11180 SW 115TH AVENUE ADDRESS:
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CITY Or TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Linc: 639-4175 Business Phone: 6394171
Date Requested: �� 7 A.M. P.M. MST: 4k,—0 3`1
Location: / — (��n't BUP:
Tenant: '*�71 Suite: Bldg: _ Ivf�C: —�
Contractor:_ L-a ,4::/ Phone-v Phonee ..S l/� FLM: _
Owner: -- —�1 — Phoile: �'! ELC:__ —
--- —— ELR: _
SIT: _
BUIL.DUgG BLDG— c�) PLUMr.ING MECHANICAL C/tLECTR.If.W SITE
Site earn Post/Ream Post/Beatnover Service Sewer/Storm
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vault
T3smt Damp Drywall Stonn Furnace "Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Sjtry„'�hr:�t}t Fire SpMr/Alyn Crawl/Found Dr Heat Pump Low V
Approved Approved Ap)rave Approved
Appr/Sdwi), Not A roved Not Approved Not Approved of ved Not Approved
1NAL FINAL FINAL INAL FINAL
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red before next inspection 0 Unable to inspect
Inspector ------_-__-- _ -- Date. y�/ V �� _ Page of
MASTER PERMIT
PER #. . . . . . . . MST(�Gv--03*71
CITE' OF T IGARD DATEMIT ISSUED: 07/3-1 / 96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223@8199 (503)839.4171 P,ARCEL. IGI.34013-0160121
L. f-i b D 1':I . . . 11. 1 a 0 :;W I i'�_J T I A Fi V L.
SUBDIVISION. . . . : ZONINCS: P-4. 5
LALOCI:. . . . . . . . . . : LOT. . . . . . . . . . . . . .
Remarks: path I ADDING 2 DORMERS
--------------------------------------------------------------- BUILDING ---------------------------------------------------------------
REISSUE: STORIES.......: 0 FLOOR AREAS----------- BASEMENT...: 0 sf REQUIRED SETBACKS—— REQUIRED---------------
CLASS OF WORK.:ALT HEIGHT......... 0 FIRST....: 0 sf GARAGE.....: 0 sf LEFT..........: @ SMOKE DETECJRG: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 140 sf FRONT.........: 0 PARKING SPACES: 0
TYPE OF CONST.:SN DWELLING UNITS: 0 FINB'GMFNT: 0 sf RIGHT.........: @
OCCUPANCY GRP.:R3 DORM: 0 BATH- 0 TOTAL------ 140 sf VALUE.$: 12400 REAR..........: 0
------------------------------------------------------------------ PLUMBING -----------------------------------------------------------------
SINKS......... 0 WATER CLOSETS.: 0 WASHING MACH.,: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........:
LAVATORIES....: 0 D,:4WASHERS ..: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRATNS: 0 CATCH BASING—: 0
TUB/SHOWERS...: 0 GARBAGE DISH..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCHFLW PREYNTR. 0 GREASE TRAPS—: 0
OTHER FIXTURES: 0
--------------------------------------------------------------- MECRANICqL -------------------------------------------------------------
FUEL TYPES----------- FURN ( I MW ..: 0 BOIL/CMP ( 3HP: K 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 OUTLETS...: 0
---——-—-------------------------------------------------- ELECTRICAL --------------------------------------------
—RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRYC/FEEDERG-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADDIL INSPECTIONS---
1000
NSPECTIONS—1000 SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 alp,.: 0 W/SVC OR FDR_: 0 PUMP/IRRIGATION; l? PER INSPECTION: 0
EA ADDIL 50@SF.: 0 201 - 400 amp..: 0 41 - 400 amp..: 0 l5t W/O SVC/FDR: 0 SIGN/OUT Ll" LT: 0 PER HOUR......: 0
LIMITED ENERGY.: @ 4@1 - 69.3 amp..: @ 401 - 600 amp..: 0 EA ADDL DR CIR: 0 SIGNAL/PANEL...: 0 iN PLANT......: @
MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 6014amps-10@0 v: @ MINOR LABEL -10: 0
10004 aRp/yolt.: 0 ----------------------------------- PLAN REVIEW SECTION -------------------------------
I.Pconnect (inly,: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
-----------__----------------------------- ELECTRICAL - RESTRICTED ENERGY ------------------------—-------------------------
A. SF RESIDENTIAL---------------------------- P. COMMERCIAL---------------------------------------------- ------------------------------
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM.....: !NTERCOM/PAGINI: OUTZ: LNDSC LT:
BURGLAR ALARM..: OTH: BOILER.........: HVAC...........: LPNDSCAPIE/IRPIG: PROTECTIVE SIGN:
GARAGE DPENER,.: CLOCK..........; INSTRUMENTATION: MEDICAL.........: OTHR:
HVAC...........: DATA/TELF COMM.: NURSE CALLS....: TOTAL # SYSTEMS: @
Owner. ---------..---------------------....__Contractor: ----------------------------- TOTAL FEES:$ 136.86
CARL ANDERSEN LARRY FINLEY
11180 SW 115TH AVE 7730 BIRCH qVE
TIGARD OR 97223 GRAND RONDE OR 97347
Phone #: 590-4996 Phone #: 879-5609
Reg #..: @867@3
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all othev,
applicable laws. All work will be done in accordance with approve! plans. This permit will expire if work is net started within 180
days of issuance, or if work is suspended for more than 180 days.
