11048 SW 111TH PLACE r
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DEPARTMENT OF LAND USE St TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
®LINTY INSPECTION REQUESTS: 503/640-3561/693-4415
1 PHONE: 503/648-8464—
OREGON L)
NOTICE TMIs permit thecomes null and void It the work or construction for which 11 Is Issued Is not commenced within 180 days Once construction hay started.
one permit becomes null and void If construction Is Interrupted tot a period of 180 days. 1 cattily that the Information presented by the applicant and
his agent or agents In support of this permit Is tone and correct to the twat of our kncnvledge I acknowledge that the Building Department's reliance
upon false and misleading Information may Invalldale this permit All provlrIons of applicable laws and ordinances governing the construction and use
of this building or structure will be compiled with whether or not apecllled on the plans or noted on the plans correction sheets I acknowledge that
the grarting of a permit does not grant authority to access private property or In use easements I further acknowledge that the use or occupancy of
the stricture or building permi9ed depends upnu my calling for Inspections at various limes during the process of ronsiruclion end the building
Inspection staff verifying compliance with the various codes, Use or occupancy of the building or structure permitted prior to approval by the
Bulldln?Department Is solely at the risk of the applicant end such use or occupancy Is revocable until all inspection requiremonts are salis'led and
approval is given by one Building Official 1 further acknowledTle that alien maybe placed on the title of the property upon which the permit Is Issnrd
specifying that the use or occupancy of the bulldinq or structure is provisional and revocable until the satisfaction of all Inspection requiremerds
PPLICAN ` IONATURE
WASHINGTON COUNTY ELECTRICAL PERMIT
/^ Department of Land Use & Transportation E..
Electrical Inspection Section
ortFirst H5 l ho oh Oregon Avenue,9714 350- 12 APPLICATION
Information: (503) 640-3470 Fax: (503) 693.4412 Project/Permit
Number _ _ Date _
P,1611111#0
e _ sections, a 5.
4. Complete Fee Schedule below
Number of inspections per permit allowed
i. Location of installation ----- _
Address__Il0 y,�r -5-, W,, 111t-14 G Service included: Items Cost(ea.) Sum
City i L,A R.D SuiteBuild
No. A. Residential - per unit
1000 sq,It or less _ $110.00 4
T enant Name Each additional 500 sq ft
(if commercial) _ or portion thereof $25.00
Limited Energy $25.00 __-- 1
Tax Lot Map No, - Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Ma Book: Page: �� ._ Section;___
DirectionsT�___Y P�0 _1r'� 0 3_ _ aGf�+ B. Services or Feeders
T o Ge�c VA . W dr--S T 7 i// t-JA-
Installation,alterations or relocation
200 amps or less $60.00 — 2
Commercial ❑ Residential[_ - 201 amps to 400 amps ..__ $80.00 2
401 amps to 600 amps -- $120.00 2
2a. Contractor installation only: 601r1000a amps to psory i000 s $18000 2
Over 1000 amps or volts $340.00 2
Electrical ContractorReconnect only $50.00 2
Address
Date_ Job Number C. Temporary Services or Feeders
Property Owner F:0_ WA- �— o A/ Installation,alteration or relocation
Contractor's License No. _79V-2-3c— 200 amps or less _— $50.00 2
Contractor's Board Reg. No. 93,EIL 201 amps to 400 amps $75.00 _ 2
401 amps to 600 amps $100.00 _ 2
Signature of Supra E ec'n + 4.- -L.� Over 600 amps to 1000 volts see'B'above
License No..,3 _ Phone No. gal D. Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a) The foe for branch circuits with
purchase or service or feeder fee.
PrintOwner's Name Phone I'lo Each branch circuit $5.00 2
b) The fee for branch circuits without
Addroas —_-� purchese of service or feeder lee.
