ Solar N
Engineering
Phone: ) /�D Other
Contractor:
SQL Items Required
Address: �Il��, ��L��i�7� j� _ Subcontractors
Truss Details
Otter
Phone ' D 3 Notes
Contractor's License # _
(a ch cn,,)y of curren! Oregon license'
Contact Name:
Contact Phone:
Subcontractors: ArchitecUEngineer:
d
Plumbing: v Addiess:
N `�
Mechanical: �/
J (attach copy of current OR Contractor's License)
Phone. �_ )
LD 5`oRA c
Uj JOB DESCRIPTION
D OND ('d o e rn� Jv1".
r'
Aoolicant Signature Applicant Phone number
C__
Received by: `" _ _ Date Received. r r I I >
aymmnvncro '
Permit# Account Description Amount AML Pd. Bal. Due
M.if,qs-6.3 20 Bldg. Permit (BUILD) gas V im)
Plumb. Permit (PLUMB)
Mach. Permit (MECH)
State Tax (TAX) , _
Bldg-,
Plumb:
Mach.
Plan Check (PLANCK) , 0 3 2�'�� 3 0 v
Bldg: �- u
Plumb:
Mach:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Resldential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C) _
Industrial TIF (TIF-1) _
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL) _
N Water Quantity (WQUANT)
Fire Life Safety (FLS)
r-�
G7
Erosion Cntrl Permit (ERPRMT)
U.)
Erosion Planck/USA (ERPLAN)
Erosion Planck/CIDT (EROSN)
TOTALS: Z.
ms ;:s■wVwWWW-
ELECTRICAL PERMIT
CITY OF TIGARD DATEIISSUEDaCil%03;95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SAY Wall Blvd.Tigard,Oregon 97223*8199 (503)539-4171 PARCEL: .1 ,134DA-00300
ITE aDDRL'. . . . . 1 1 1 b 0 G 1.0b ria AVE-
SUBDIVISION. . . . : NORTHERN FINE ZONING: R--4. 5
£LOCI.. . . . . . . . . . . LOT. . . . . . . . . . . . . . t 3
Pr• o.ject Description : adding bed roam and car- vort PATH I
- -RESIDENTIAL UNIT--.-- --__TEME SRVC/FEEDERS---- - --MISCELLANEOUS-----
1000 SF OR LESS'. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMI-I/IRRIGATION. . . . : 0
EACH ADD' I_ 5006F. . . v 4e) 1:1,01 -- 400 amp. . . . . . . : 0 SIGN,'OUT '_,INE LTt. . : 0
1_111ITCD ENERGY. . . . . 0 401 -- 600 amp. . . . . . . : 0 SI&41AL_/1-',ArJEL.. . . . . . . : 0
MqNF. HM/ SVC:/FDR. . : 0 601+amps- 1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
-SERV ICE/Ff_-EDER-._- -- -- DRAIICIJ CIRCUITS--------,- •---.-ADD' L INSPEc'FIOhis-__.
0 - 210 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 - 400 ztmp. . . . . . : 0 1 st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0
+01 - 600 amp. . . . . . : 0 EA ADD' L PRNCH CIRC: 1 IN PLANT. . . . . . . . . . . : 0
6 -11 - 100171 amp. . . . . : 0 -______...____.-_____..._PI_.AN REVIEW SI-.0TION--__.________. __._..
001+ amp/volt. . . . . : 0 ) ==4 RES UNITS. . . . . . . . : ) 600 VOL-1' NOMINAL. . :
RNrunner_t only. „ . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC
Owner: --_._.___.__.__.._______________.___.____..____...______.._..___......_..__.____ FEES
BRAD WI_IS type amo,_1nt- by d.1te reapt
1 1 180 SW 106TH AVE PRMT s 40. 00 ,JD 11/09/9*,;- '?%5-272.687
5PCT 4 00 JD 11/09/95 'KI-27261.17
TIGARD OR 972;='3
Phone #: 684-6562
Contract o -.