----------------------------------------------------------- REQUIRED INSPECTIONS ----------------------------------------------------------
Framing Insp
insulation Insp
5yp Board Insp
rD Pain drain Insp
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Building Final
I S s 1�t e CJ B y
e m i t;t e e 13 i q i i a t; .A t,e
Call far, inspection 639--4175
Aman Check# _
Ih`Y OF TIGARD Residential Building Permit Appl!cation Recd By �r
13125 SW HALL BLVD. New Constriction Additions or Alterations Date Recd -7 If - 'XI
-ICARD, OR 97223 Single Family Detached or Attached Date to P.E._`^!r
iO3) 639-4171 Date to DST ! - 2 Y- �G
Permit# '45116-0�7 I
Print or Type Called-:; "^ Lc aft iii,
Incomplete or illegible applications will not be accepted Name of Subdivision Lot# Name
Job - i --
Address Site Address
Architect Mailing Address
Name
i 1 City/State Zin Phone
Cot /� r
Name
Owner Mailing Address
i i I.L. S, cc ' , /(� ur Engineer "flailing Address
City/State Zip Phone
f ie / f c l� _G�. `� — CitylStale +Zip Phone
Nde
General 0111C u, G % -- ILAl(r, Describe work new O addition O alteratior repair O
Contractor Mailing Addmks to be done:
2 Z, ) Additional Description of Work:
City/State Zip Phone
Oregon Const.Con(. Board Lic. Exp. Date _
Attach copy or U` Cv G Z Project p�
Cu-rent COT Business Tax or Metro# Exp. Date Valuation L/� �m��• ��
Licenses
Name NEW CONSTRUCTION ONLY
Mechanical Sq.Ft. House: Sq.Ft.G3rage: ]
Sub_ Mailing Address u I
Contractor Corner Lot Yes No Flag Lot Yes T iVo
City/State Zip Phare (check one) _ (check one)
Restricted Audio/Stereo Burglar
Oregon Const. Cont. Board L c# Exp. Date Energy System Ala.rn
Attach Copy of
Current COT R_-^-ss '(ax or Metro# Exp. Date Installation Garage Door HVAC
Licenses Opener Systems
Name (check all t'matOtl--r: -'
Plumbing apply) F I
Sub- Mailing Address Will the electrical subcon'ractor wire for all Yes No
Contractor restricted energy Installations?
City/State Zip Phone Has the Subdivision Plat recorded? fJ/A Yes No
Oregon Const. Cont. Board Lic# Exp. Date Reissue of MST# Solar Compliance
Attach Copy of _ _ (calculation Attached)
a Current Plumbing Lic.#+ i Exp. Dame I hereby acknowledge that I have read this application,that the
LL Licenses information given is correct, that I am the owrir or authorized agent of
COT Busint. Tax or Metro# Exp Date the owner ,. +that plans submitted are in corroliance with Oregon
} State I:iv s. _
F- Namm3 �� Signature of Owner/Agent Date
Electrical 'L(. ticiasc —' —
c Contact Person Name Phone
Sub_ Mailing Address
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Contractor / j i� S,�(J /S' A., � FOR OFFICE USE ONLY:
City/state Zip Phony��ql Plat# Map,TL#
t C t r ek_ - 'I
Or, n Const. Cont. Board Lic# xp Uate L,N'. (/i 1
Attach copy or Setbacks Zone: Solar.
Current Electrical Lic.# Exp. Date f /�
Licenses P' )- q.� NJA
COT Business Tax or Metro# Exp Date Engineering Approval: Planning Approval: TIF:
tststmstapp doc �,
P rm' Account Des
iption 8mount Amt. Pd. Ba . Due
M T. Permit (BUILD)
Plumb. Permit (PLUMB) _
Mech. Permit (MECH) _
ELC/ELR Pe,,:iit (ELPRMT)
State Tax (TAX) _ Ly17
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Bldg. y r
Plumb:
hl--ch:
ELC/EI-R:
Plan Check
MST: (BUPPLN)
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Re�iiew (LANDUS)
— — Sewer Connection (SWUSA) —
Sewer Inspection (SWI, - P)
Parks Dev Charge (PKSJC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT) �—
F Erosion Control Permit (E RPRMT)
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Erosion Planck/USA (ERPLAN)
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Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS: X 5f4^.F��iZ-�� ~Jc./. ;
hditWstapp doc
Rev.7196
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 ng -Mech.
PISg.Und/For/Slab P:bg.Top Out Insulation -Elect.
Post/Beanl 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: 0 L 3�
BLIP:
Con/Own: �,—' _ MEC:
PLM: _
ELL:
TH FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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Inspector: — - - - Date:
—APPROVED __DISAPPROVED/CALL FOR REINSP. CF CO
CITY of TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Senilce FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech, Shear/Sheath FramingMach.
P1bg.Und/Flr/Slab Pibg. Top Out i do /-Eleci.
Post/Beam Struct. Mech. Rough-in Gyp. Bd -Bldg.
San. Sewer Gas Line Appt;Sdwlk Reins.
Other: J _
Date: �'? _ A.M. __F.M. Entry: _
Address: 1_lZ 4f0"*
Tenant- — Ste: MST:
BUP:
Con/Own: ��`f/l MEC:
PLM:
ELC:
E FOLLOWI G CORRECTIONS ARE REO IRE D: ELR.
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etr: Date:
_DISAPPROVED/CALL-FOR REINSP. CF C01
CITY OF TIGARD BUILDING INSPECTION NOTICE
inspection : 639-4175 Business Phone: 639-4171
Footing I1 - V lain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath ramin ' f -Mech.
Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mech, Rough-in Gyp. Be. -Bldg.
San. Sewer Gas Line Appr/Scwlk Reins.
Other. � �
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Date: A.M._P.M. Ent
Address:1-1 _���- j _
Tenant: Ste: MST: 96 0�3 71 01
BUP: _
Con/Own: _ :e - MEC:
PLM:
4<'(�f� �''/��l .�� ELC:
THE FOLLOWING RREC710NS AR QUIHED: ELR:
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b,_A''� PPROVEDtSA PROVED/CALL FOR RE SP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Ins,. cation Line: 639-4175 Business F hone: 639-4171
Footing Rain Drain Cover/Se-vice FINAL
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech, i
Plt�g.Und/Fir/Slab Ping. Top Out Insulation -Elect.
Poot/Beam 5truct. Mech. Rough-in CGyIL i3d_� -Bldg.
San. Sewer Gas Line ApprrSdwlk Reins
Other: /46&"_2- c.
Date. -! 7- L A.M. P.. Entry:
Address- Sig)
Tana-, Ste: _ MST 911
BUP: _
Cone—��� MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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Inspector: __- A Date.f
APPROVED _-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. Sheat/Sheath Framing -Meeh,
Plb;j.Und/Fli/Slab Plbg.Top Out Insulation -Elect.
PosV,"Aeam Struct. Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: _ H.M. f Entry:
Address: �'
Tenant: Ste:—._. MST: i 3-71
BLIP: _
Con/
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t��U LY `�7� C N) PLM:
j ELC:
THE FOLLOW14 CORRECTIONS ARE REQUIRED: ELR: _
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Ins ector -- e . uI
Date'
APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE
inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL: t
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Meeh.
Plbg.Und/Flr/Slab Plbg.Top Out Insulatio -Elect.
Post/Beam Stro:,;t. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: —
DatE: A.M. R14. Iitry:
Add-ess: Q � "
Tenant: — Sw- o-j� Ste: MST:
BLIP:
Con/Own:_ MEC: — II
PLM:
ELC. —
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LOWING CORRECTIONS ARE REQUIRED: ELR:
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Inspector: _ _ Date: ��
__ APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO
PAYW-.N*i PLUOP'l NU. 96. 284 138
cHECK AMOON F m 4 J. �'.5
NAME r ANDERSEN, 8HI4.RRILL CASH AMUUNr a 0.00
ADDRESrd 1 11180 bW llb'lH AV6 PAYMLN't DAI U a i ei/o:s/qf.,
SUBUIVISIUN
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1 1,0 Rat OMt UN7 PAID 84. �,,�
Permit 0311 _
Address: j 11so S W ! l S"1^ t�R�� .0 t�
Issued by: L" ,. nate: T3
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 Co arra�-lors Board to sign the
f rllowing statement before a building permit can be issued T hi.s statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt,/rom registration under ORS 701.010(7),
need not submit this statement. This statement will he filed with the permit.
Fill in the appropriate blanks and initial hoxes 1 and 2,and either box 3A or 313:
5311".
1 own, reside in, or will reside in the completed structure.
�,Ir_'. 1 understand that i must register as a construction contractor if the structure is sold or offered for sale
�" before or upon completion.
3A. My general contractor is 1-/t(��`C L. �IJLL� _ (� 7
l-1 (Name) Contractor regis. #
i will instruct my general contra,,,,-that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
313. 1 will be my own general contractor.
If I hire subcontractors. 1 will hire only subcontractors registered with the Construction Contractors
Board. If 1 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
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name of the contractor.
F-
I herel)v certify that the above information is correct and that I have read and do umlcrstand the Information
Notice to Property 0%vners about Construction Responsibilities on the reverse side of this form,
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(Signature of permit applicant)
(White copy to issuing agencv permit file.
pink copy to applicant)
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SS ...........__.........._.............«. . ...........
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ANYWHERE S !T E PLAN
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ZONED R4 (FRON-T 20', SIDE 5', REAR 20' )