13725 SW FERN STREET i
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BLJILDTNG PERMIT
PERM."T #. . . . . . . : BUP94-020c-
C11Y OF TIGARD U,ITE ISSUED: 07/27/94
COMMUNITY DEVELOPMENT DEPAI�TAK
13125 SW Hall Blvd.Tigard,OrGgon 9722'1.6169 (50)illg-V1 PARC:-7L.,. -ESTV41M1--"400
SITE ADDRESS. . . : - - 1*W-WftLNU 1 :44 ;). :s 10 '°f00 /(M
SUBDIVISION. . . . : 43725 5L,; Fe-r#, -57 - ZONING: R-7
BLOCK. . . . . . .. . . . : LOT. . . . . . . . . . . . .
REIS5UE: FLOOR EXTERIOR WALL CONSTRUCTION--
CLASF OF WORTS. :DEM FIRST. . . . Sf N: S: E: W:
TYPE OF USE.,. . :SF SECOND. . . : 5f PROTECT OPENINGS? --
TYPE (IF CONST. *5N- THIRD. . . . : Sf N: 5: E: W:
OCCUPANCY GRP. : R3 TOTAL-----: 0 sf ROOF CONST: FIRE RET? :
OCCUPANCY LOAD: BASEMENT. : Sf AREA SEP. RATED:
STOR. HT. : ft GARAGE. . . : s OCCU SEP. RATED:
BSM'T') ME Z Z .') REOD SETBACKS-------------
FLOOR LOAD. . . . : psf LEFT-, ft RGHT: ft FIR qPKL.: SMOK DET. . :
DWELL-ING UNITS: FRNT: ft REAR: ft FIR ALRM: HNDICP ACC,
BEDRMS: lAA FIAS IMP SURFACE: PRO CORR: PARKING:
VOLUE. $: 0
Rem ar,ks: DEMOLISH EXISTING HOUSL. SEPTIC I HE PUMPED, FILLED, & INSPECTED.
CREDITS FOR PARKS SDC, STORM SDC, OND TIF WILL APPLY TO NEW HOME.
OwnsFEES
DANIEL TEPEI type amount by date i,ecpt
13725 SW FERN ST PRMI $ i25. 00 JG 07/27/94 -
5PCT f 1. 25 JG 07/27/94 -
T I GARD
TIGARD OR 972c'-_'3
Phone #: 646-1269
Conti-actor-:
FITZGERALD HEATING
P. O. BOX 212062
MILWPUKIE OR 97269
Phone #1 503-653-2775 $ 26. 25 TOTAL
Reg #. . : 83617 REQUI4ED INSPECTIONS
This permit is issued subject to the regulations contained in the Pump/Fiil Ser tic
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Ins pec ion
applicable laws. All work will be done in accordance with
------
approved plans. This permit will typire if work is not started
within 184 days of issuance, or if work s st.spendpd for more
than 180 days.
er^mittee !'i gnat ut :
By
Call for, inspection 639-.4175
Resid.--ntial Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
Office Use Only
Subdivision: �. Lot#
Planck/Rec#
Valuation:
Permit#
Corner Lot? Y
-� Reissue of
Flag Lot? Y N)
Map & TL #� ^_
Owner: �N-,,i\ ��. Approvals Required
Address: l_� F, Fir Planning
Engineering .�.
Phone: yz-Lq — Other
Contractor: >;-1e.j�; t 1 711+-, Items Required
Address -- Subcontractors
Truss Details
Phone: !; 1 1 / rel• Z��-1141 Other
Contractor's [-:cerise #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Architect/Engineer:
Plumbing: _ Address _
Mechanical:
(attach copy of current OR Contractor's License
Phone.
