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12165 SW 126TH AVENUE 1 12165 SW 126th Avenue CITY Y OF TIGARD --- MASTEF' PERMIT PERMI! #: 1v1ST2002-00158 DEVELOPMENT SERVICES DATE IS!,J D: 3/18,102 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12165 SW 1 :61-H AVE PARCEL: 2S104AA-03100 SUBDIVISION: BELLWOOD ZONING: R-4.5 BLOCK: LOT: 035 JURISDICTION: TIG REMARKS: 12x14 Addition (168 SF) to NE (.orner of existing douse. BUILDING REISSUE: STORIES: 1 FLOOR AREAS _ Rr'11: .ED SETBACKS_ REQUIRED___ CLASS OF WORK: ADD HEIGHT: 8 FIRST: 166 of dASEMEN r. of LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR,.OAD: 40 SECOND: at GARAGE' ^i FRONT: PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: s1 RIGHT: 16 VALUE: $ 15,22000 OCCUPANT"GRP: R3 BDRM: 1 BATH: TOTAL: 168,00 at REAR: 27 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS. RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: I IJBISHOWERS GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FUhi:<100K: BOIL/CMP<7HP: VENT FANS: CLOTHES DRYER: FURN>•170K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCCS: VENTS: WOODSI'OVES: GAS OUTLETS, ELECTRICAL RESIDENTIAL UNIT SERVICE FEET' R TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS — __ADU'L INSPECTIONS 1000 SF OR LESS: 0 200 amp: 0 200 amp: WISVC OR FOR: 1 PUMPIIRRIGATION PER INSPECTION: EA Ar,D'L 50CSF: 201 •400 amp: 201 40U amp: lot W/O SVC/FDR: SIGNIUUT.':'.T: PER HOUR. LIMITED ENERGY: 401 600 amp: 401 - 600 amp: EA ADDL BR CIR SIGNALJPANEL: IN PLANT MANU HMISVCIFDR: 901 1000 amp: 60-amps-1000w: MINOR LABEL. 1000+amp/volt PLAN REVIEW SECTION _ Reconnect only: >+4 RES UNITS: SVCIFDR>+229 A.: >600 V NOMINAL: CLS AREAISPC UCC: ELECT RICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.Cr MMERCIAL_ _ AUDIO&STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTEPLOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA11 ELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Contractor: TOTAL FEES: $ 509.54 Owner: This permit is subject to the regulati-ins contained in the ALAIN FAHIO OWNER Tigard Municipal Code,State of Ort. Specialty Codes and 12165 SW 126 T AVE. all other applicable laws. All worts will be done in TIGARD,OR 97223 accordance with approved plans This permit will expire If work Is not started with in 180 d eys of Issuance,o, it the work is suspended for more than 180 days. ATTENTION: Phone: Phone Oregon law requires you to foltowrules adopted by the Oregon Utility Notification Center, Those rules are set Reg a forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of thee.4 rules or direct questions to OUNC by calling(503)2/d-1987. RILQUIRFD INSPi=CTIONS ", Electrical Rough In I mal insllel hrn Footing Insp Insulation Insp Foundation Insp Rain drain Insp Underfloor insulation Electrical Final —I Electrical Service Plumb Final Issued By: Permittee Signature : �' �►rn�-Pw Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next uslness day r� 45f'3-i-0 z 'S Building Peewit Application t Datereceived: 7 2 Permit no.: jS%7___ City of 'f igard � ProjecUaN;�I,no.: Expire date: CiryofTigard Address: 13125 SW H ����all Blvd, lgard,Phone: (503) 639-4111 Datcissued: ny: Fax: (503) 598-1960 Case file no.: Payment type: t`'t Y ��' I&2 family:Simple Complex: Land use approval. 11 i 1 &;family dwelling or accessory U Commercial/industrial U Multi-family U New construction U lDemolition Addteration/:replacement U Tenant improvement U Fire sprinkler/alarm U Other:lob addj i vC �i,Ll �. G: Bldg.no.: Suite no.: Lot: j Block. Subdivision: _,,,y ;a ��Trax map/tax lot/account no.: Project name: �)CLf AA L�. Description and location of work on premises/special conditions: 7 -iUNow /Q -- Name: A l ��l I f� ( 11. t Mailing address I?-(v -Fo I & 2 family d"elling: o� City: TIl J.i J State:l.' ZIP:` 72 2 �. Valuation of work........................................ $ L�= Phone � i `i 9'%'1 Fax: E-mail: No.of bcdrooms/haths................................. _ --- Owner's representative: Total number of floors................................. tax• r-mail: New dwelling area(sq.R.) .......................... W&I U 61 1101 0hrage/carport area(sq.ft.)......................... —- Name: n �� -� - Coveted porch area(sq..... ft.) .......................... -- -_ -- Mailing address: � -r-r� Deck arca(sq. ft.) . -- Oilier structure area(sq. ft.)