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Permit ,F CITY OF TIGARD MASTER PERMIT PERMIT #: MST2002 -00287 s z:L 4 :lit DEVELOPMENT SERVICES DATE ISSUED: 7/3/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13995 SW 102ND AVE PARCEL: 2S102CC -03600 SUBDIVISION: FRELEON HEIGHTS ZONING: R -3.5 BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: 1098 square foot addition of habitable space, 328 square feet of shop space and 224 square feet of covered deck. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 14 FIRST: 1,098 sf BASEMENT: sf LEFT: 22 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 328 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: VALUE: $ 110,936.40 OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 1,098.00 sf REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: 1 LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: 1 VENT FANS: 2 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: 0 HOODS: OTHER UNITS: 7 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 1 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL; 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,983.95 , ALAN W KEN NIELSON CONSTRUCTION This permit is subject to the regulations contained in the PECK, ALAN ELIZABETH A KEN EL COLE LANE Tigard Municipal Code, State of OR. Specialty Codes and 10255 SW MCDONALD ST TIGARD, OR 97224 all other applicable laws. All work will be done i TIGARD, OR 97224 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: 503- 781 -8092 (mobile) Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: LIC 32871 forth in OAR 952 -001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control lnsp 8 Underfloor insulation Electrical Service Low Voltage Plumb Final Footing lnsp Footing /Foundation Ill Electrical Rough In Insulation lnsp Final inspection Foundation lnsp PLM /Underfloor Framing Insp Rain drain Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Electrical Final Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Mechanical Final Issued By : �J (. .r/� Permittee Signaturef. ��� �—a____--- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application f .. Date received: (0/7 / Permit no.:11�4 &v �. $7 . 3 1 : ( ;1 1 11 . City of Tigard `:. F Vir Address: 13125 SW Hall Blvd, Tigard, OR 9722 i. Project/appl.no.: edate: City of Tigard Phone: (503) 639 JUN Date issued: y I Receipt no.: Fax: (503) 598 - 1960 JUN 7 2�0� Case file no.: Payment type: x Ji 1 &2 family: Simple Complex: Land use approval: :"psi ,t 5 _ v TYPE OF PERMIT l• 1 & 2 family dwelling or accessory U Commercial/industrial U Multi - family U New construction ❑ Demolition 0 Addition/alteration /replacement 0 Tenant improvement ❑ Fire sprinkler /alarm U Other: TT JOB SITE INFORMATION Job address: 6 5w / 07 N . /E Ve. , Bldg. no.: Suite no.: Lot: . Block: Subdivision: �� Tax map /tax lot/account no.: . _ - ` rr 2 Project name: QQ.{ k b ( w — pe, k. f foc.c S G T i 1-tavt ' • 7 / ' , Description and location of work on premises/special conditions: ADD 1,018 SF Ltto c "9 Are4 ; G -- G- ti OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: A (614N f , ,,,,,, >=1 1'7 r>.6 e fln ?a-P/11)/Am (Floodplain, septic capacity, solar, etc.) Mailing address: 3 etets 5 (d2,a V, 1 & 2 family dwelling: / City: "( 1�. , I State I Z IP: c (7223 Valuation of work $ / /U ! G - y Phone: o f - , ,� ; • .• ax: , . E -mail: No. of bedrooms/baths Owner's representative: • ( p Total number of floors Phone: Fax: E -mail: New dwelling area (sq. ft.) (C9 /8 APPLICANT Garage /carport area (sq. ft.) 332A 0- V O C overed porch area (sq. ft.) 224 Name: / r/l T•CC.�L Q.vtcl Fl iz4b���it �.�4t �oe�.�n '-.. Mailing address: , 0 - a , pbt� Deck area (sq. ft.) City: I State: I ZIP: Other structure area (sq. ft.) — Phone: Fax: E -mail: Commercial/industrial/multi- family: CONTRACTOR Valuation of work $ �( s�f�ruetz Existing bldg. area (sq. ft.) Business name: Kew • �`�( - New bldg. area (sq. ft.) Address: 4 40 i AP (. a T ct Stater ZIP: q 7 Zq Number of stories City: l 7 Type of construction ... Phone: , -,9 _ i ; Fax: E -mail: Occupancy group . Existing: CCB no.: 2 e--- ( (., i •0 New: City /metro lie, no.: Notice: All contractors and subcontractors are required to be AR('IIITE(°h /DESIGNER licensed with the Oregon Construction Contractors Board under Name: 5 provisions of ORS 701 