JOB DESCRIPTION: . Lr,.•1, «�, la�.� �1 Lis.. �___ �_ __�
Applicifnt Signature & Phone number
Received by Date Recelved:
N ORDWOMDEVARESAPP
Permit# Account Description Amount Amt. Pd. Bal. Dve
_ Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH) _
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (Sr)SDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commerri;;; "I IF (TIF-C)
Industrial TIF (T'F-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O) _
Water Quality (WQUAL)
Water Quanto (WVUANT)
Fire District (FIRE)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (FRPLHN)
Erosion Planck/COT (EROSN)
TOTALS:
DEPARTMENT OF LAND USE&TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
r/1�N-�/ INSPECTION REQUESTS: 503/640-3561/693-4415
\\J�O �� ii f PHONE: 593j$ 8-B761
Perm1C 'lypr 1«r lue:lltlal L'Iect. ri e 1.i Permit # U`+f)`_,'/r'%
Pc•tini t; �*'tat,I.;.. Al PROVLL) Applied 08/18
.Situs Address 1:3'/L� c,W t-'f-:HN ,.''1' '; iSsue.I Ut1/'.Lt'/
!'ernut 'Title _FH NEW HU1.+_i1-, l:ompleted
Permit. Uescr • 10 k:xl)1rf UL/14/
!to lect Titic� t'1i NI-134 HUU':iE 1'tc;jee r # : E100431"
Project
Parc_tel. Number 251'1'1 Land U:�r Uistt ict
Valuat i-tl )
Legcai Ue�scr .
Uwtl(.'r 1Nz)Ph; :'lUN '1'16AHL) cgll,�truction
Appli.c•a1it. Name URLLA, tuts 1 N LLQ:( Lt_ c'J..i�'i 1 it at i r: n tUn
Applicant Addr . : 2901 :iL 1 e iTH ()ecuj:_'),ane'y
YI_+11'1'LAN0 (.)H + /21-,h Vaioat .�e_1 I>y L•:b
Applicant Phone :
/bZ- 2269 �'
CUN'1HACTUH : HU131N (UkLLA k:Ll✓l:': ttlt.' Lir 1' Zh- /b2c; /rrl--,..:r, )
�rele description Unit^ i•'ce/IJrlit Kxt i (.•e f.)•i rl
uare IV'l-)o t ca(1e Enter ::r e'1 , 1 t
Subtotal Electrical
9
St.ate
'Total Lief t r ical Ir ee:; : I X14 .
k* k I•ef?s ke(Allir`•.1 *kk k * A F e.••; I c�Ilectc 1 a, 1_tec.fit. G
-- -- --- - --- Mct.hocj Check ri fteccii: + N :) . 1)atc 1'c yntf:rrlt
CK 141`) ut-i/118, 94 1911
TOTAL '1'H 15 D/0'H * * A * k A k k A
tee:>, : 194 . ib
U(I I',-) e'ree3: t; : Li
'Total Fees : 194 . 2:-, l'otaI Payments 194 . Z'•
iia lane:e� Oil
NOTICE This permit hecornas null and void If the work or construction for which If Is Issued Is not commenced within 1130 days. Once cons-ruction has started,
the permit becomes null and void If construction Is Interrupted for a period of 180 days I certify that the Information presented by the applicant and
his agent or agents In support of this permit Is true and correct to the best of nur knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Informatlon may Invalidate this permet. All provisions of appllcahle laws and ordinances governing the construction and use
of this building or struch,ra will be compiled with whether or not specified on file plans or noted on the plans rorrectlon sheets I acknowledge that
the granting of a permit does not grant authority to access private property or to use easement I further acknowledge that the use or occupancy 01
the structure or bullding permitted depends upon my calling for Inspections at variou+times during the process of construction and the building
Inspection staff verlfving compdance with the various codes. Use.)r Occupancy of the building or structure permitted prior to app,oval by the
Building Department Is solely al the 014'�DIM*. illcant and such use or occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by the Building Official. I fOrther__knowledge that a Ilan maybe placed on the title of the properly upon which the permit is Issued
specifying that the use or occupancy of the building or s:ruclure Is p ovislona'and revocable unlit the s :I ctl(�n of all Ir pectlon requirements
APPLICANT'S SIONATIIRE
DEPARTMENT OF LAND USE&TRANSPORTATION
WASHINGTON I-AND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
COI 1�TY1 INSeECTION REQUESTS: 503/640-3561/693-4415
V PHONE: 503/648-8761 _� t,,j U .j"t ;
OREGON Page , (.)L
I bate 1;8 1
'fume lh : U'/
t'(r'tlTtlt 'L „ KeG.l,leCTtl.-+.i. h.1,-CtrlC,a.1 NNLRI] t r�1ITTit � (:`.+U'� /2!i,:
l'r t.(TI 1.1: SLcltu AYL'KUV!: U
App Iie,1 : 06/18/94
.-itus Addzes-- 13 /25 ,W k LN,N ;,'1' '1'1 J.c,*,ti i 08/1ts/ l4
111•rml.t Tit. l - :: r13 -- [)Iet,:(.1
t�ermlt
Des 'Iu Expiir-• lit/14/'.-t`.'
