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CITY OF TIGARD BUILDING INSPECTGION IVISIO
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
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Date Requested: 67—/ 7-q 7 _ A.M. P.M. MST:
Location: ��_( l� ��� / BUR
Tenant:_ Suite: Bldg: — MEC:
Contractor: / , Phone: PLM:
Owner: �� L IJ/ G(f Phone: —, 476 ELC:
ELR:
SIT:
BUILDING BLD con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site MsZeam Post/Beam Post/Bcam Cover/Service Sewer/Storm
Footing Roof UndF'/Slab Rough-In C.:ting Water Line
Slab •Lamin Top Out Gas Line Rough-In IJG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr/Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FI,,,AL FINAL FINAL
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Inspector:___ Date:��"/�-"l�7 Page_ of !_
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspedionn Line: 6394175 Business Phone: 6394171
Date Requested: _ `�/ "/4=, 7 7 A.M. P.M. MS?:
Location: 6 OkJ L) l/,% BLP:
Tenant: Suite: Bldg: — MEC:
Phone: PLM:
Owner / Phone: 7"7 75 _--- ELF:
ELR:
STI':
BUILDING BL con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof �,� UndFI/Slab Rough-In Ceiling Water Line
Slab raming� �' Top Out Gas Line Rough-In UG Sprinkler
Foundationsu a ton Sewer I Iood/Duct Reconnect Vault
I3smt Damp Drywall Storm Furnace Temp Service; MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm CrawVFound Dr Heat Pump Low Volt
Apprecl` Approved Approved Approved Approved
Appr/Sdwlk Q o A r eU Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
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Inspector: ,w1 j6C°A1q2A-,,42 Ay Date: %//d 1 !z 7 Paged of _
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CITY OF TIGARD BUILDING INSPECTION DIVISION r,�A
24-Hour Inspection Line: 69-4175 Business Phone: 6 -410 �
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Date Requested: �1 2 7 A.M. M. MST. c7 7-(,I31,6
Location: (/15 ��'(� BUP:
Tenant: Suite: 2 Bldg: MEC:
Contractor: --�./1'1!. — //�1 _ Phone: 5�10 ^J 5 1 PLM:
Owner: Phone: ETC:
ELR:
SIT:
BUILDING cont) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post'Beam Cover/Service Sewer/Storm
Footing R UndFUSlab Rough-In Ceiling Water Line
Slab f FramiTop Out Gas I Rough-In UG Sprinkler
Foundation sula'_ tion Sewer Hood/Met Recv-.mect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Had Pump Low Volt
Approved Approved Approved Approved Approved
Appr/Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL,
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Inspector: Date: Page of
CITY OF TIGAI LD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: 7A.M P.M. MST:�-6 3 62
Location: m 0 i Li BUP:
Tenant: Suite: Bldg: MEC:q f-D35V
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Contractor: one & vim.V— a /L PLM:
Owner: -��_ t.t i.rl.�_ Phone: ��� ' J�Q / ELC: `
FLR:
_ SIT:
BUILDING .BLDG(con'ty PLUMBINGMECHANICAL ELECTRICAL SITE
Site m Post/Beam : o earn—`�� Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Fourdation Insulation, Sewer flood/Duct Recom►ect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry ^oiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spkl:/Alm Crawl/Found Dr Heal Pump Low Volt _
,Approved Approved (_ Approved__") Approved Approved
Appr/Sdwlk `''- avcd_ Not Approved Not Approver) Not Approved Not Approved
FINAL FINAL � FINAL FINAL
�i��,�'[/yC� /� P_�r`i .•(f i't�� 1" � cJ t'�/t�'�?�'2 �C nil '_
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Inspector: Date: Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION I
24-Hour Inspection Line: 6.394175 Business Phone: 6394171
1
Date Requested: 1010 '"0 C 'Q z A� P.M._ MST:
Location: 10/300 /,( > �l BUR
Tenant: _ Suite: Bldg: _ NEC:
Contractor:_ �/n. �_ Phone: -3 5Opz PLM: _
Owner: Phone: ELC:
77
a-Yl_E'JLl2� O C �l}'1.f/Ih YJ! ELR: _
SIT: _
BUILDING, BLOG(^on't) PLUMBING ECHANIC ) ELECTRICAL SITE
Site Postillco n Post/Benn Post/Beam Cover/Service Sewer/Storni
Footing Roof IJrdFUSlab Dough-In..` Ceiling Water Line
Slab Framing Top Out /Gas Line _ Rovgh-In UG Sprinkler
Foundation Insulation Sewer flood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Hent Pump Low Volt
Approved Approved Approved_ Approved Approved
Appr/Sdwlk Not Approved Not Approved e--Not A rove Nut Approved Not Approved
FINAL FINAL FINAI:Z FINAL FINAL
Gam L1y\.Q yaS51wr e 7{ eskeL rdvr-,A , (-AI-wh i0' 2' 4
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Inspector:_���"-� b ct 01A Date: 110- 2 ' Page___L_of_'__
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
Date Requested: /0 —U/— 2 A.M. rm.