OWNER $ 4;.'. 00 TOTAL
------ - - REQUIRED INSPECTIONS - --- - _
Wall Cover-
Phone
overPhone #f: illectrial Final
Reg #. . : 000000
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Pe.,m i t t ee Signature
applicable laws. All work will be done in accordance with
aooroved 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. Is ed-Py
_---__OWNER INSTALLATION
The installation is �� rade on property I own which is not intended for
alE . lease, cit.- rent
i UWNE R' S SIGNATURE: ' _.... _____--.._._......- DATE:
INSTALLATION
J
C0 5 T GNP T U RE OF SUP'R. ELECT' N s DATE:
ca
_. I L:L N L NO:
Call for inspection — 639-4173
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. c7��
Tigard, OR 97223 Planck/Rec. # �1`
Permit # t;L r";-_`'
Phone (503) 639-4171 Date Issued
CITY OF TIGARDFAX (503) 684-7297 Issued by
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development jf2el S Number of Inspections per permit allowed
Address I { 1 t�D s, (f'W 1 Service included: Items Cost(ea) Sum
City/State/Zip 41s. Residential-par unit 4
1000 eq I, or Ie.ae $11000
Name (or name of business) Each additional 500 aq 11 or 1
portion thereof $2500
Commercial El Residential
Li Each Energy $2500
Each Menut'd home or Modular 2
Dwelling Service or Feeder $6800
2a. Contractor installation only:
4b.Services or Feeders
Installation,alteration,or relocation 2
Electrical Contractor _ 200 t mps or Ines $eA 00 2
Address 201 amps to 400 amps $8000 2
401 amps to 800 amps $120 00 2
City State Zip 801 arnpa to 1000 amps $18000 2
Phone No. Over 1000 amp&or volts $34000 2
Contractor's License No. Reconnect only $5000
Contractor's Board Reg. No., 4c. Temporary Cervices or Feeders
Installation altoration,or relocation 2
Signature of Supr. Elec'n 200 amps or less $50 00 2
201 amps to 400 amps $75 OJ 2
License No. _ Phone No. 401 amps In 800 amps $10000
Over 600 amps to 1000 volts
2b. For owner Installations: see•b'above
r G
Print Owner's Name/ a .5 4d. Branch Circuits
Now alteration or eelonsion per panel
Aodress 6,c, ^ n)The lee for branch circuits w:th
purchase of service or feeder fee. 2
City_ State._ Zip Each branch circus $500
Phone No. . 1 )
�1`�J b03�;3 b The leo for branch circuits without
The installation is being made on property I own which is purchase of service of
feeder fee. i 2
First branch circuit $35 00 2
not intended for sal ase Of rent. Each addihonal branch arty,;, t:5 00
Owner's Signature r_ 49. Miscellaneous
(Service or feeder not included) 2
3. Plan Re section (I/ required): Each pump or irrigation circle $4000 _ 2
Fnch sign or outline lighting $4000
signal circuigs)or a limited energy 2
Please check appropriate item and enter fee In section SB. panel,alteration or oufennion $4000
�- 4 or more residential units in one structure Minor Lelels(10) $10000
Service and feeder 225 amps or more
V) _System over 600 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
j as desrnbed in N.E C Chapter 5 Per inspection _^ $.3500
Per hour $5500
J In Plant $55 00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services.
5. Fees:
ILL) 5e. Enter total of above fees $ / T
-� NOTICE 5%Surcharge(05 X total fees) $ L.
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Soc 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account e $
f
Balance Due $ t .
.antY.aeid�N.begrn ry
..r
II 7,007
I
� o
m
1; l y z
�NIN
y
LLJ
��-
.p0-;�•
First American Title Insurance Coma .-_____
p ny of Oregon ti
8O ntume0 OusM°aa 114m°o/TITLE INSURANCE COMPANY OF OREGON
1700 S.W. FOURTH AvE.. P(jRTLAND, OR 97201-5512
(503) 222-3651
NORTHERN PINE
--- --------- ____-_.._ -- -- MAP 1 S-1 , 3 4 DA
> -a-- -..
2 1/4 SECTION CORNER
170' \
67,60 ` i 103 9p
NO '45'W e212 I 4, I._� 1.\\
N99°5051"E C� 134.29 PT', S a9 50'SIS W
1905 1800 1000 „ 900 INITIAL PT. INITIAL ° 1os.9
3800
23Ac. .96AC. 445 I = 71_1 P. 9?A� 100
o
134
1100 134� Z TRACT ..B.2•
.. 6.3BAC.