......................... City: State: ZIP: Phone: ' • i- Fa C E-mail: t ommercial/industrial/multi-family: ytr Valuation of work............................ ........... $ Existing bldg.area(s t.) ..... Business name: ' �` _ New bldg.area(sy.ft.) Address: Number of stories .... ............. City: State: ZIP: Type of construct' ... Phone: I'ax: - E-mail: Occupancy group(s): Existing: —__.-_--_-- CCB no,: _ _— New: _ City/metro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Constiuction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in the Address: _ jurisdiction where work is beit:g peifotrned. If the applicant is City: -- Sldll. 71I': exempt from licensing,the following reason applies: Contact person: Plan no.: Phone: Eat E-mail: -- -- __ Name: I t nt,) i person: Fees due upon application ........................... Address: Date received: City: State: ZIP: Amount received ......................................... S --- Phone: Fax: _ E mail: Please refer to fee schedule. — _M I hereby certify I have read and examined this application and the t:,all iuridktions acct"credit tarda,pkat call itseiv ictlun ra tare inimrantion attached checklist.All provisions of laws and ordinances governing this U visa U Mastercard work will be complied w�th.whether specified herein or not r c.edlt cord numho: — Authorized signature: _ _�'• Date: 1.r` Name or cardholder a shown on cmdi cud Print name: i t Can olsn.:.ure ; Amount — Notice:1 his permit application expires if a permit is not obtained:ithh.190 days atter it has been accepted as complete. W V,I I tMXWOM) One-and Two-Family Dwelling Building Perinit Application Checklist Reference no.: Ciryu('!'tg`rrd City of Tigard Associated permits: g U Electrical U Plumbing U Mechanical Address: 13125 SW lull Blvd,Tigard,OR 97223 ❑Other: Phone: (503) 039-4171 �— Fax: (503) 598-19(ni tED FOR PL N REVI Yes No N/A I ]Land use actions completed.See jurisdi-tion criteria lirr concurrent reVICWS. 2 Zoning.Flood plain,solar balance points,seismic soils designation,tsistoric district,etc. 3 Verification of approved platllot. _ 4 Fire district approval required. S Septic system permit or authorization for remodel.Existing system capacity fi Sewer permit. 7 Water district approval. 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit rt red.Include drainage-wa protection,silt fence design and location of catch-basin protection,etc. i 10) 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state - building codes.Lateral design details and connections must he incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if co yri ght violations exist. 1 I 'Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property cosier elevations(it' there is more than;14-11.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direct n„c�lot arca;building coverage arta;percentage of coverage, )us area;existing structures on site;and sur" 'age. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection vent size and location. _ 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,ate. 14 Cross section(s)and details.Show all framing-membLr sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction. More.than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,rxrf slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and rcmodeis. Exterior elevations must reflect the actual grade if the change in grade is greater than four rout at buildit,q envelope. i'ull-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for — non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/ro of assembHr I,indicating member sizing,spacing,and hearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and u tails showing placement of rehar. For engineered system.—,,see item 22,"Engineer's calculations." 19 Beam calculations.Provid.;two sets of calculations using curent code design values for all beams and multiple joists over 10 feet long and/or any beamdjoist carrying a non-uniform load. 20 Manufactured fioorlroof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided. n �hcar wall,roof truss)shall he stamped by an engineer or arch itecl licema•d in t h­Pon and shall he shown to he ,s11l1hcahle In the project undor review. 23 Five(5) .ate plans it,,reyuned liar Iletll I I shove. Site plan~mint hr K 1/`" x I I"or I I- x 17". 