MST:
Location: 1_,l�1j _ BUR
Tenant: _ Suite: Bldg: , MEC: "7 D 3' �
Contractor ` Phone: (ova PLM:
Owner:_ Phone: ELC:
ELR:
SIT:
BUILDING BLDG(con't) PLUMBING ECHANI ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In i1G Sprinkler
Foundation Insulation Sewer I food/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr/Sdwlk Not Approved Not Approved Not A iroved Not Approved Not Approved
FINAL FINAL AL FINAL FINAL
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Inspector: _ — Date. �� - � _ Page _of�_
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-hour Inspection Linn: 6394175 Business Phone: 6394 i"r
Date Requested: 16 A.M. X -, P.M. MST: _-- —
Location: p Q UP:
Tenant Suite: 6 I _
Contractor:_ Phone: 6M P
Owl,er: L� 0/ d ,l1��Yt_ Phone: ELC:9 7—46 56
ELR:
SIT:
BUILDING BLDG(con't) PLUMBING IV YCHANICALLECTr RI L SITE
Site Post/Beam Post/Beam Post/Beam ice Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top riot Gas Linc Rough-In UG Sprinkler
Foundal in Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spktr/Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved App Approved
Appr/Sdwlk Not Approves-dI Not Approved Not Approved ) Not Approved
FINAL FINAL FINAL AL FINAL
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Inspector: —f m ���[_ Date:�-L—= ^ Page �I
CITY O F TIGAR D ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT 4.' .- ELC97-0650
131:5 SW Hall Blvd., Tigard,OF?97223 (503)639.4171 DATE ISSUED: 10/03/97
PAPCEL : IS134BD-07014
SITE ADDRESS. . . : 10800 SW 115TH AVE
SUBDIVISION. . . . :ENGLEWOOD NO. 3 ZONING: R-4. 5
BLOCK. . ,
LOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :E03 JURISDICTION! TIG
ProJect Description : Corwin
UNIT---- ----TEMP SRVC/FEEDERS----- -----MISCELLANEOLJS------
1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADDIL 500SF. . . : 0 201 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HIM/ SVC/FDR. . : 0 601+alrps-!!': 00 volts. : 0 MINOR LABEL, 0
----Sri RV I CE/FEEDE R- --- ----BRAN"H CIRCUITS----- ----ADD' L INSPECTIONS—-
0 - 200 --.n.p. . . . . . : 0 W/SERVICE OR FEEDER: 0 PEK INSPECTION. . . . . : 0
_01 - 400 amp. . . . . . : 0 1st 1410 SRVC OR FDR. .- I PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 -- took amp. . . . . : 0 --PLAN REVIEW SECT I ON---------------- --
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS;. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR )= 225 AMPS— : CLASS AREA/SPEC OCC. :
Owner: ---------------•------------------------------------- FEES ----------------
STEVEN G COR',41N type amount by date recpt
10800 SW 115TH AVENUE PRMT $ 35. 00 JSD 10/03/97 97-299784
TIrqRD OR 97223 5FICT $ 1. 75 JSD 10/03/97 97-299784
Phone #- 684-9634
Contractors -----------------------------------------------------------------
OWNER $ 36. 75 TOTAL
------- REQUIRED INSPECTIONS
Rough-in Elect' l Final
Phe-iii? #: Elect' l Service
R,ea #. . . 999999
This perAit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
app!.74bli laws. All work will b� done in acc-)rdance with approved plans. This permit will e..pire if work is not started within 180
days of issuance, or if work is suspended for nore than 188 days. ATTENTION.- Oregon law requires you to follow the rules aOopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-01-0110 through OAR 952188$-1987. You say obtain a copy
of these rules or direct questions to OUNC by calling (503)246-1987.