and may be required to be licensed in the Address: 41e5 $a.t/e r .r, . pd . c ti.k to ( jurisdiction where work is being performed. If the applicant is City: '5 , (, c ,,, % State:( I ZIP: e l 7702 exempt from licensing, the following reason applies: Contact person: S , 5 Plan no.: Phone: �, - ; . -_ Fax: E -mail: ENGINEER EZIMIRIUMM Contact person: A ,,, ' , Fees due upon application $ Address: (319.5 G (p? - AV Date received: City: it , _ State, ` ZIP: • t Amount received $ Phone: ei,8.800 Fax: E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this 0 Visa 0 MasterCard work will be complied wi , w ether spe d rein or not. Credit card number: 1 / Expires Authorized stgnatu e� I Date: c( Name of cardholder as shown on credit card Print name: /� {,/ I el A" ?Per— " IG. Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 0 days after it has been accepted as complete. 440 (6J00/COM) 1V(cT r One- and Two - Family Dwelling -, Building Permit Application Checklist Reference no.: Associated permits: City of Tigard city f Tigard Y b ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 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 -basin protection, etc. 10 3 'Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state builaing 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. 11 Site/plot plan drawn to scale. The plan must show 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 and / 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, ✓ 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. More than one cross section may be required to clearly portray construction. Show 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 additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. V 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 - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. 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 calculations. 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. ✓ 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, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 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 architect 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 be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/03/COM) . , Mechanical Permit Application /a Date received: w7 p_ Permit no. '1 ' , A ' City of Tigard '•� �! ty g Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT C 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: 13 9.1 5‘ / &.) Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: I -2c - "U <X5 profit. Value $ . Lot: 4 IBlock: Subdivision: `e (d.tr *See checklist for important application information and Project name: thi„ f 00€.4sC Additzv►n jurisdiction's fee schedule for residential permit fee. City /county: Top c* A d /�p,s1. I Z IP: 9'72;23 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location l of work oq premises: _ N V4 _ AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE l PM - S f_ add% fray _ - Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res.only Res. only Tenant improvement or change of use: HVAC: Air handling unit CFM Is existing space heated or conditioned? LeYes ❑ No Air conditioning (site plan required) i Is existing space insulated? lYYes ❑ No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors V State boiler permit no.: Business name: + ge ! " HP Tons BTU /H , . Address: Fire/smoke dampers/duct smoke detectors City: I State: I ZIP: Heat pump (site plan required) Phone: I Fax: I E -mail: Install /replace furnace/burner�BTU /H i CCB no.: Including ductwork/vent liner In Yes ❑ No Install/replace/relocate heaters - suspended, City /metro lic. no.: wall, or floor mounted — Name (please print): Vent for appliance other than furnace CONTACT PERSON Refrigeration: Absorption units BTU /H Name: fi PeG Chillers HP �e Compressors HP — Address: I.' ti et S 1,v (02�� 5 En ironmental exhaust and ventilation: City: r,- arc I State 17223 Appliance vent Phone: ∎ . ; - i Fax: E -mail: Dryer exhaust OWNER Hoods, Type 1/ 11/res. kitchen/hazmat hood fire suppression system Name: Atovn ,per a...ve Llt R4,rtk ( Exhaust fan with single duct (bath fans) Mailing address: ,rua,,.ai na. Exhaust system apart from heating or AC , City: State: I ZIP: Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: Fax: E -mail: Fuel piping each additional over 4 outlets Process piping (schematic required) Number of outlets Name: A „ Ped C I . Other listed appliance or equipment: Address: ecs e iba "aa... Decorative fireplace City: I State: I ZIP: Insert - type Phone: Fax: I E -mail: Woodstove/pellet stove � Other: Applicant's signature .p I Date: 6 ?