'1' N L1J 8Q0 -; FOR STORM DRAIN
Z
PURPOSES
tL1 ,Q e
:oW
n 1 Nut L l
67,67_ 1200 g
L) 3 700 (�
°
C-),)11 ° 9
3 c- 1300
6200 600 L�
I B 10 5 16999
ev a 1400 3 50 4 4f
5 (D
s ^ Q 500 �3I 4 N
2 "" II ° - 0 5 = 60
u O 20 1500 2 Q
T Q 20 3355 6 401 j 24 „
I ,• lQD 55 95 —'�^ 42 N 40 0
aul 6100 400 r2-99 !EI-m '"
1 n_ e.18AG 1600 12 N3600 NGF 4200
ao aQ .37Ac. 7
134.26 c�
0 0 300
~ 13 3500 ~1- 4300
1 N a
_1 55.I ri 55Aa 134,3 u/. 302 : 1 1p I j Er 'N° 8 10
0 w www _ ,- to 115.2e 72.99 zi >3
1— o
T � fV 0 R I H-�--�-�- 10�--�-�
C
4 C.R. NO. 452
o 7
0 Lot 13, NORTHERN PINE, IN THE CITY OF TTGARD $1� N\-NORT'I
a J EXCEPTING THEREFROM THE FOLLOWING DESCRIBED PORTIONY OF WASHINGTON AND STATE OF OREGON:
in Beginning at the Southwest corner of Lot 13 of NORTHERN PINE ADDITION, a duly recorded 00
> plat on file in Plat Book 42, page 13, in the Records of the County Clerk's Office of
~ Washington County, Oregon, and running thence along the Westerly boundary line of said
J 4C.
.� Lot 13, North 0 37.'00" East for 46.00 feet; thence South 89038'10" East for 115.28 feet;
Thence South 0031'00" Wgst for 46 feet to a point on the Southerly boundary line of said
CM
Lot 13; thence North 89 38'10" West for 115.28 feet along the Southerly boundary line
U-)
-' of said Lot 13 to the point of beginning of this description;
A
1 1 r 4I OVVU e.
.., rN a
T, 7
►
L .1 VY M I I U4410) IJlr.l.t- I I I I Jit I If I r OR:N I I"I I I I I I'll I,,
11111.11 JI'l 1.
S, 14 Hit)1) 1 ilil(MAN 1 x 10. 014
I I I MA 4-5W 106111 f Wt. N-I lobi- I I I V`i
11 41-4.1fit- t 0 Pi4)r 1`111 N I $Wll 11 IN I I'll I J) P! It 14 114 (fI P1 I i I*.N 1 44ml.1tiri 1 PH 11)
W1111AW I 'l PIv1 MSJ95-031l/1 Ij
I " ON Gff.�.-.Cte, 00 I-Al-'J.,1 pfl.Al- PI 11`11 1. 00
i Vf—
Ill Uft AMI-ILIN 1 F'1`111) 184. 4.3
i )l III I I I it it'I) it- if I 111 1.4 1 1!T III 141, IJ j I 1 1,111'.
(D Ku-NI, I it 1 1, 0,11 it MA I
IWI . I 1 41-11 It If II VO
11"If., 111 HVI 6 Eq- 65 6 a lilflyl,lf III DIM
I.P(I4A 111 1 Is I)i I-If 1`41 11 IN I f I P
11. 111x11 II 111 1 1'1 11 0
Permit#:
Address:
—
��. z
Issued by: _i-- —_—� Date. — —
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, e.cempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill irk tl1G appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
l O I, own, reside in, or will reside in the completed structure.
I understand that 1 must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
(� 3A. My general contractor is
I_1 (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
E10- I will he my own general contractor.
If I hire sCocontractors, I will hire only subcontractors registered with the Construction Contractors
Un Board. 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.
LL I hereby certify that the above information is crrrrect.end that I have read and do understand the Information
Notice to roperty Owners abouut Construction K:Lsponsibilities on the re•,-erse side of this form.
(S'gnature of permit applicant) I I'atet
(white copy to issuing agency permit file,
pink copy to applicant)