Pprmittee Signature : 1 ,,cil.iPci By -
---------------------------OWNER INSTALLATION ONLY-----------------------------
The installation is being made on property I own which is no', intended for
sale, lease, or rent.
OWNER' S SIGNATURE: DATE%
-------------------------CONTRACTOR INSTALLATION ONLY---------
SIGNATURE OF SUPR. ELECIN: DATE:
LICENSE NO:
......r......f. .•+++++++++++++++++++++++++++++++++++++f+++•}+++++.1-4-4............4.......
Call 639-4175 by 6:00 p. m, for an inspection needed the next business day
CITY.OF TIGARD Electrical Permit Ap,,N:ication Plan chec,- -
13125 SW HALL BLVD ReodBy
Date Recd
TIGARD OR 47223 Date to P.E. _
Phone (503) 639-4 171, x304 Date to DST
Print or Type - --. •
Inspection (503) E39-4175 Permit»
Fax (ctio (503) C3 Incomplete or illegible will not be accepted Called
1. Job Address: 4. tL nmplete Fee Schedule Below:
Name of Development _ _ Number of Inspections per permit allowed
Name(or name of business) S TCv f'rt U Co rwi it, Service included: Items Cost Sum
Address 109d-) SW ( (s 4a. Residential-per unit
7`�tft ?�ral� 2 71 1000 sq.ad t1.or less 9110.00
City/State/Zip
( 2 3 Each additional 500 sq.it.or
portion thereof $25.00
Commercial Residential
Limited Energy $251)0
Each A1anuf'd Home or Modular
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical Contractor Installatim,alteration,or relocation
200 amps or less $60.00 _
Address -, 201 amps to 400 amps $80.00
City_-- State Zip-- 401 amps to 600 amps $120.00
Phone No. 601 amps to 1000 amps $180.00 z
Job No. Over 1000 amps or volts $340,00 2
Elec.Cont. Lice. No. _Exp.Date - Reconnect only $50.00 2
OR State CCB Reg. No. Exp.Date__ . 4c.Temporary Services or Feeders
OT Business Tax or Metro No. _Exp.Date.__ Installation,alteration,or relocatio r
200 amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 amps _ $7F.00 2
9 - - 401 amps to 600 amps $".00.00 2
Over 600 amps to 1000 volts,
Licens,No. Exp.Date see"b"above.
Phone N•)._
- _ 4d.Branch Circuits
New,r.iteration or extension per panel
2b. For owner installations: P) The fee for branch circuits with
purchase of service or
Print Owner's Name _Sl eu v7 G Carwt-t feeder fee. I+
Address �_w_ 1-2 0- cacti branch circuit $5.00 2
O q 7L 2 3 b)The lee for branch circuits
City .rn." State�._ Zi p_ without purchase ol
Phone o. 5'17V- 3 S 8-1 service or feeder lee.