First branch circuit ___— $35.00 2
Ity State Each add'nl branch circuit $5.00 2
E. Miscellaneous (Service or Feeder not included)
The installation is being made on property I own Each pump or irrigation circle__ $40.00 2
which is not intended for sale, lease or rent. Each sign or outline lighting $40 00 2
Signal circulus)or a limited
Owner's Signature �__ ._ - _, energy panel,alteration
or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
I Plan Review section (if required) Per inspec tir;n
Please check appropriate Item and enter fee In section 58. Per hour $5500
In Plnnl $55.00
—4 or more residential units In one structure
-,Service over 800 amps; feeder 800 amps or more 5. Fees
-__System over 600 volts nominal A. Enter total of above fees $
_Classified area or structure containing special 5% Surcharge (.05 X total fees) $
occupancy as described in NEC, Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $ -
above apply. Not required for temporary construction
services. Subtotal $ _
Less Bulk Label Fee
Balance Due $
For inspections call This perm"becomes null and void Itthe work authorized by the perm"Is not commenced
640-3561 or 693-4415 within 180 days from doted Issuance of such permit or If the work authorized Is
suspended or obandoned of ony time shot work Is commenced fur•period of 1W dove.
24-hoVr recorder, one working day in advance of Heed rlectrlealperm"•goo non refundable and non tranoferoble
1 94
CITY OF TIGARD D(l+T'EI1 [S�LiL:De „ �1� :1�1�����►. C�:,. � '
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171 IS134AC JE0113
1,10ifO W i J.I i i I P1
SUBDIVISION.. . . . JE"I"FREY F S'rAI*F-") R-4. 5 11D
1i Q C K. .. . . . . . . . . .. :013
............
CLASS 0 F W 0 R K. H F W b A R D A G E D 1:5 F'OS A I.-G) I.
T'YK'E 0 F U S E. . . . ..S F WASHING MACH. . . . .. . . . I BACKFLOW PRE.VN'T'R,5. 0
CCCUPAI%l(.',Y GRI-:1. R3 1:1-(' OR DROINS- . . . . . ...0 "I'RAPS.. . " . . .. . . . . " .. " .. ::P)
SIOWIJ..b. . .. . . . . -.2 WA I L.I-'%' HEAJ LRS. . - - -, .. :: I LA-T'CH 14AS I NG. 0
F 1.XJ'(J R E LAUNDRY T*R0YS. - - -0 SF WIN
$1NKS. G R E PS E 'T'R A PS 0
L..0 V(VT 0 R I ES. . 4 O'l I.JER f7:1 X FURLS., .0
11-1 :f/SHOWERS. . SEWER LJNF._' 0
W A'T'E'R CI I OSE'T". . :1.3 WR IE1_111E 1.H0
DISHWASHERS. . . 1. 2 1 RAIN DRA.1111
Rellla,rk.s- PWIA .1
OWNER: F:EE S)
F(.')IJR 1) CONS URUC1 1ON 11.F $
d. Old F.i W Ob/1.t:,/94
11:1 0 BOX I'W'? B P R'T* $ 400. 00 9W 05/16/94
F:P I-C $ '.-j0. 0(%) J L..H 04/(48/'-)4 94-251.06E?
cm 9,70*75 B 5 P C q*, 20. 00 SW 05/1.G/94
'tone flic 641-0935 SSDC $ 280. 00 "3W 05/16/94
I::1 A R K $ :•r001 00 SW 05/1.6/94
Lumbinq 11FIR1, $ 4;3. :`,0 13W 05/1(,/94
I1PLC, $ 1.0. 88 SW 05/16/94
2. 18 SW 0'5/J.6/94 .
..............
P P R'T' L/40. 00 13W 0b/16/94 .
r.j.)..?.L.) P 5 C 13 W
1:1 htoned
-
`;1;�1
712
..................