-0P Other: Name (print): /4f ei 1,r L Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ❑ Visa CI MasterCard Notice: This permit application Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. TOTAL $ Cardholder signature Amount 440.4617 (6/00 /COM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 1 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit a $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond fraction thereof. footnotes below. Comp •* Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit $ to 100K BTU ( 1 14.00 8% State Surcharge $ 8) 3 -15 HP; absorb 25.60 unit 100k to 500k BTU 25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00 Required for ALL commercial permits only unit . 1 mil BTU TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20 unit 1 -1.75 mil BTU 11) >50HP; absorb unit >1.75 mil BTU 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00 Value Total 13) Air handling unit 10,000 CFM+ Description: Qty (Ea) Amount 17.20 Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler ducts & vents 10.00 Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct ducts & vents I 6.80 Floor furnace including vent 955 16) Ventilation system not included in Suspended heater, wall heater or 955 appliance permit 7 10.00 floor mounted heater 17) Hood served by mechanical exhaust Vent not included in appliance 445 10.00 permit - 18) Domestic incinerators Repair units 805 17.40 < 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator to 100k BTU 69.95 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 20) Other units, including wood stoves 10.00 15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets mil. BTU ( 5.40 30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) 1 -1.75 mil. BTU 1.00 >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Minimum Permit Fee $72.50 SUBTOTAL: $ Air handling unit to 10,000 cfm 656 8% State Surcharge $ Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent system not included in 656 appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: 1,170 1. Inspections outside of normal business hours (minimum charge - two hours) Domestic incinerator $62.50 per hour. Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour) Other unit, including wood stoves, 656 $62.50 per hour inserts, etc. 3 Additional plan review required by changes, additions or revisions to plans (minimum Gas P I P 9 in 1 - 4 o utlets 360 charge -one -half hour) $62.50 per hour _ Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU. TOTAL COMMERCIAL $ **Residential A/C requires site plan showing placement of unit. VALUATION: All New Commercial Buildings require 2 sets of plans. is \dsts \forms\mech- fees.doc 02/11/02 Plumbing Permit Application a Date received: 70 7 d.,.1 Permit no.: -/ /keg V 7 City of Tigard }" i y g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT r. 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special infor ation use checklist) Job address: (? .S1A' Le► Description Qty. Fee (ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: � (includes 100 ft. for each utility connection) Z. Tax map /tax lot/account no.: 2-5 1- ' - �/V SFR (1) bath Lot: 4 Block: Subdivision:l,l kl'3 SFR (2) bath Project name: taki.k k Pe 1c t{p c _e SFR (3) bath City /county: M. „ __ A A,. ZIP: ,72 Each additional bath/kitchen Description and Ideation o work on premises: Pt t.tai.bC.a. ,t Site utilities: - r' 4 b j'Lt. n -vi Catch basin/area drain Est. date of completion/inspection: Drywells /leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: A Manholes Address: yaw. Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory I Name: A ( oc Pec Clothes washer Dishwasher Address: L'z,(1 Q 5 55 02..4 AU Drinking fountain(s) City: Th. 0. 4d I Stater I ZIP: 17 Z 3 Ejectors/sump Phone: • , - Fax: E - mail: Expansion tank OWNER Fixture /sewer cap ` Name (print): ,k((Gyt F awl F(i.DLe'f4'i Garbage drains/floor disposal sinks/hub address: Garbage disposal Mailing �-� ca., °bO'�"t' Hose bibb I City: I State: I ZIP: Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal Name: A c.,...