First branch circuit $35.00
The Installation is being made on property I own which Is not Ea^h additional branch circuli_ $5.00
intended for sale,lease or rent. 4e.Miscellaneous
Owner's Signature �-- -�1 C_ , (Service or feeder not $40.00
of included) it
Each pump or irrigation circle
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):' Signal circuits)or a limited energy
panel,alteration or extension $40.00 2
� -.-
Please check appropriate item and enter fee In section 5S. It• :or Labels(10) $100.00
4 or more residential units In one structure 4f.Each additional Inspection over
Service and',eder 225 amps or more the allowable in nny of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described In N.E.C.Chapter 5 In Plant _ $55.00
a
Submit 2 sets of plans with application where any of the above apply. 5. Fees:
*Not required for temporary construction services. 5a.Enter total of above fees $ r ''
5%Surcharge(.OF X total fees) $ ----
' NOTICE Subtotal $ �Ly
5b.Enter 25%of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHURIZEU jO I Plan Review if real I�tSec.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trtst Account 1k _
Total balance Due a �-
I•.nS1S Fl�nN;pr'r+ n.>r W4q � -_
CITY OF TIGARD MASTER PERMIT
PERMIT #. . . . . . . . MST970366
DEVELOPMENT SERVICES DATE ISSUED: 09/09/97
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
P,ARCEL: 1S134BD-0*7014
SITE ADDRESS. . . : 10800 SW 115TH AVE
SUBDIVISION. . . . :ENGL_EWOOD NO. 3 ZONING: R-4. 5
BLOCK. . . . . . . . . . L_(i T. . . . . . . . . . . . . 37 JURISDICTION: TIG
5emarks; Replaciag chi;n;v with framing for gas fireplace.
BUILDING
REISSUE: STORIES.......: 0 FLOOR AREAS---------- BASEMENT...: 0 sf RE(XJIREL) SETBACKS---- RF'k)IRED-------------
CLASS OF WORK.:ALT HEIGHT........: 0 FIRST....: 0 sf GARAGE.....: 0 sf LEFT..........: 0 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 0 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0
TYPE OF C3NST.:5N DWELLING UNITS: 0 FINBGMENT: 0 sf RIGHT.........:
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL------: 0 sf VALUE.1: 2940 REAR..........:
------ —------ PLUMBING -----------------——---------------
-
SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 0 DISHWASHERS...: 0 FLDIR BRAINS..: 0 SEWER LINE ft: 0 b3F RAIN DRAINS: 0 CATCH BASINS...- 0
TUB/SHOWERS...,. @ GARBAGE DISP.. 0 WATER HEATERS.: 0 WATEP LINE ft: 0 BCKFLW PREYNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
MECHANICAL ---------------___ ---- ----------------- ------- ----
FUEL
------
FUEL TYRES—--- FURN ( 180K 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: 0
FURN )zlW 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 8
MAX INP. I BTU FLOOR FURNACES: 0 VENTS.......... 0 WOODSTOVES.... 0 GAS OUTLETS...: 0
------------------------—------------------------------- PIECTRICAL --------------- -------------
-•RESIDENTIAL UNIT-- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS--- INSPECTIONS--
1000
NSPECTIONS—IM ST OR LESS: 0 b - 20@ amp..: 0 @ - M alp..: 0 W/3VC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 Pial - 400 amp,.: 8 201 - 44M amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY. : 0 401 - 600 amp... 0 401 - 6N alp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: I IN PLANT......: 0
MW HM/SVC/FJR: 0 601 - IM zap.; 0 601+alps--I000 v: 0 MINOR LABEL -19: 0
IM+ alp/volt.: @ -------------------------------- PLAN REVIEW SECTION
Reconnect only.: 6 1=4 RES UNITS..: SVC/FDR)=225 A.- 600 Y NOMINAL: CLS AREA/SPC OCC:
---------- ELECTRICAL - RESTRICr - ENERGY
A. SF RESIDENTIAL- B. COMMERCIAL--------- ---------------
AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO .1 STEREO.: FIRE ALARM.....: INTERCOM/PARING: OUT LNDSC LT:
BURGLAR ALARM..: OTH: BOILER.........: HVAC...........: LANIUM/IRRIG: PROTECTIVE Silt:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICA........: OTHR:
HVAC...........: DATA/TELE COMM.: MJRSE CALLS....: TOTAL I SYSTEMS: 0
Owner: —---------Contractor: ------------------------------- TOTAL FEF90 65.46
STEVEN G CORWIN OWNER This permit is subject to the regulations contained it, the
16800 SW 115TH Tigard Municipal Code, State of Ore. Specialty Codes and all
TIGARD DR 97223 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone #: 590-3581 Phone is not started within 180 days of issuance, or if the work is
Reg L.: IBM suspended for more than 18@ days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility
C9:
Notification Center. Those rules are set forth in OAR 952-01-00I0 through OAR 952-00I-N80. You may obtain copies of these rules or
direct questions to OUNC by calling (513)246-1987.