REOUIRED
j.J-?rnu (. is j.ssued to the rey .-
,jj.Atj.uj,js conta:tnecl in the Tigard FOUt/fOUIld 111sp Pain clfairl .11.1up
ar,le, State of 0-re:,. Specialty Lodeti alld all post/Heim btruct Water L.Inlra D-1151)
ether applicable -Laws. All work. will be done Posit/Beam Mechan npp(,/!:),(JwlTf. Insp
in acc.ordance With approved plane!;- 1'hi---, 1--,1.m u n d i.-.1.A b 1.n s p Ilpchanical
)ermit will exrjirF.,% if work. is not started P L.111 IJ n d e r f 1.o or p1l u ni b 1: J.11 a I
1.80 days of :Lssuarlce, ur if work. vi Ilechanill..'Al 1.1-113P Buildillil 1::,irlal
L0;;peV1dP.d for more than '180 days. Plumb 'TOP OL%'t E r a s.t c)n C o nt v of
Framing Tiisp C r a W.I. 1)ra 111
Fireplace 111sp ......
Gar, L.ine lrlsp ..........
�` {l. I r L�� {�.�>� S ,/� [..`�_. .... IIISUlal-iOn 111SP
G Y 1) B C)a r d 111sp
C a n t r a r t a r S i.q 11 A t U r e
for i.ncrpectian f,39--4J.'7 5
o n t r a c t a r Notes:
........................
............
............................... ...............
CITY OF T I CARD MASTER P�-':Rllfl T*
PERMIT MST94-013-,.
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSULi, c 05/16/94
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171
:ITE ODDRES(L.. . — 11048 1�k4 j.i1jil I.,,
QBDIVISION. . . . JEFFREY ESTATES ZONING: R-4. 5 PD
' LOCK. . . . . . . . . . LOT . . :013
------------------------------- BUILDING
�EISSUEIMGT94-9013 DWELLING UNITSsI BASEMENT. . . . . . . . so st
:LASS OF WORK. :NFW BEDRMS:4 DATHS:3 GARAGE`. . . . .. . . . . . 1420 S-f
; YPE OF USE. . . :SF FLOOR AREAS ---------- ST.,:
TYPE OF CONST. :SN FIRST. . . . :899 Sf LEFT. . : I@ ft RIGHT. :18 f �
' C(:UPNNCY GRI'. :R.3 :SECOND. . . :81.7 S FRUNT. :20 ft REAR. . ; 19 I'l,
1.) 10 R I L!-.). . . . . . . :2 14-11 RD. . . . -0 si f R E U U I R ED-- ------
HEIGHT. . . . . . . . :25 ft TOTAL.-.- : 1770 Sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE— — % 88980 PARKING SPACES. . .- I
Keniart-n: r-*'ATH I
--------------------------------- PLUMBING
SINKS. . . . .. . . . .. . !! I FLOOR DRAINS. . .. . :( BACKI"LOW PITEVNTIRS. 0
LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
rurl/s=ERs. . . . :,,? LAUNDRY INAYb. . . :W CATCH BASINS. . . . . . . Q)
WAILN ULUSE TS- 0 SEWER LINE (ft) . :W GREASE TRAPS. . . . . . . so
DISHWASHERS. . . . : 1 WATER LINE ( ft) . illfl@ u r H ci:r� r I x'j U R ES
GARBAGE DISP. . . : 1 RAIN DROIN (ft) . :0
WASHING MACH. . . : 1 SF F&IN DRAINS- 0.