24 Two(2)sets each are required for Items I o, 19,20&22 ahus e. — 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale" indicates standard 'ritect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List. Checklist must he completed hefirre plan review start date. Minor changes or notes on submitted plans may he in blue or black ink. Red ink is reserved for department use only. W-4614 rrraacono Electrical Permit Application — � Date received: Permit no.: City of 'I,igard Projecl/appl.no.: Expire date: City n(Tigard Address: 13125 SW Itall Blvd,T igard.OR 97223 Date issued: By: Rcceiptno.: Phone: (503) 639-4171 Case file no.: Payment type: Fax: (503) 598-1960 Land use approval: _ 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U'T'enant improvement U New constniction U Addition/alteration/replacement U Other:— ❑Partial 1 1 L,)I,,,,dss: 1 14 S `.�'= /No rN ( Bldg.nu.: Suite no.: Tax map/tax lot/account no.: Blo k: Subdivision: me: Description and toation of work on premises:date of completion/inspection: Com1 Fee Max Job no: - ca. I otal no.ins n Business name: _ - -- Newrrsidendal-sin-gleormulh-fatnilvItel Address: _ dwellingunir 6rchukwalli'd rigar"ge. City: Stale: – ZIP: Service included: Phone: Fax: l mail: 1000 sq.ft.or less d Each additional 500 sq,ft.or ortion thereof CCB no.: Elec.bus,lie,no: I.imitedenrrgy,residential 2 Limited energy,non-residential 2 City/metro lic.no.: Each manufactured home or modular dwelling _ — Service and/or feeder 2 Signature of supervising electrician(required) s Dote Services or feeders-Installation. Sup.elect.name(print): License ria: dterallon or relocation: TUMEM 2W amps or less 2 201 amps to 400 amps 2 Name(print): AL Kit-A R • i Ae'1(' m 2 401 amps to 600 aps Moiling address: - nt.'- I k'rl-1 ti 60'amps to 1000 aloes 2 City: Ilr({Pt') State: t 1 ZIP: 12-7 ? Over I(M amps or volts 2 Phone: C ', ,� C,'PL Fox: E mal: Reconnrctonl 1 To-,r„.,-n'services or feeders- Owner installation:The installation is being made on property I own irstallation alteration,orrelocatlr it: which is not intended for sale,lease,rent,or exchange according to 2(N)amps or Ic+ _ 2 ORS 447,455,479,67f1;J7RI. ) ( 201 amps to 4G 1 amps 2 JJ I 11 Date: 2 '�! 4UI106011am 2 Owner's si naturc: 3 �__.- ENGINEER Dranch circuits-new,alteratlon, or extension per panel: Name: A. Fee for branch circuits with purchase of - service or feeder fee,each branch circuit Addrefts: State: ZIP: B. Fee for branch circuits without purchase Clly: ----- of service or feeder fee,first branch circuit. - 2 Phone: Tttx'. E-mail: Each additional bianchchruit IK.(Ser or feeder nut Included): Each um oriniltallOoLuVIC 2 79U Service river 225 amps-comniefdol j I It -care facility Each sign or outline II htin _.._-'___ service over 320 amps-rating of 1&2 U Ha,irdous location Signal circuit(sl or u limned energy panel, familydwellings U nodding over Itc'Xx)square feet four in Signal cir ui C%)or lit• System over 600 yr IS nominal more residential units in one structure _-. -- ❑Building over three Stories Feeders,400 amps or more •tkscn tion:_--- --- -- U Occupant local over 99 persons U Manufactured structures or RV park Each additional inspection oter the allowable in army—oaf the—ab�ov—e U F.gressIlightingplot, U Other! _ ---- Per inspection I 1--1-- Submit nu of plass with my of the above. Investigation fee — 71e above are not applicable to temporary comitrudioo net vice. other Permit fee. .................. -- No all luNsdichuns accept credit cards,please call iurixlicnoo for more information Notice:This permit application Plan review(at 9b) $ UVisa U MasterCard expires if a permit is not obtained within 180 days after it has Men State surcharge(8%)....$ — uredo cold number: i -- a tea _ accepted as complete. 'TOTAL .......................$ .— --. Name of cu o r as shown on c it c s 461 S 1NtxK'OMI Cardholder signature Amount 4Mt ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Com leta Fee Schedule Below: — — p I Restricted Energy Fee..................................................... $75.00 r— Numb?r of Inspections Eer permit allcwed 1 (FOR ALL SYSTEMS) Service included: Items C,)st Total Check Type of Work Involved: Residential-per unit 1000 sq It or less _ $145.15 I ❑ Audio and Stereo Systems' Each additional 500 sq It or portion thereof _ $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $90.90 ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation ar.d Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 