------------------
REWIRED INSPECTIONS
Framing Irip
misc. Inspection
r.0 Buildirg Final
LU
IssuedPermittee Signature: =to
+++++++++•
........ ........ .......................++++4 4-+ +4-4-++ +++
Call 639-4175 by 61@0 p. m. for an inspection needed the next LUSiness day
Permit#: I -�
Address:
z� Issued b ate:
X859
Statement: Information Notice to Property Owners
A lout Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction pennil 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 :d 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:
SL 1. I ov:., reside in, or will reside in the completed structure.
S 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
ll 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 subcontractors, I will hire only subcontractors registered with the Construction Contractors
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.
J
I hereby certify that the above Information is correct and that I have read and do understand the Information
w Notice to Property Owners about Construction Respoilsibiiities on the reverse side ofthis form.
G7 (Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Plan Check#
CITY OF TIGARD Residential Building Permit Application Recd By
"125 SW HALL BLVD. New Construction Additions or Alterations Date Recd
rIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. S ( _
J 503-639-4171 Date to DST
503-684-7297 Permit#..
Print or Type Ca ed 9��-��C►`
Incomplete or illegible applications will not be accepted AAAA,
Name of Project Name
Job FAJ4 (.1)pC-)�1) � � Ou P7
Address Site Address Architect Mailing Address
0 9("7 l LTJ I S City/State zip Phone
Name
Owner Mailing Address Name
10'v 5-V 1�•S� EngineerMailing Address
city/State CZip 91223 Phone
T/ 12 �O3?$'� -
City/State Zip Phone
Name
rerteral W Describe work New O Addition O Alteration}el Repair O
Contractor Mailing Address to be done Rte /tc cid-ln r wr rh Frapom , pj ICr� /.rcc
Additional Description ofWork:
City/State Zip Phone
Oregon Const.Cont. Board Lic.# Exp.Date
Attach Copy of
Current COT Business Tax or Metro# Exp.Oa?e [PROJECT
Licenses _ VI 4LUATION $ (7
Name l NEW CONSTRUCTION ONLY:
Mechanical 0 we7 er
Sub- Mailing Address — Sq• Ft. F�ouse: Sq. Ft. Garage
Contractor Corner Lot YES NO Flag Lot YES NO
City/State Zip Prone check one _
( ) (check one)
Oregon Const.Cont. Board Lic.# Exp.Date Restricted Audio/Stereo Burglar
Attach copy of Energy System _ Alarm
I Current COT Business Tax or Metro# Exp Date Installation Garage Door HVAC
Licenses Opener Systems
Name (chect;all that Other:
Plimbing L Jejt, 0�115 apply) L::1 _
Sub- Mailing Address Will the electrical subcontractor wire for all YES NO
'� -�5 �tt /IJ restricted energy installations?
Contractor
��'
CirylState Zip Phone Has the Subdivision Plat recorded? N/A YES NO
v� �• GR 9'Gtl �(o rJr
Oregon anal ont. Board Lic.# Exp Date Reissue of MST#: Solar Compliance
Attach Copy of IQ .-.6 N Calculation Attached)
Current Plumbing Lic.# Exp. Date I hereby acknowledge thatI have read this application, that the
Licenses information given is correct, .hat I am the owner or authorized
COT Business Tax or Metro# Exp.patg agent of the owner, and that plans submitted are in compf ince
4 $ S I / with Oregon laws. _
Name
r Signatu a of Owner/AgWt Date
Electrical L u,'fl'e
r Sub- Mailing Address V C Fact Person Name lone#
-� Contractor r
h z, _ FOR OFFICE USE ONLY: �� 1 e c
c Ci y/State Zip Phone _ ,
OR q 70(T. - (Jr- Plat#: '/ Map/TL : 07-1
Oregon r'onst. ont Board Lic.# Exp.,Data S / ��- (� ��/`t JF,1A1iC"jC'4'P 3 ?o
Attach Copy of t .;7 Setbacks: C - OtO ,o' Zp7ne: _ sola ...
Current Electrical Lic.# Exp. Date -5- f - ,
Licenses Engine ring Approval: Planrli/ng Approval: TIF:
COT eusinesa Tax or Metro# Exp D t II
I SFAPP DOC (DST) 4/97
�v
Permit# Acct. Descritpivja COT WACO Amount Amt. Pd. Bal. Due
MST. Permit (BUILD) (UBUILD) �_�
Plumb. Permit (PLUMB) (UPLUMB)
Mech. Permit (MECH) (UMECH) _
ELC/ELR Permit (ELPRMT) (UELPMT)
State Tax (TAX) (UTAX) t �=
BLDG:
PLUMB:
MEI-H:
ELC/ELR:
Plan Check
MST: (BUPPLN) (UBUPLN) �� '
Plumb: (PLUMB) (UPLUMB)
Mech:
(MECPLN) (UMEPLN) _
CDC Review (BUILD) (CDCBLD) (UCDC)
CDC Review(PLN) (CDCPLN) N/A
Se,ier Connon (SWUSA) (LISWUSA)
Reimbur. District ( ) ( 1
Sewer Inspection (SWINSP) (USWINS) _
Parks Dev Charge (PKSDC) N/A
Residential TIF (TIF-R) (UTIF-R)
Mass Transit TIF (TIF-MT) (UTIF-M)
Water Qualit! (WQUAL) (UWQUAL-)
Water Quantity (WQUANT) (UWQANT)
Erosion Control Prmt (ERPRMT) (UERPMT)
Erosion Planck/USA (ERPLN) (UERPI-N)
Erosion Planck/COT (EROSN) (UEROSN) �.-'`---�'-
Fire life Safety (FLS) (UFLS)
TOTALS: C"
T I:SFAPP.COC (DST) 4197
C:1"►Y nF 1 I GARD - kl CI I P1 POY'MEM I kEGE I N'I NU. .q e-•R9 9el iq
( WICK AMUUN F s 40. .3
NAME: s C OPW I N, :31 I:.UL''N G ::AsH AMCIUN t s 0. 00
ADDRESS s CORWIN, JUYCE:. L PAYMLNI DA1L 1 09/09/9'1
10800 S14 115TH SUBDIVISION s
T 1 HARD C.IR 9 ,c.23—
POR'POSE CIF PAYMLN'I AMOUN1 PAI D PURPOE& W WAYMI<.N I AMrll.)N1 PMD
HLIILDINt i-'E�tMI'l 38. b0 - t BUILD FE.k 1. 93
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CITY OF TIGARD MECHANICAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . : MEC97-0354
DATE ISSUED: 09/2:2/97
PARCEL: IS134BD-07014
SITE P.DDRESS. . . : 10800 SW 115TH AVE
SUBDIVISION. . . . : ENGLEWOOD NO. 3 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :203 JURISDICTION: TIG
------------------------------------------------------------------------------------
CLASS OF WORK. . :OTR FLOOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF IJ3E. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRF-,. . :R3 VENTS W/O APDL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUE'- TYPES------------ 0-3 HP. . . . - 0 DOMES. INCIN: 0
3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . - 0 WOODSTOVES. . : 0
GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS------------ AIR HANDLING UNITS OTHER UNITS. : 0
FURN ( tOOK BTU: 0 <= 10000 cfm: 0 GAS OUTLETS. : I
FURN ) =100K BTU: 0 ) 10000 cfm: 0
Remarks : Add gas piping for new gas fireplace.
Owner: ------------------------- ----------------------- --- FEES --------------
STEVEN G CORWIN type amount by date recpt
10800 SW 115TH AVENUE PRMT $ 25. 00 GEO 09/22/97 97-29944E
TIGARD OR 97223 5PCT $ 1. 25 GEO 09/22/97 97-299442
Phone #: 684-9634
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397 ------------------------------------
26. 2-5 TOTAL
TIGARD OR 97223
Phone #: 624-2704
Reg #. . : 000763 REOUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Ins
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within IN days of issuance, or if work is suspended for more
than 190 days. ATTENTION: Oregon law requires you to follow rules
Of adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-MI-0010 through OAR 952-901-W. You may
obtain copies of these rules or direct qu�,stions to OUNC by calling
(563)246-9187.
Uj
Issue By : 14 4140�� Permittee Signati
........................4............................%..... .................,++++ .....
Call 639-4175 by 6:00 P. M. for insoections needed the next business day
.........................................................4.......................
Plan Check#
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
Tr IGARD,Ok 97223 Date to P.E.
(503) 639-4171, X304 Date to DST
Print or Type Perm it#glee°
Incomplete or illegible applications will not be accepted Called
Name at Devebpmer.VPro Description(U I Table 1A Mechanical Code QTY PRICE AMT
Job Street Address surteil A) Permit Fee -0- -0- 10.00
Address
Bldg* a /slate zl 1.) Furnace to 100,000 BTU 6.00
including ducts&vents
Name(or name of business) 2.) Fumace 100,000 BTU+ 7"50
Owner ij L�_i rt,+J I 11 including ducts&vents
Mailing Address 3.) Floor Furnace
I(] , s W 1,5-- includingvent 6
C state y� zip Phone 4.) Suspended heater,wall heater 6.00
r 7 ? ` ) a'� or floor mounted heater
N (or name of business) 5.) Vent not included in appliance permit 3.00
--
Occupant •sailing Address 6.) Boller or comp,heat pump,air Gond. 6 01.
to 3 HP;absorb unit to t00K BUT"
C"Istate Zip Phone 7.) Boiler or comp,heat pump,air cond. 11.00
3-15 HP;absorb unit to 500K BTU"
Contractor N!n1e a.) Boder or comp,heat pump,air coed. 15.00
(Pnor to C.�I /) 15-30 HP;absorb unit.5-1 mil BTU"
issuance Mailing Address 9) Boiler or comp,heat pump,air Gond. 22.50
applicant _P0 . 30-50 HP;absorb unit 1-1.75mil BTU"
must provide all c Zip Phone 10.) Boiler or comp,heat pump,air Gond. 3750
contractor stota d 7.22 _ >50 HP;absorb unit 1.75 mil BTU"
license b Const.Cont.Board t-ic x Exp.Dote 11.) Air handling unit to 10,000 CFM 4.50
information 'A":3222 C /.-0-2-
for CGT CQjBu
70
- !rax or a Exp.Dote 12.) Air hancling unit 10,000 CFM 7"50
database). ( r- -S .,0 1
Architect Narne 13.) Non-portabla evaporate cooler 4 50
or Mailing Address 14,) Vent fan cone--ted to a single duct 3.00
Engineer CrtyrState Zip Phone 15.) Ventilation system not included in 4.50
appliance permit
Describe work New O Addition O Alteration O Repair O 16) Hood served by mechanical exhaust 4.50
to be done Residential,0" Non-residential O
Additional Description of work 17.) Domestic incinerators 7,50
19.) Commercial or industrial type 30 00
Incinerator
Existing use of 19.) Repair units 4.50
building or property i � W
20) Wood stove 450
Proposed use of 21 ) Clothes dryer,etc. 4.50
building or property
22.) G!her units 450
Type of fuel-oil O natural gas O LPG O electric O 23) Gas piping one to four outlets I 200
a
I hereby acknowledge ii,at I have read this application,!hat the 24) More than 4-per outlets(each) 50
vt information given is correct,that I am the owner or authorized agen!of
r the owner,that plans submitted are in compliance with Oregon State QTY.SUBTOTAL
F- laws
Signature of Owner/Age Date -'SUBTOTAL
c
5%SURCHARGE r �-
w �?
-� arson Name Phone PLAN REVIEW 25%OF SUBTOTAL
I
U-' � /U T TOTAL
�y1
i.Ws -pmt.doc (rev 9 'Minimum permit fee is S25+5%surcharge --'
"Residential A/C requires site plan showing piacernent of unit. ��'
��-
INSPECTION NOTICE
City of Tigard Building Department
13125 BW Hall Blvd. Tigard, Oregon 97723
Innpection Line (Rec-O-Phone): 639-4175 Bueinejs Phone: 639-4171
Inspection: ]G �X /41,-�!— --
F.oting Plbg. Underslab H h. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Pont/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hach. Rain Drain Insulation -Plumb.
Plbg. Underfloorne Gyp. ed. -Mach.
Date Roque Fated: ____--
Time: AM PH
Addvees: V Uo , n ' Permit i:f'LM 61?Z-0 l I
Pu i l.der: '�-C� n -/ — a�
THE FOLI.OWING CORRECTIONS ARE REQUIREDt �^
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7_7
Inspect rt nares__ ? 7
/ 1�011iD DISAPPROVED _ '.PPROVF.D SUBJECT TO ABOVE.
T Call For Roinsp.
CjITY OF TIGARD RECEIPT OF PAYMENT Rr-CFIPe9•-i :3'8098 T NO.
GHLCI AMOUNT LA. 00
NAME a CORWIN, STr.VEN CASH AMOUNT a 15. 75
ADDRESS a PAYMENT DATE a 03/22/93
10800 SW 115TH AVENUE SUBDIVISION
-TTC,ARD, OR
PURPOSE OF P-)'(MF'N-r AMOUNT VH Y D PURPOSE' OF PAYMENT AMOUNT PAID
r I I NO PERM 15. 00 ST. IALI I L.D PE R 0. 75
cl:
C-0
ui
WfAL AMOUNT PAID 1 T—o- 75
CITY OF TIGA RD D
COMMUNITY DEVELOPMENT DEPARTMENTPLUMBING PERMIT
13125 SW HWI Blvd P.O.Box 23397,TOW,Oregm 97223(503)639-4176
7-1// 1"ERM I
W,
E+ 9 4171 DATE ISSUED:
JiJE, 10800 SW 11,5TH AW, 1-',RFRCEL:
-'WOOD NO. ZONING: R-4i.:-)UBD I V I S I ON. ENGLE_
LUT. . . . . . . . :
Li-P.S3 OF WORK, ;W-W GARBRGE DIOPOSAL-t3. M01AIL.E.'- HOME SPACES.
YYPE OF' USE. . . . I Sl,-' WASHING MACH. . . . . . . : DAU'U'LOW PREVNTRS. . . 1
OLLUP(-4NCY C;DiP. . :R. FLOOR YRAPS. . . . . .. . . . . . . . .
S I UR I ES. . . . . . . . :0 WATLR HEA*('E:RS. . . . . . CATCH BASINS. . . . . . .
FIXTURES- L(--WhWRY TRf'4YS. . . . . . .. SF WIIN C)RAING. . . . .
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . .
1-PIVATORlES. . . . . L)THLR f XTERES. . . . . :
-F UB/bFIOWERS. GEWE,R LINE (Tt, *1- . . - .
W1-4T E!i GLOSE1 WATEk LINE (ft:) . . . .
T)ISHWASHERS. RAIN DRAIN (ft ) - - -
In,�tali res' I bAcH 1 low aevice foi, 'lawn sipt, Sys.
t.jwn er : FLL5 -
f'[:.'VLN GORWIkl type ant(ji-int icy (J at 4? r-ecpt
ipaoo SW 115r; 1 AVENUL PRMT 4 15. ori LA Ft 93-237
7-5 B R 0 3 3 23 7
I 6A N D U R L 3�
one 10:
, actor'..
�iRCIUR 1,401 01"1 11*11-E'
it. 15. 77-, T'01AL
14
REOUIRED INSPLCTIONG
This polvit is issued subject to the regulations contained in the Top-oLtt insp
T gard Muricipai Gide, state 0' Cre. cpe,-ialty Ccdes and all other Final inspection
applicable laws. All wo'. q,,l be done in accordance with
approveo plans. This pervit will Pipiri if mcwk is not started
within !80 days of issuance, or it work is suspended for more
tur 16*1 days.
CL
call for inspection 639--4175