I'ta pct. '1'ttlF• . Si-li - NEW HOIJSk: pr(jJec.t. N 1'IIU931 H
Prc ject UeJcr .
* r;KUb.L l.I1V A ,
parcel Nr.unt.r t 2 1'.L'i. -. Ldn,'1 Use District
Valuation U
Loyal Ue pct .
UWl'ler LN,: ECA'iUN - '1'1l�AKU C,11ctruct.ion U'1'H
Applicaiit. Name, UKLE.A, KUBLN LL1;(."!'EtLc_ c.L.ir sif kation 900
App i. ican t. A(.Idt . : 2901 5iE 119TH t-)�'c uj�nrtcy
PUP'I i,AND 014 9'/21)6 Vrli.ldat e(I Jty k::13
Applicant: Phc)ne : '/u2-2,,f--) I Jri: l_,f•ctc,t' Arc.-a
CUN'1'KAC"Tc?K : Hljbj.N UKLEA ELE;t."1'K1(.: J.,lr (. 66 C '/62-22t.,'4
Fee desciiptiart 11nit0 E•'e1=•,'f.;:lit Ext tee Data I
ZOO-anTt., 'ot lc?s.___.-- -- ----__ 1 5U , U(I
Suk_,tot.al Es'lectt: i( al k•'ees—
Total Liectrical Fef--. :
AAA t•'ee^ HI-411-11l.e(1 AAA AaA k•',:�(>�, C'c,1.Jer_'tP(E b f:redits ** '
ME!t.h Od c_'heCk # P-ceij 1. N-) . Datr' k'aynlent
K 1415 ()H/1Hj44 `,1. . 1,..
'I'UTAL J'H I.:; [;A'l't: A* A A A A A A 52 5 u
Ad Jus t.menr.; : (I(.i 1'nt ,11. c_'t r.•cf u;.
.i o i-a1 Fees : 1 l'nt .a1 1'3yillr ` 2 . '7tl
1.fa iartl e ltu I)
NOTICE This permit become*null and vold 11 the work or construction for which It Is Issued Is not commenced within 190 days. Once construction has started,
the permit becomes null and void If construction Is Interrupted for a period of 190 days 1 unllfy that the Information presented by the appllcan,and
his agent or agents In support of this permit Is true and correct to the best of our knowledge I acknowledge that the Building Deparlmeni's reliance
upon false and misleading Information may Invalidate this perm" All provislona nl applicable laws...d ordlnsnces governing the construrtion and use-
of this building or structure will be compiled w"lr whether or not specified on ilia plans or noted on the pl.ns correctlon sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements I further Acknowledge that the use or occupancy of
Ilia structure or building permitted depends upon roy calling for Inspections at various times during the process of construction and the building
Inspection atoll verifying compliance with the various codes- Use or occupancy o!the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until oil Inspection requirements are satisfied and
approval Is given by the Building Official I further acknowledge that a Ilan may be placed on the title of the properly upon which the permit is issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the sail�l(s+t tier{of In1eclIiort requirements.
J
APPLICANT'S SIGNATURE
GTON
Department
COUNTY ELECTRICAL PERIV I
_ Department of Land Use & Transportation
Electrical Inspection Section
155 North First Avenue, 11350-12 APPLICATION
Hillsboro, Oregon 97124
Information: (50j) 640-3470 Fax: (503) 693-4a12
Permit ,r
PLEASE PRINT Number - 572 5/q Date
�4. Complete Fee Schedule below
1. location of installation Number of Inspections per permit allowed
Address 137 ___ S uJ r-E-�M �T _ Service included: Items Cost(ea.) Sum
Buildingg A. Residential - per unit
City T'i t��}R—� Suite fJo. p ,/O,
ft.or less $1 10.0 0 G4
Tenant Name Each a 1000 sq.additional 500 s ft
(i1 commercial) _ q
- or portion thereof _ $2500
Map No. Limited Energy $25.00 __ 1
Tax Lot Each Manuf'd Home or Modular
Dwelling Service or Feeder $66,00 — 2
Thomas Map Book: Page: Section: A
Directions--------__ B. Services or Feeders
Installation,alterations or relocation
-w—
200 amps or less $60,00
Commercial Residential Y 201 amps to 400 amps $80.00 _
401 amps to 600 amps $120.00 _ 2
2a. Contractor installation only: 601 amps to 1000 amps $180.00 2
Over 1000 amps or volt, _ $340.00 2
Addreis 2Electrical Contractor R_U IN U__ Re —' --
� tl connect only $50,00 _
901 S — `
Date -� Job Number _ __ _ C. Temporary Services or Feeders
Property Owner Installation,alteration or relocation
Contractor's License N— a, �6_=762 -- 200 amps or lase SSo.00 _av
Contractor's Board Reg. No. -77(c) --7 - 201 amps to 400 amps $75.00 z
401 amps to 600 amps $10000 2
Signature of Supr. Elec'n Over 600 amps to 1000 volts see•B•above
License No.�795t) PhoneD. Branch Circuits
New,alteration or e0ension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or feeder lee.
Each branch circuit _ 2
rinl b Harte acme _ _ - Phone--Nn- _-- _ $5.00
b) The fee for branch circuits without
Address - - ---- - purchase of service or feeder fee.
First branch circuit $35.00 ?
city tate Each add'nl branch circuit $5.00 2
E. Miscellaneous (Service or Feeder not included)
The installation is being made on property 1 own Each pump or Irrigation circle $40.00 2
which is not intended for salt:', lease or rent. Each sign or outline lighting $40.00 2
Signal circuit(s)or a limited
Owner's Signature ..___._ energy panel,alteration
or extension $40.00 _ �Y 2
---- F. Each additional inspection over the allowable
in any of the above
3. Pliln Review section If required) Per in!q,,_..fief1 $..s
Please check appropriate hem and enterfee In sectior158. Per hour _ x55 00 __
In('Inrt
�4 or more residential units in one structure $55 00_
__Service and feeder, 800 amps or more S. Fees
_System over 600 volts nominal A. Enter total of above fees $ _
_ .__Classified area or structure containing special 5°6 Surcharge (.05 X total fees) $
occupancy as described in N.E.C. Chapter 5 Subtotal $
Submit 2 sets of plans with application where any of the B. Enter 25% of line A for
above apply. Not required for temporary conrfructlon Plan Review if required (Section 3) $
services. Subtotal $
Less Bulk Label Fee $
For inspections call Balance Due $
I his perm"becomes null and void If the work sulhorlrod by the perm"is not commenced
640-3561 or 693-4415 within 100 days from date of Issuance of such perm"or"'he work authorized is
24-hour recorder, one working day in advance of need
suspended or abandoned at any time a"rr work to commenced for a period of too day a.
Electrical Permits are non refundable and non traneferabi*
4'94
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, PHONE: 503/640-3470
OREGON INSPECTION R - hours): 503/,'40-3561 or 693-4415
Permit. u5-1i8i Proj&ct. It P00431SO Lt.at.v,i; �.4i- Pidu4iil Y„e;m 1 of
Ai:pli*d H/18/94 Iarued 08/18/94 Expxr& (12/14/9' Oji/I1 /95 os . (, !
RESfiLEC
Permi t T3 t.1 a ::Fit - NEW flolI F OTH
Dercription BEgun : 08/18/',A
j.-)h Addr*ass 13125 SW FERN nT TI
'.,weer Nam* INSPECTION - TIGARr) Rrgic,n 0
li
Applicant. Name URLEA, RUBIN ELECTRI _'
Phone nuvLber 762-2269 Valuat.1011 U
Inspector Covarwent r Re j*ct*dY___-----
I VR-kfiSLILI`.
RF:offS5T ERR,:
Plumbing
Mechanical
Electrical
Struc:trual
(len*ra
i ri:spec t.ed by - .._- .__ __ Dat.: - � / .S_
lr,sp,*.-tion Requwgt.t:i
* Covor & Servic q 9403 E AP DN i�IR
05/11/95 R1 MAS'