El Vacuum Systems' 401 amps to 600 au ips _ $160.60 2 601 amps to 1000 amps $240.60 ❑ Other Over 1000 amos or volts $454.65 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $75.00 200 amps or less $66.85 (SEE OAR 918-260-260) 201 am;•to 400 amps $100.30 __ 2 401 amt._to 600 amps $133.75` 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. ❑ Audio and Stereo Systems Branch Circuits Now,alteration or extension per panel ❑ Boller Controls a)The fee for branch circuits with purchase of service or L, Clock Systems feeder lee. Each branch circuit $6 65 _._ ❑ Data Telecommunication Installation b)Thu fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 HVAC Miscellaneous Instrumentation, (Service or feeder not Included) Each pump or Irrigation circle $53.40 Each sign or outline lighting $53.40 _ E:j Intercom and Paging Systems Signal circuits)or a limited onergy panel,alteration or extension $75.00 _ �J Landscape Irrigation Control' Minor I-abels(10) $125.00 Each additional Inspection over I ❑ Medical the allowable In any of the above ❑ Per inspection _ $62.50 Nurse Calls Per hour $6250 _ In Plant _ $1375 ❑ Outdoor Landscape Lighting' tees: ❑ Protective Signaling Enter total of above fees $ ❑ Other 8%State Surf harge $ __- — Number of Systems 25%Plan Review Fee See'1Ilan Review"section on $ No licensee are required licenses are required for all other installations front of applk atlon ___ ----- - - Fees: Total Balance Due $ ---- Enter total of above feet $ C7Trust Account q 8°4 State Surcharge = _ Total Balance Due $ All New Commercial Buildings requlro 2 sets of plans. i,ndstx\fomu\eIc-feee.doc 08/30/01 �r D � .\ J ol b n a 9� +in UN t (iN � r 'G 0� cn o M ......... 7 ' � 12 ,jI• /i; r - re a s� i N ,Bim P� ME j-o3 - S90► M?7 /Ac"* Alf. LbT .3 5� f� fl wee 0 s�► '� S O .1•r�3 i v c� ,� - rc good s r- Permit#: 11n5 -), —L---Q158 _ Q Address: �_`'�\ 1� }_U.►. 12�� --- J � o Z z Issued by: Date: Statement: Information Notice to Property fawners About Construction Responsibilities No—,: Oregon Law, ORS 701.055(4), requires residentialconstruction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building,jermit can be issued. This statement is required for residential building, electrical, mechanicvl, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. )~ill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: I. 1 own, reside in, or will reside in the completed structure. 2. I 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 — l-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 © 3B. I will be my own general contractor. If I hire subcontractors, 1 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. I hereby certify that the above information is correct and Ili-it I have read and do understand the Information Notice to Propert Owner t out Construct!;..) Resimosibilities on the reverse side of this form. (Signature cut'permit applicant i (Date) (White copy to issuing agency,permit fila, pink copy to applicant) A CITY OF TIGARD 24-Hour 5INSPBUILDING Inspection Line: (503)639-4175 MST - &'0 /5- INSPECTION ECTION DIVISION Business Line: (503) 639-4171 BUP _ - Received - _Date Requested AM PM __ BUP Location ��1 / �% > �G suitte- MEC Contact Person Ph( ) �/`�l 2130 y PLftr! __ ------.-----.-_- Contractor ---- ---------- -- -- Ph ( ) - - -- SWR - ------ __BUILDING Tenant/Owner - __- ___ ELC _— Footing� ELC _ ---- Foundation Access: Ftg Drain ELR ---- Crawl Drain Slab Inspection Notes: i - SIT Post& BeamShear Anchors Anchors Ext Sheath/Shoar Int Sheath/Shear Framing — Insulation Drywall Nailing -_-- --- _- -- -_-_. -_ Firewall Fire Sprinkler - -- Fire Alarm Susp'd Ceiling - - -- Roof O F ) AS PART FAIL - PLUMBING Po_`st& Beam Under Slab - Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain -- --- - -r-/-�-- -- - -Shower Pan r -cr1.� I -.�O �.� - &o.✓ �LS�J , () 'LJ. OthaL_11i3z;AK, -------- ------- Ina i PASS PART FAIL -- --- - - - -- MECHANICAL Post& Beam Rough-In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL _ Service Rough-In UG/Slab Low Voltage Fire Alarm 14!121=5 0 Reinspection fee of$ __ required before next inspection. Pay at CityH 125 SW Hell Blvd, S PART FAIL MTV- Please call for rernspecti n RE: _ _ _— &n-able to inspect-no access Fire Supply Line ADA Date I L (J Inspector ExtApproach/Sidewalk — Other:_ Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL