13855 SW HALL BLVD r
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13855 SW HALL BLVD
\ CITY OF TIGARD MASTER PERMIT �-
PERMIT #: MST2004 00216
DEVELOPMENT SERVICES DATE ISSUED: 7/20/2004
13125 SW Hall Blvd.,Tigard, OR 97223 `)03)639-4171
SITE ADDRESS: 13855 SW HALL BLVD PARCEL: 2S102DD-00801
SUBDIVISION: EDGEWOOD ZONING: It-4.5
BLOCK: LOT: UU6 JURISDICTION: 110
REMARKS: 816sf. garage attached to resident via breezeway.
eUILUING
REISSUE: CUSTOM STORIES: i FLOOR A, EAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 12 !7=17... of BASEMENT ar LEFT: 5 SMOKE DETECTORS: N
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: If GARAGE If FRONT: u PARKING SPACES:
TYPE OF CONST: 514 DWELL114G UNITS: 1 tHRD sl RIGHT 5
000 00
OCCUPANCY GRP: R0 BDRM: BATH: TOTAL: 0 sl VAI,OF 19, RF.ARt,,
PLUMtsING
SINKS: WATER CLOSETS! WASHING MACH: LAUNDRY TRAYS, RAIN DF.AIN: I',n TRAPS:
LAVATORIES: DISHWASHERS: FLOOF.DRAINS, SEWER LINES: SF RAIN DRAINS. CATCH RASINS:
TUBISHOWERS: GAkBAGE DISP: WATER HEATERS: WATER LINES: DCKFLW PREVNTR: GREASE TRAPS.
OTHER FIXTURES-
MECHANICAL
_FUEL TYPES _ FURN<100K. BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER:
FURN-100K: UNIT HEATERS: HOLDS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOUDSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FFEOER TEMP SRVCIFEEDERS— BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 200nmp: 0 2008mp! 1 WISVC OR RJR: wl PUMPtIRRIGATION: PER INSPECTION:
EA ADD'L 5005F: 201 -400 amp: 201 -400 amp: 1st WIO SVCIFDR: SIGNIOUT LIN I.T: PER HOUR:
LIMITED ENERGY: 401 -$00 amp: 401 -600 amp: EA ADOL OR CIR SIGNAUPANEL: IN PLANT:
MANU HMISVCIFDR: 1101 - 1000 amp: 41104+4mpa-10oov: MINOR LABEL
1000+amplvolt:
PLAN REVIEW SECTION
Reconnect only: —
»4 RES UNITS: SV^IFDR�e225 A. >800 V NOMINAL, CLS AREAJSPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: L4NDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAITELE COMM: NURSE CALLS: TO'rnL a SYS 1 iEMS:
TOTAL FEES: b 661.94
Owner: Contractor: This permit is subject to the regulations contained In the
13855 3855 SBOGAN, BUTCH AND SUSAN H,ANSUM OWNERR Tigard Municipal Code,State of OR.Specialty Codes
1HALL BLVD and all other applicable laws All work will be done in
TIOARD,OR 97223 accordance with approved plans This permit will expne
if work Is not started within 180 days of issuance,or if the
work is suspended fur more than 181)days.
Phone: 503-312-2418 Phone: ATTENTION Oregon law requires you to follow r -s
adopted by the Oregon Utility Notification Center. Those
Rep" rule are set forth in OAR 952-001-0010 through
952-001-0080. You may obtain copies of these rules or
direct quastlons to OUNC by calling (503)2.46-1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681-4444 Shear Wall Insp Final Inspeetinn
Slab Insp Exterior Sheathing Inst
Electrical Service Rain drain Insp
Electrical(tough In Electrical Final
Framing Insp Plumb Final
Issued By : a� Permittee Signature A41_
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business 4y i
BuiLding Permit Application
City of Tigard Received PemiitNo.:
Date/By:: / i1�,a'T �1 -o0,% b
13125 SW Hall Blvd.,"figard,OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 Diu'/Sy'
ate/By Other Permit:
Inspection Line 503.639.4175 Date Ready/9y: — laru ® see Auacned Checklist for
Intemet. www.ci.tigard,or.us Notified/Method:-�— __ - 'r Supplemental Information
TYPR OF WORK 1RE gUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit tees'are based on the value of the work performed.
-- --- --- - - --- - --- Indicate the value(rounded to the nearest dollar)of all
❑ Additiotl/alteration/replacement ❑--Uther. equipment,materials,labor,overhead,and the profit for the
C'A'T'EG'ORY OF CONSTRUCTION
�t'ork indicated cn this application,
T - —
__-__- Valuation $
_I-and 2-family dwelling 0 Commercial/industrial
❑ Accessory building ❑Multifamily Number of bedrooms: y
❑Master huilder ❑Other Number of bathrooms:
JO13 SITE INFORMATION AND LOCATION Total number of floors,
Job site eddra9s:_IG �L (j1_ New dwelling area: square feet
City/State/ZIp: Garage/carport area:�j - square fact ]
Suitelbidg./apt.no.: Project name:! p � `j � _ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
-_` Other structure area: square feet
8EQIITRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: _--` Lot nvPermit fees"are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel nn
equipment,materials,labor,overhead,and the profit for the )
work indicated on this application.
-_ NEIL, t t)- ___'---- Valuation: S
Ej
�� �- 1111-�- 'lZs` -
��,•�,tl. � �'�'S->< i �j �,�� ` Existing building area: square feet r
New building area: square feet —
❑ PROPERTY OWNER [] TENANT Number of stories:
Name: > � Y � Type of construction:
Address: !'1 �,Gj—.—.1��Y�[��►-1 l } _ Ccuupancy groups:
City/State/ZIP: f/ G_ Lam' Existing:
Phone:(l" •l� +�+'=-.� ' F )7 (�'��� Ce
1 7 ?� c N.w _
PPI ICANT 'ONTAC'1' PF.It�ON --� -
- —_`-L L All contractors r _
_ _-- ---`__`---�_. NO'T'ICE
'3usiness name: /� 1 l _ and subcontractors are reruired to be
Couta^.t name: licensed with the Oregon Construction.:ontractors Board
�" under ORS 701 and may be required to be lice•sed in the
Addre a
One- and Two-Fainily Dwelling
Building Pc-rrnit Ap ilication C heeldist
Cit of Tigard Received
Y g Date/By: l'cmut
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits,
Phone: 503.639.4171 Fax: 503.598.1960
24-Hour Inspeetinn Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www,ci.tigard.orus Cl Other
1 Land use actions completed. Scejunsdiction criteria for concurrent mviews.
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc.,_ _ ❑
3 Veriticatlon of approved plat/lot, _ ❑
--a,
4 Fire district approval required. Name of district: ❑ El I Ell
S
Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit. __ _ ❑
7 Water district approval.
8 Soils report. Must carry original applicable stamp.and signature on file or with application
9 Erosion control ❑plan ❑permit required. include drainage-way protection,Silt fence design and location of catch-
--S--�-
basin protection,etc.
10 .1_Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state
buildi„g codes. Lateral design details and connections must be 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
_copyright violations exist. _
I I Site/plot plan drawn to scale. The plan must shw lot and building setback dimensions;property corner elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
Jand driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan, Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, c ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-
floor,wall construction,roof construction. wrote than one cross section may be required to clearly portray
construction. Shnw details of all wall and roof sheathing,roofing,roof 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-idditions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
_ Full-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-
__arescn hve ath analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacimrg,and bearing ED
(ocations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems,see item 22,"Engineer's calculations.”
19 Beam calculation. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. v __ �]
i Energy Code compliance. identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances. _
22 Engineer's calculation. When required or provided,(i.e„shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall bt Fhown to be a licable to theru act under review.
23 Five SI site tans arc required for Item I I above. Site plans must be 8-1;2••x I I"or I l"x 17 [] ❑ ❑
24 Two(2)sets each are required for items 16, 19,20 and 22 above. _ _ �T �[
25 Building plans shall not contain red lines or tape-ons._"Mirrored"building plans will not be accepted. ]
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑
27 "Drawn to scale"indicates standard architect or engineer scale. EJ
23 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard
Street Tree List. _
29 Site plan to include tree protection measures as required by conditions of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, I ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellir.;,s
on a lot of record approved prior to September 9, 1995.
i.\Building\Permits\One-Two-FamilyChecklist.doc 12/03
Building Fixtures RECEIVED
Plumbina Permit Applicatnu�n,. $ 1
City of Tigard CITYlave/By:
o ea Pernut No
OF T,l
13125 SW Hall Blvd.,Tigard,OR 972? a a W1H an Review Other Permit No.:
Phone. 503.639.4171 Fax: 503.598.I. 1LDN4G D„� _
24-Hour Inspection Line: 503.639.4175 I v�s Date Reedy/By: 3crir 0 See Page 2 for
Internet' www.ci.tigard,or.us Notified/Method: Supplementallnfortnntion
TVPV OF WOtuc - FEE* SCIIEDin,E
❑New construction ❑Demolition For s eciul in ormation use checklist.
-
Description I Qty Ea. I Total
Addition/alteratioti/replacement ❑Other: New I-2-family dwellings(includes 100 R for each utility connection)
CATEGORY OIr CONSTRUCTION SFR(1)bath 249.20
!-and 1-family dwe)ling ❑Commercialh nd us trial SFR(2)bath 350.00
❑Accessory building ❑Multi-family SFR(3)bath 399.00
- -- - Each additional bath/kitchen 45.00
El Mosler builder ❑Oth�rr: -
___�.� - Fire sprinkler(,__sq.fl.) Page 2
_-JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I xj +,cj rj ��{Q y } Catch basin or area drain 16.60
City/State/ZIP: e-- Dry-well,leach line,or trench drain 16.60
Suite,%Idg/apt.no.: _ Project name: - Footing drain(no.linear fl.:�) Page 2
Manufactured home utilities 110,00
Cross street/directions to job site: -
_ -- - Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no linear fl.: ) Page 2
Storm sewer(no.linear fl. ) Page 1 �-
Subdivision: Lot no� water service(no linear fl.: ) Page 2
- --- - Fixture or Item
Tax rnap`parcel no.:
Absorption valve 16.60
11$ RIPTION OF NVORK Backflow preventer Page l
y C 9�t1 ) Backwater valve 16.50
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY TENANT O NiFR, ❑ - -
__...��.aus�._-._�� Ejectors/sump 16.60
Name. -Ll-,C L-1-4 - - -- Expansion tank 16.60
Address: {�j �`1 ���( � Fixture/sewer cap 16.60
City/State/Z[P: 'r�Ln���, `'-, Floor drain/floor sink/hub 16.60
Phone!( 1j) -?, _ � ' Fax:( 1Z) (�'Z, 7�. Garbage disposal 26.60
-- � -`�` Hose bib 16.60
AQPLICAIVT ❑ CONTACT 1 FRSON^
Ice maker 16.60
Business name: -)
l i -1 Interceptor/grease trap 16.60
Contact name: �. 1' `1?�;0 N Medical gas(value:$ ) Page 2
Address. �C" -- 2 l - -_ Primer 16.60
City/StatdL.IP: Fes- Lti ',S Roofdrain(commercial) _ 16.60
yq Sink/basin/lavatory 16.60
Phone:p1'�) Tub/shower/shower pan 16.60
E-mail:
r--r-r•-- Urinal 16.60
Water clos•t 16.60
Business name: O � -! Water heater �W^ 16.60
Address: Other.
- - Subtotal
City/Slate/ZIP: - -
_ _ --�- Minimum permit lea 572.50
Phone:( ) Fax.( ) Residential backflow minimum permit fee $36.25
CCB Lic.: Plum ng Lic.no.: Plan review (25%of permit fee)
Authorized signature: _ State surchargeAof permit fee)
_ TOO'r ALL PERMIT FEE
Print name: Date: 41 This permit application exp;,-es If a p^rmlt is not obtained within
180 days after it has been accefted as complete.
*Fee methodology set by Tri-County Buildit.g Industry Service Board
i WuitdinaU'ermiUtPLMF•PennkApp doe 12!03 440.4616T(10/02/COM/W88)
111tiniWiliL, i'errnit Application - Ckv of Tigard
Page 2 - Supplemental Information
Fee Schedule: _ Residential Fire Suppression Systems:
_
Site Utilities City' Fee(es) Total ' ° tare Foots e: -Permit Fee:
Footing dram- I" 100' 55 00 0 to 2,000 _—i $115.00
Footing drain-each additional 100' _ 4u.40 2,001 to 3,600 $160.00
3
Sewer-1st 100' SS.OG ,601 to 7,200 $220.007,201 and greater $30900
Sewer•each additional 100' 46.40
Water Service-Ist 100' 55.00
Medical Gas Stems:
Water Service-each additional 100' 46.40 ValuationPermit Fee:
Storm&Rein Drain-1st 100' 55.00 $1 00 to$5,000 00 Mimrrium fee$72 50
Storm&Ram Drain-each additicnal 100' 4640 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1..52 for each
Fixture or Itemcity. Fee(ea) 'Total additional$100.00 or fraction thereof,to and
including$10,000.00.
Commerciul Back Flow Pteventwn Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1 54 for
Residential Backflow N.vention Device each additional$100 00 or fraction thereof,t0
minimum permit fee$36.25 27.55 and including$25,000.00
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1 45 for
--- each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or
specially requested inspections•pet hour 72.50 end including00fthe$50,0
50, _
Subtotal: 550,00!.00 and up $742.00 for the first$50,000.00 and$1.20 f0:
each additional$100.00 or!Taction thereof
Fixture Work:
Are you capping, moving or rt-placing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures_could result in increased sewer fees*.
uant i.y b Fixture WorkPerformed
Flxtut a•Type: Replace
Nein Moved F.aleting Capped Comments regarding fixture work:
Ba tistr 1 ,-t - — _.�
Bath -Tub%Shower
-Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher -Commercial
-Domestic
Drinking Fountain ---
E e Wash
Floor Drain/sink
3' —
4"
Car Wash Drain _ —
Garbage -Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
-Industrial
Ice Mach./Ref-I .Drains Increase of sewer EDLTs,a sewer permit will he Issued and
Gil Separator Gas Station -- -- —` fees asFessed for the sewer Increase must be paid before the
Rec.Vehicle Dump Station plumbing permit can he issued.
Shower -Gang
-Stall
Sink -Bar'l.avatory Ottantity Total
-Bradley
-Commercial Isomehic or riser diagram is requiredif fixture quantity
-Service total Is>9.
Swimming Pool Filter
Washer-Clothes
Water Extractor Plan Reyi9w
Water Closet-Toilet Plan review r- required if fixture quantity total is>9.
Urinal —
Other Fixtures•
i kBuddinjxPermiukFLM-PamttApp doc 303
Electrical Permit Application FOR OFFICE USE ONI,V
City of"I i and Ref.CIVe" _,`. —90 )0
g Uate,B L Penni(No �rylST� f ON
13125 SW Hall Blvd.,Tigard,')R 97223 Plen Revie
Phone: 503.639.4171 Fax: 503 598,1960 plan a : Utlter Hermit.
Inspection Lino: 503.639,4175 teM
Date Ready-/ay: lure 0 See Page 2 for
Internet wwW ai dgard.or us NotifiedUtthod 7/ Supplemr nai Information
_ _ __ - PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply:
❑Demolition ❑Other: []Service over 225 amps,comm'I []Hazardous location
[]Service over 320 amps-rating ❑Buildng over 10,000 sq.ft.,
CATEGORY OF CONSTRUCTION, of I-and 2-family dwellings 4 or more new residential
E] I-and 2,family dwelling [ICommercial/industrial ❑System over 600 volts nominal units in one structure
❑Accessory building
❑Multi-family El Master builder ❑Other ❑Building over three stories [I Feeders,400 amps or more
:_ []Occupant load over 99 persons []Manufactured structures or
JOB SPIE INFORA1 TION AND L'OCATiON ❑Egress/lighting plan RV park
Job nod. Job site ado•ess: 1)Jl C' � � /,( I 01 -care faMity ❑Other
-�`-s.� Submit 1 sets of plans with any of the above.
City/State/ZIP: n. , p _ Fhe above are not applicable to temporary construction service
Suite/bldg./apt.no.: UProject name. V SCHEDULE �•
op ne.cripuon --1 Qty. Fee. Tatd
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
Includes attached garage.
_ 1,000 sq.ftor less 145,15 4
Subdivision: ,— R Lot no. Ea.add'I 50U sq.ft.or portion 33.40 1
Tax map/parcel no.: Limited energy,residential _ 75.00 2
bIrSCRiPTIUIV OF WORK — y,; Limited energy,non-residential 7500 2
a, Each manufactured or modular
dwelling,service and/ot (ceder 90.90 2
Services or feeders Installation,alteration,and/or relocation
200 amps o;less 80.302
--— +
-- --OPERTY OWNER [j TENANT 201 amps to 400 amps 106,85 2
-- --- 401 amps to 600 amps 160.60 2
Name: Ka , 601 amps to 1,000 amps 24060 2
Address: i;y1 �� LL � Over 1,000 amps or volts 454.65 2
C�=� 1 ' Reconnect only 2
City/State/ZIP: 1-1 Temporary services or feeders Installation,alteration,an
Phone:(C !t) t���--- Fax:( [ � 27_!,l relocation •_
��^,I,.• 200 amps or less ff666.85I
Owner installatlon: is installation is being made on property that I own which is not 201 amps to 400 amps 2
intended for sale,lease,rent,or exchange, According to ORS 447,449,670,and 701. 401 amps to 600 amps _ 2
Owner signature. Date, _ Branch circuits-new,alteration,or extension,per panel
PPLICAN' �' ❑ C A PERSON A.Fee for branch circuits with
--- ' ' 1- - - service or feeder fee,each 6.65 2
Business name: , branch circuit
B Fee for branch circuits
Contact name: �� without service or feeder fee, s 4685 2
Address: Tie- Z-�Z. - each branch circuit _L
Each WWI breach circuit 6.65 2
City/State/ZIP: Miscellaneous(,service or feeder not Included) �
Pump or irrigation circle 53.40 2
Phony(�'" 7` 1' ? Fax: ( ' 7 -� -- —
I!O / ;% _�� Sign or outline lighting 53 40 2
F.-mail (,.':x 4y ,�y,�� �-� k- _ - Signal circuu(s)or limited-
energy panel,alteration,or
extension.Describe Page 2 2
Business name
Address: eiF %� 5 Each additional Inspection over allowable in ally of the above
_ - - --- Per inspection 62.50_ -V
City/State/ZIP: 77 Invest igatlor,per hour(I hr min) 62.50
Industrial plant per hour 73.75
LL
Phone: ) I r 0 / Fax:( ) _ tLES CTkIcALL PERMIT PEES'i _
CCB Lic.: v 1 Electrical L1c.,-0- Suprv. Lic3CV(V$-- Subtotal
Suprv. Electrician signature,required: Plan review(25%ofpermit fee)
Print name: Date: State surcharge(8%of permit fee)
TOTAL PERMIT FEF.
Authorized signature This permit application expires if a permit Is not ob lned within 18
days after it has been accepted as complete
Print name: , Date: Fee methodology set by Tri-County Building Industry Sen ice Boa
Number of inspections per permit allowed
i',8u0dtn$\Pc-mitz1V.C•PemutApp doc 12 01 440-41615i110i02/CO\VWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined....... $. .00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating. Ventilation and ,'.ir Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: a"t 10 . .
Fee for each commercial system... ................... $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
D Boiler Controls
❑ Clock Systems
;] Data Telecommunication Installation
❑ Fire Alarm Installation
❑ IIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Contro!*
❑ Medical ,
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling a
❑ Other 4_
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i'Bw1dmg,Pe—,ts1FLC PermitAvp doe 04/01
.,uJu1 . 13. 20041, 9:53AM 'CLEAN WATER SERVICES 503 6614439._ 5037223813ND %;6? p z
_ JUL 0 9 7004 t-dc Number
r
C dea watcr F
Services -�"-�
C%qfr enn,rfill u,ri11 is rte0, B �ensit;Jv ereening Site Assessment
.Airitid;ction
.� __ Ualf3 _
Map &Tax Lot ?:z:l .Ola Owner Site Address -�rC-, r6y
tee SRi0 c�f_LT-•�� � �Contor.t W yp
Proposed Activity _ n ddress
Phorte� ����j�►�• =�1__ d P1.t� ,
ttnWlut
Y N NA V N NA
9 f 1' 0 SanSdiCo posite Map Stormwater Infrastructure maps
C-7 S cf�adoplert studies or maps Other i
- — ---- l Spccffy�z1--0f
Wised on., rnviewr of the above information and Iho requirements of Clear.Water
Services Daeign and Cr:nstruction Standards Resolution and Orrfofr No. 04-9
Sensitive areas ^ote.ntially exist on Tito or within 200'of the site. THE APPI (CANT
lif PERFORM A SITE CERTiFICATICN PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent propartles, a Natural Rcasources
�7!
Assessment Ftoport may Mao be required
ys; Sensitive areas do not appear to exlrc on site or within 200'of the site. Thls pre-
screening site,assessment does NOI eliminate the need to evaluate and protert
w-,ter quality sensitive areas if that. ara subsequently discovered on your
property NO FIJRTHFR SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED, THIS FORM WIL.I SERVE AS AUTHORIZATION TO ISSUF A
STORMWATER CONNECTION PLRMIT
The proposed activity does not meet the definition of devolopment.-No SIZE
ASSLSSMLNT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments'
Reviewed By*
- --
Returard to Applicar.t
Mai! Fad( Cnrrnts!r
Poet-W Fax Nae 7611 to Date' 11�
To 6,At Y r0Jk-, c �?
Co.tD*0 - CoPhom
eiC7:Z r'�rf)r'�A�'h;s Phone#.-
rMal i
L�3(3)-47 jFdm#Sol 68 VVS9 --
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Address: L 3 X55 SW
Issued by _ Date:
Statement: Intorrnation 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 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 and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be fled with tke permit.
Fill in the appropriate blanks and initiA boxes I 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.
i l 3A. My general contractor is
U (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 gc;neral contractor.
If I hire subcontractors, I 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 off ice issuing this building permit of the
name of the contractor,
1 hereby certify that the-,hove information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
'- ijndure of permit applicant) (Date)
(White copy to issuing cogency permit file,
pink copy to applicant)
informaticn Notice to Property Owners
About Gom5truction Responsibiiities
'17rr: lrl,/( rrr(rtr(in Noll(( .v t(if E rI.$ t)I0I('I, tlbc io r onstruc tion Rr',lytcinsrlril�tite�
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EMPMER PESPO NSI BII_#TIES:
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OTHER RESPONSIBILITIES AND AREAS CSE CONCERN:
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that nxl, Ile Mori ,ht til lruar.)Itcnuurl thiixlgh ;m':Ilt�(tlltns. "" ,�
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SO 1 ;,)'i-4021 t 'Hie R(t,l:4.1 1, 11,( ,1,:.d ,11 711!{Sit nittic I St NIStitc 31M),in S2llern.
I
NIT 0WIT110
I/lig?
GARY YOUNG
ARCIII . 4CT
FACSIMILE TRANSMITTAL SHEET
FROM: -
�S.�G1��f' ..�} — Gary Young
t'OMPANI'� 1 DATBt
fAK NUMBI-":R: TOTAL NO.OF PAGES INCLUDING Co47iR:
PHONF.NUMBF.R: SENDER'S REFERENCE NUMBER:
a Fax#503-722-3813
RR YOUR REFERENCE NUMBER:
Phone-503-940-6553
❑ (IRGEN'1 ❑ 1-OR REVIEW ❑PLEASE COMNIVV' ❑ PLEASE REPLY ❑PL`:ASE RECYCLE
i
1 400%&
LIV
=32
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1
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I'.(). I1(►X 4242 11ORTEANI►, OR P72408
CITY OF TIGARD- SITE PLAN REVIEW
BUILDING PERMIT NO,:ro%S'r 2w0dl• 00.�Lb "
PLANNING DIVISION- kH a
Required Setbacks' g Approved ❑ Not Approved
side: Sheet Side: ...L...,.._
Front. Garage: _-,?-2q_. Rear: _5
�'i;►t;►I Ovarano: qft ❑ Approved ❑ Not Approved
At �.�ittittnt 13111I;iir..: 116"'ht 3-0 feet
("A"I 'qtr ice Provider Letter Required: t] Yes No �
, '0 [] Received
k V im` t!'cu �.e, Dale:
I it tI�JI:t.IlINCi DL I'AR'I'ML N'1•: ' �''"�. ;• •, •.'��•• •.',•.'•►
:i It►I U13e: °U 14 Approved Q Not Approved
Site III (*Approved ( ta• /pproved .4th, •� ;, ;r)•• ,� , . . .�. ',,
Li
Cale:
y2
6I1 •�/� nvw-1•v
..,Q LCul,}vtis-.� ..G'YI[�I-f ctd Cf✓rti�l4.�'I. .. i�,; • � .
1 ' • •., y � ir•
N, Y •
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` Y i• • 7`
.�• •.VIP
CITY OF TIGARD 24-Hour �1
BUILDING Inspe/Llne- 03)639-4175 MSTINSPECTION DIVISION 13u,31n03)639-4171
BUPReceived Date Reques ed_ b5 PM____ BUP
Locaiion ` .�S .�� --Suite.____----
MEC _
Contact°arson _— ---- - Ph(---) — —---_— PLM --------- --
Contractor — - - ----_- _ -- __ -
- Ph( _ ) ----- ---- SWR _-_ ------- -------
BUILDING TenanVOwner -_ -
_
Footing �_, ELC
Foundation A,Gess: ELC
Fig Drain ELR
Crawl rein
-
Slab Inspection Notes: _ S:T _
Post R BeamShear Anchors __-- ----_ --- _-- - -__.
Ext Sheath,'Shear
- -
Int heath/Shear - -
Framing
Insulation
Drywall Nailing
Firewall �-
Fire SprinklerFire Alarm
Alarm /
Susp'd Ceiling
Roof
Other:.- ! -
�-- _ ►
�AS PART FAIL ---- --
!?ING
Post ABeam
Under Slab _-
Rouqh-In s —
Water Service —- -- - - -- ---- _
Sanitary Sewer - -
Rain Drains - ----- - - --- -
Catch Basin/Manholo
Storm Drain - - -- - ---- --
Shower Pan
Other. -- - --
Final
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 -�-
Final Reinspection fee of$.-_-_--_ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_
SITE Date Please call ter reinspection RE: _ _ Unable to inspect-no access
Fire Supply Line - _ Z ADA `,AApproach/Sidewalk InspectorExt
Othor.
Final AO NOT REMOVE this Inspection if..cord-fram the job site,
PASS PART FAIL
CITY 7F TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Ca
Received Date Requested_ ,C J r AM �PM BUP
Location -2-) S S } -rs Suite MEC ..--- ---_--_--
Contact Person -ZLZt-�� Ph( ) 2 �U " �' S`�-3 . PLM
Contractor _ Ph I-) SWR
BUILDING Tenant Owner ___ ELC
Footing — ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes SIT
Post&Beam _--
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - - -------------- ----- -�._
Insulation
Drywall Nailing -- .� n - --- '^/ -
Firewall �� v--7 '� .15 1
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
(loot
Other: -._ -----� -
Final
PASS PARTFAIL
_ GPLUMBIN ._-_ - --- ---- _-_- ---- _-- -
Post&Beam -
Under Slab ---- - - --- - -- ----- - ---
Rough-In
Water Sereice - _- -------- - -- _-__ _ --
Sanitary Sewer
Rain Drains ---- - - - - - ----- --— _
Catch Basin/Manhole
Storm Drain -- - -- - - -- -- - --
Shower Pan
Other: _ -- - _ - _ - -----_. -- ----- --------_ _—
Final
PASS PART FAIL
MECHANICAL _
Post&Beam -
Rough-In - --- _ ----- -- - -._.__---- --
Gas Line
Smoi.e Dampers --- - - -- -_- - -------------------- -- -_ ----
Final
PASS PART FAIL ---
ELECTAICALT^ -- -
oufh-In
UG/3iab
Low Voltage
FiL4LAlarm
fr
ma ❑ Reinspection fee of$___- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd,
S PART FAIL
S Please call for reinspection RE: _ _ ___ - Unable to inspect--no access
Fire Supply Line
Approach/Sidewalk Date �ADA �, � Inspector
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
1
CITY OF rIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPOR*PANT PERMIT NOTICE
L H MORRIS ELECTRIC INC
7051 SW SANDBURG ST, #10C
TIGARD, OR 97223
Electrical Signature Form
Permit #: MST2004-00216
Date Issued: 7120!2G04
Parcel: 2S102DD-00801
Site Address: 13855 SW HALL BLVD
Subdivision: EDGEWOOD
Block: Lot: 006
Jurisdiction: TIG
Zoning: R-4.5
Remarks: 816sf. garage attached to resident via breezeway.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be va'A, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN-. Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
BOGAN, BUTCH AND SUSAN HANSON L H MORRIS ELECTRIC INC
13855 SW HALL BLVD 7051 SW SANDBURG ST, #100
TIGARD, OR 972.23 TIGARD, OR 97223
Phone #: 503-312-2418 Picone #. 503-639-2334
Req #: LIC 1839
ELF 20-39
St'll 3000S
AN INK SIGNATURE IS REQUIRED N, HIS FORM
X _ _
7Sige of Su-6-,-Vising Electrician
-cj
If you have any questions, please call 503.718.2433.