---- MECIPIANICAL -------------------------------- FEES ----------------
FUEL TYPES------- - --- UNIT HTRS. . :W type amount by date -recpt
/GAS/ VENTS . . . . . :0 TIV $ 1520. 00 SW (til5/16/94
MAX INPUIQ BTU VLN1 I-ANS— :4 BPHI $ 400.WM SW 05/16/94
FURN ( INUK . . : :t HOODS. . . . . . il BPLC $ 50. 00 JLH 04/08/94
rURN ) -1001? . . :0 WOODSUOVES. :O B5PC $ 00- 00 SW 0'5/16/94
FLOOR FURN. . . . u@ CLO DRYFRS. : I SSDC $ 280- 00 SW 05/16/94
BCIIL/CMP ( JHPQ OTHER UNITS: I PARK $ 500- 00 SW 05/16/94
GAS OUTLETS: l MPRr s 43. 50 SW 05/16/94
Ownier : ------------- -- --- ------ --- - -----MPL(' $ 1.0- 88 SW 05/16/94
F-OUN 11 L0NSikUGI10N MbP(.; $ 2. 18 SW 05/16/94
0 BOX 157/ r.,P 17�r s 1.40. 0(1) S'-;W 05/16/1.)1
$ 7. 00 S61 05/16/94
(1':0 V I..:10'0111 U R 9 707`S
Plione #- 641 0935
Contractors
(-')UR D C0NF-3'TRUC7ION
Q BOX lb/'/
BEAVERTON UR 97075
Ila'flone-, 0: 641 . 0935
$ 2973. 5f, TOTAL
This pewit is issuea nout to the regulations contained in On ------- REQUIRED INSPECTIONS
Tigard Municipal Code, Stab of On. Specialty Codes and all our Foot/found Insp Fireplace Tnsp
aphaWr Ins. All work mill be done in accordance with approved Post/Bealli Struct UAS Line ] n5p
plans, This perMt will npue f work is not started within 181 Past/Neani Machan Insulation Insp
days of issuance, or if mul, is sispended for more lac Pini/Lnidslab -11111iP Gyp PoArd liiirq)
JLM/Undip-r f loor Rain dr,iin Intip
SchanicAl Initip Water Line I1715p
I ""TIN top Out; App-r-/15dw.0t In%p
-is
.......... ........................ -111111119 Il � p FinAl
Call for inspection 639-4175
SEWER CONNLC'T*1::, *.101-4
CITY O F T I GARD f-IERIVII'T
COMMUNITY DEVELOPMENT DEPARTMENT 1)(-iT1:-: I.SSUED: 05/j.(.,/94
13125 SW Hall Blvd.Tigard,Oregon 97223e8199 (503)639-4171
IDARCEL,-, 1.S134AC JE 0 1,3
1,1048 SW 1-1--
S(J.b1)1V1S1ON. JEFFREY ESTr-11*ES ZONING: R 4. 5 VID
BLOCK. I U T*. . . . . . . . . . . . .
..............
1'E N 0 N'T' NAME. . . .
US() NO. . . . . . . . . . . F1XTURE UN:11*S.
or: WORK. . . .N E W D W E7 I L.I N G U Iq 11'13.. 1.
'TYPF OF USE. . .. SF 140. OF BUILDINGS. ].
f Iq!-)1'0 L L Jf P 1::'.. 1:+1. S W R 3.11 r:1 E R V S U R FA C L'.. f
Renia-rt,!,.
Owtier".
FOUR D (;ONS'TRLJC'T1UN tyle all)(It.ti-it by date -r e C 1:)t
1-1 U 80X P'R M I' 220V- 00 SW 05/16/94
INSP-1 1i :3::;. 0(!l SW 05/:L6/':i4
OR `)7075
F11)(ir1e #-. 641-0935
Covit-rac-t-a-I. ..
CONTRAC'T'OR N07' 014 FTLE-
..........
1 '11o11p 0.. $ 2235.00 'rorm-
R,e t 44
RECMIRE D :INS PEC'I'lONS
This Applicant agrees to comply with all the rules and regulations Sewe-r 111%pec.,tii.(:1111 ...........
of the Unified Sewage Agency. The permit expires 18R days from ...................--.— ..
the date issued. The total amount paid will be forfeited if the ...........................................
permit expires. The Aqoncy does not guarantee the accutrLy of the
side sever laterals. If the sewer is not located at the measurement ..............
giver.' the irstalley shall prospect 3 fe!t 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 inst 01 a lateral. ..............................
I e f in j.t L e e I]) 0001A, .......—-
.......... ...................
t;Li r e
ri U C,d P y LOW ...........
Cm I for i 1-1 P e i C)r1 639 41.7`.`i
4A U
00
R�
Residential Building Permit An lication
City of Tigard
1312.5 SW Hall Blvd.
Tigard, OR 97223
(503) 639-411-1
t4obsite Address:
Subdivision: S?y &_e T' T6 Lot# 13 Office Use Only
Plancic/Rec # ,
j
valuation:
Permit
Lowner: rk i/r r-/O k/ Reissue of i� N�.r,� MST- ��� 70-7G
t �
Address: ��: :' ��X i' Map & TL
I�rJ
Approvals Required
Phone: ' —
PlanningI.
Contractor: Engineering
Address: _ Other
Items Required
Phone: _
Subcontractors
Contractor's License #
(attach copy of current Oregon license) Truss Details
Subcontractors: Other
'141umbing:
,,Mechanical:
(attach copy of current OR Contractor's L/censr)
Architect/Engineer:
Address: el
Phone:
COMMENTS:
Applicant Signature & Phone number
Received by:�- l",.+ Date Received
'Permit # Account Descriptloir Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) J400
Plumb. Permit (PLUMB) 24�0
Mech. Permit (MECN) 3. .o ,w
State Tax (TAX) ,2
Bldg: to .cv t--
Plumb:
Plumb: ?.uo
Mech:
P' ii Check (PLANCK) /,,o.�'�� �'L '✓ ' ���.
Bldg: r/
Plumb:
Mech: _/0•��_'
c,�GQ 0/3a Sewer Connection (SWUSA) 0 U u V
Sewer Inspection (SWINSP) ,.3_5 3
Parks Dev Charge (PI-,SDC) _,SU _ SUO,
Storm Drainage Chg (SUSDC) ZeV
Residential TIF (TIF-R) / // 0
Mass Transit TIF (TIF-MT) /i U
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WOUAL) _
Water Quantity (WOUANT)
Fire Districl (FIRE)
TOTALS:
TIFIE
CI TYT
CER
" OF IGARD OCCUPACATNOF'
C'!
COMMUNITY DEVELOPMENT DEPARTMENT p 1--
P.M11' #. . . . . . . t MST94-01M
13125 SW Hall Blvd. Tigard,Oregon 97223e81199 (503)639.4171 DATE IS'SUED t 02/03/95
PARCEL: IS)1341)B-05700
3I TE ODDRESS. . . : 11048 5W 111TH PL
IJUSD I V I S I ON. . . . : JErFRF-.Y ESTATES ZONING:R-4. 5 PD
PLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :013
CL.W-7S OF WORK. *NEW
TYPE OF UGE. . . :SF
OCLUPAI'4CY GRP. :R3
(ICCUPANCY LOAD:225 4
TENANT NAME. . . :
-mat- kvix PATH I
mer: --.— '--.------I-'- - -—--.1--1
)UP 10 GONGTRUCTION
0 Lm,,< 1577
AVEJMIN OR 97075
gone #i 1,41 -0935
)UP D CONOTRUCTION
1 ) BOX 1r-s77
-AVE100N OR 97075
,iorie #i 641 -0q3'y
% 11 0. . s *11037
j�rijparjc-y of tt-le above referenced bu i Id i nq i hereby q i Yetl, and cert i f i es
ip compliance with the StatP Of Dragon Specialty rod,;s I'vir the group,
�ckqlancy, and use under` which the vpfertnrc�d per mit 4"
NG' rN!,
Pl--ACI
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection I me (Rc:,-O-Phone): 639.4175 Business Phone: 639-4171
Inspection.
nspeSusp. Ceiling Sprink. Rough-in Appr/Sdwlk
Footing
Mech. Rough-in Fireplace
Foundation Plbg. Underslab
Elec. Rough-in FINAL:
Post/Beam Struct. Plbg. Top Out g
Post/Beam Mech. Sari. Sewer
Gas LineId
Framing Plumb.
Plbg. Underfloor Rain Drain g
Insulation
Alarm Watar Line _�-
Underflr. Insul. Shear Wall Gyp. Bd.
-Elect.
Date Requested.__r j- �'� —•
Time: AM >4M
Address: / . -'—
Permit
Builder:_
THE FOLLOWING CORRECTIONS ARE REQUIRED.
----------
Date:-2-'-
Z/APPROVED `DISAPPROVED —APPROVED SUBJECT TO ABOVE
Call For Reinsp.