► 1:> L, R. E- • Water closet I Address: 5`,, as Q,6,cs,..,e... Water heater City: I State: I ZIP: Other: Phone: I Fax: E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application Pl review (at _ % ❑Visa ❑MasterCard ( %) $ expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00 /COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY - (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb. 1 16.60 Two (2) bath $350.00 Shower Only ' 16.60 Three (3) bath $399.00 Water Closet I 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical I Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San /Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only I , Drinking Fountain 16.60 Water Closet t Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3 „ Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL ,4_ , Isometric or riser diagram is required if s Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ R * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. is \dsts \forms \plm- fees.doc 12/26/01 . , Electrical Permit Application Date received: ` ' ' Permit no.:; ;; .2 _ pp�g qt l �r +L „:/ I 1? City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT 1 & 2 family dwelling or accessory ❑ Commercial /industrial U Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: / gQ 5 (4 ) [QZ. AU Bldg. no.: Suite no.: Tax map /tax lot/account no.: . fie —?,age Lot: lock: Subdivision: 'F (cove 1,,.r Project name: d oy, f(^bu K_ P i c 1 I Description and location ork on premises: ,ci i j.., _ l0 et s Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: Fee Max U,,� Description Qty. (ea.) Total no. insp Business name: "`y ► L I CkS New residential - single or multi - family per Address: dwelling unit. Includes attached garage. City: I State: I ZIP: Service included: Phone: I Fax: I E -mail: 1000 sq. ft. or less I 4 Each additional 500 sq. ft. or portion thereof i CCB no.: I Elec. bus. lic. no: Limited energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): t I 12€J 014 Ep {�pwyi 201 amps to 400 amps 2 `,, , 401 amps to 600 amps 2 ? Mailing address: [ S ' .A) �2i'� lCv 601 amps to 1000 amps 2 City: and D State I ZIP: c- '3 Over 1000 amps or volts 2 Phone: 3< 4 6(40 I F ax: I E -mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation: 200 amps or less 2 ORS 447, 455, 479, 670 01. 201 amps to 400 amps 2 Owner's signature: Air ��r� wL Date: el" 7 - 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: AL,,,,,, �,�4. P / E• A. Fee for branch circuits with purchase of Address: s2 Q,�. a 19a"-C-- service or feeder fee, each branch circuit 2 City: I State: ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): ❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each signor outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ Other. Per inspection 1 1 1 Submit sets of plans with any of the above. Investigation fee w The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / 1 within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /COM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less ( $145.15 4 n Audio and Stereo Systems` Each additional 500 sq. ft. or portion thereof I $33.40 1 n Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular n Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation and Air Conditioning System` Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n Other Over 1000 amps or volts $454.65 2 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 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. n Audio and Stereo Systems Branch Circuits n New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit $46.85 n Each additional branch circuit $6.65 HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 n Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 n Nurse Calls Per hour $62.50 In Plant $73.75 n Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees A $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ All New Commercial Buildings require 2 sets of plans. i:\dsts \forms \elc- fees.doc 08/30/01 Permit #: 'ST %- - OO a 7 Address: I S V 5 S Vl) /Oct. 4 l Issued by j Date: '7 --3 -o v 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 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 filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: H 1. I 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. J I--/ 3A. My general contractor is � kf Nt �S OA 3 a _,F Z (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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction R.sponsibilities on the reverse side of this form. 411011:411. „,oie,' - 7- 3 ' (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) I nformation Notice to Property Owners About Construction Responsibilities \\vc /7n/ /o6rm^v/"// Nt/tic ' o, /ron,nr 0'n/^•/ about (}v/v, c//u/' 8e^7sw//hilitm /csli4e/by the (`um/mu60), �'mmun� &/n/ ciCCOlYitmCt.' 08 - N.ojj/j) \f)ooare ourovo you cart prevcrit many probien is by bcin,.; oftl following responsibilities and areas of col EMPLOYER RESPONSIBILITIES: you hire persons not registered vith the Construction Contractors Board to do labor in constructing or assisting in /hc construction orimprnrrmumo& residential structure_ nowiU. in most instances, hc ruled |o6ean employer and the people you hire uiU be employees. As the emp|oyer, you mxmcomp|y with the follow io�� Oregon's withholding tax km: A';ai employer. vat '' withhold income t from employee wages m the time cmy|oyrcs are paid. 't on \\ 1! he liable for the tax pa went e‘ en ifyou duniuc1uuUyvi/hhoQt6utauhom}nuremp!oyecx. For more information. call the Oregon Urp\ Res cane o1o45-8UV1 Unemployment insurance xnx: /\ an employ er, you arc required (0 pay a tax for UtlenlplOy tnent insurance purposes On [11C \\ ages oL I employees. I or mare in formation, call the Oregon hmpIo meat Department at 378'3524. Workers' compensation Insur4nce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation inuoraocc for your employees. K You fail o, obtain workers' compensation insurance, you may be subject to penalties and w ill be liable for all elaitn costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department olConsurner and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer. you must withhold federal income tax from employees' V. ages. You will be liable for the tax ptp,, ment even if you didn't actually withhold the tax, For more information, call the Internal Revenue Service at |-800'829'1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, >ouuorcq,usiNe forrra,|,iuguoy[ai|urcVomec|codcmqvimnunKs that m as he brought to our atte h rough in spec. ions. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage tOr accidents and omissions such a:, falling tools, paint overspray, , Aater damage from pipe punctures, tire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work ofrough- in and finish trades. and to notify building officials at the appropriate times so they can perform the required inspections. Ifs on hae additional questions. write or call the Construction Contractors Board (PO Box }4|40, Salem, ORV7309'5052. 503/378-4621). The Board is located at 700 Summer St. 1s Suite 300, in Salem. mvr^mu.pm+ ENVIRONMENTAL HEALTH MEMORANDUM Washington County CR #: No Charge Dept. of Health and Human Services Refer: Septic System Environmental Health Subject: HHS Approval 155 N. First Ave. Suite 200 Location: 2S1 -2CC -3600 Hillsboro, Oregon, 97124 SW 102nd Ave. Phone: (503) 846 -8722 Applicant: Peck Purpose: Addition to a residence with no increase in sewage flow Health and Human Services requirements have been met in full: YES: X NO Additional requirements, as follows, must be met before the Dept. of Health and Human Services approval can be given: YES: NO: X COMMENTS: (1.) No change of use to take place (2.) No increase in sewage flow (3.) All DEQ setbacks must be observed signed date JUN - 7 2001 CITY OF TIGARD , 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RECEIVED RAICHART ELECTRIC SEP o 2 l`'!!' 2684 A ST. Cli I' Of nwuw FOREST GROVE, OR 97116 MALMO DIVISION Electrical Signature Form _0 Permit #: MST2002 -00287 g Date Issued: 7/3/02 Parcel: 2S102CC -03600 Site Address: 13995 SW 102ND AVE Subdivision: FRELEON HEIGHTS Block: Lot: 004 Jurisdiction: TIG Zoning: R -3.5 Remarks: 1098 square foot addition of habitable space, 328 square feet of shop space and 224 square feet of covered deck. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, 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 Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: PECK, ALAN W RAICHART ELECTRIC RATHBUN, ELIZABETH A 2684 A ST. 10255 SW MCDONALD ST FOREST GROVE, OR 97116 M �mo ne # : OR 97224 Phone #: 503 - 806 -6519 ITI?, Reg #: Lic 150440 ELE 34 -587C SUP 4602S AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature Supervising Electrician If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST ° 2- INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested // /(o d AM PM BUP Location / 3 ��S /a a Suite / Z d MEC Contact Person Ph ( ) �� J Contractor Ph ( ) SWR Tenant/Owner ELC noting Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other in PART FAIL • Ili ' IN e) = eam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole 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 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date f / / i fi Inspector J Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (504) 639 -4175 MST _ —& 2 S 7 INSPECTION DIVISION Business Line: (503) 639 -4171 Received Date Requested / t AM ' ' BUP Location /.35/,4 .3 5 c l S /c Suite MEC Contact Person fl. —i.-- Ph ( ) - 7 SY - 8 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain / pL In "`^^ 4 . 74 • ELR Crawl Drain Slab Inspection Notes: / , 2 SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear " 2i q(5 , ' G //0 , 0 a Framing c� l Insulation Drywall Nailing / Firewall � �j ‘r-e_C_S-ez-JZ Fire Sprinkler J ..� " Fire Alarm. S -i; Q Susp'd Ceiling R ( oof Other: J 443 „--- PASS PART 410 PLUMBING Post & Beam Under Slab -� ���► _ _ Rough -In p \ �� i,������� �/� —� Water Service u .... �� c7f _____ �. =�.--� ijil %�T l :±�I' • Sanitary Sewer 1111111,___.,A1 _v Rain Drains Catch Basin / Manhole Storm Drain Shower Pan L� a 2-- L - Q 0 S (c-N\, - d fk Other: o V `� Ina C liO)1 AA �' I/v) 0000 PART FAIL I I ' ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Ina vL:D PART FAIL E CTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: 0 Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date VcA) -2- Inspector �� , Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL I - CITY OF TIGARD 24 -Hour BUILDING Inspection Lime: (503) 639 -4175 MST 6 dag 7 INSPECTION DIVISION Business Line: (503) 639 -4171 / BUP Received Date Requested 7 L ; AM PM BUP Location i `]3 9q5 Suite MEC Contact Person � Ph ( ) 7 F/ _ b O PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Amass: ELC Ftg Drain 7 77 j� ELR Crawl Drain 1/ Slab Inspection s: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm I - in ower P • er: Final IMF 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 LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA ( 9 _- / � 7 � 1 7�J Approach/Sidewalk Date 6 2 Inspector / Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (501) 639 -4175 MST .2e62- a,7 INSPECTION DIVISION Business Line: (503) 639 -4171 7 BUP Received Date Requested 7 J AM PM BUP Location '9 5t / a - /4' -C Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL Beam Un . = lab - ou• s- • Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fin -_ Q' ? 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 ❑ Please call for reinspection RE: El Unable to inspect — no access czi Fire Supply Line )9-7) ADA Approach/Sidewalk Date I nspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (50$) 639 -4175 MST 01.007-6D a-- INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 7" 9 AM v PM BUP Location 13/ 2-5" w / ' 1 4,-, Suite MEC Contact Person /31q,C Ph ( ) 78/- PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: / ELC Ftg Cr l Dr YIP j' J ELR Crawl Drain / `� Slab Inspec o dotes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL — Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fin • PART FAIL HANICAL 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 0 Please call for reinspe tion RE: El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date i� nspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour -7 BUILDING Inspection Line: (503) 639 -4175 MST ° 2 --Oz) INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested C ( AM PM BUP Location r 7 / a 5. / / lid / —u-to -Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final ASS PAR FAIL UMBING Under Slab Rough -In Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan %- S 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 ❑ Please call for r inspection RE: Unable to inspect — no access Fire Supply Line (16 A ( qf DA [[ Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD . 24 -Hour BUILDING Inspection Line: (503) 639 -4175 _ 6 '0 D--e 7 INSPECTION DIVISION Business Line: (503) 639 -4171 MST q BUP Received Date Requested / ! / V AM `' PM BUP Location /3 `f Cj / d ; Suite MEC Contact Person A '� . Ph ( ) 7S ? ■ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Frami Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: PAS PART FAIL UMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole 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 Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA /".0/ Inspector • Ext Approach/Sidewalk Date Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 7- Z.-eJD Lb' 7 INSPECTION DIVISION Business Line: (503) 639 -4171 q BUP _ Received Date Requested ! S AM PM BUP Location l 3 9 y S 5w /Q Z M-t/ Suite MEC Contact Person Ph ( ) 77/ - iV 9 — PLM Contractor Ph ( ) SWR atIBLBlte Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors -1!- luar_nIR-11IX1► r _ ,1 f it ii <7 yr/V2 C ,,,,IN .1;r11 Ifis I '341MAIll' CTIA4;% i Insulation ` — Q Drywall Nailing Firewall ` S • as Fire Sprinkler Fire Alarm CS n A 5 <=4--_i Js Susp'd Ceiling Roof Other: , Final AI A......-Ai / 1 111 A A PASS PART AIL – v PLUMBING ' ? 6 Q 9 % 4 , Post & Beam _ 4/5/0 Z Under Slab - Rough -In Water Service ' Sanitary Sewer , _ �S 1 Rain Drains Catch Basin / Manhole 1 Storm Drain Shower Pan Other: co - Final I I1 4.;,; ' U g ( t-/'" 11 . S PART FAIL `A /� I — l �� ECHANI : L '.4 ( ' p � h �1 ly L � � 7 -�. L 1,, g oarrt-tn-A Beam l S `i 1 C [ t Llne-, -- S T Smoke Damper Final PASS PA FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA � /� Approach/Sidewalk Date /k b Inspector l Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Ltne: (503) 639 -4175 MST _g -2, 7 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 9 3e AM PM BUP Location /3 9- /D) ) - Suite MEC Contact Person K4.Pi1" Ph ( ) 7E1 SO ( 9eN, PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear J Int Sheath/Shear Fra rywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final ( S PART FAIL UMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole 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 111 Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 7- 3e a "z—Inspector - Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 1, 2.--&6 2 4 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received 9S Date Requested �� Zy AM PM BUP Location /3 / 2) Se„,) CO -( Suite MEC Contact Person Ph ( ) 7(/° irD9 L PLM Contractor Ph ( ) SWR UILDIN Tenant/Owner ELC noting Foundation Access: ELC Ftg Drain ELR Crawl Drain Sla Inspection Notes: SIT Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing 4ar /kO Ye Insulation Drywall Nailing � E S<2: "s'_ w ry AiSd Firewall ./e)C-4 ' J x,47 ' Fire Sprinkler Fire Alarm l Susp'd Ceiling 7 «,4- S�'fGr� c,c �4 e_A Roof Other: Final PASS R AIL PLUM Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL ECH ► � r.,_, _ _ -- :.ate dough -In Gas Line Smoke Dampers F i AS PART FAIL C ECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA — �S�G Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour `� BUILDING Inspection Line: (503) 639 -4175 MST �` _ af� Ps 7 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 7/f AM PM BUP Location 9J /0 a� ,rn ___ Suite MEC Contact Person (Q iiL-1 Ph ( ) 181 - gd 9 -- PLM Contractor Ph ( ) SWR BUIL ' ING Tenant/Owner ELC ooting Foundati• • Access: ELC • 9 rain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof \ 46,. Other: - PART FAIL UV BING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole 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 Li Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line l ADA 7 Approach/Sidewalk Date / I nspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL -- ..,,, ,-, 0 0 z w.---- MST — Master Permit . _ 4 Inspection Description Date Passed By Notes ' Grading Footing /Setback 'It 4 / v ! Foundation walls ) W d2 1 Slab Footing drain — Waterproof basement walls /Plumbing underslab Crawl drain Post/beam plumbing A b `7.- 5 Post/beam mechanical 7/2,6‘a � � �� Underfloor insulation '7- - 7_, Post/beam structural 7 7- li / /d~v V Shear walls /anchors '1- . 4 I' Le/Dv Exterior sheathing 'Ei` Le / o'L Plumbing top -out 6 ya Z v� Z �Z L "`S) _� ` --r ^" .,..._..)4 � Gas line & test q j `d,k Mechan rough in G� 2 Electrical rough -in 11 lQ o7� Electrical service / lb, 7k.) 2 l '- Low voltage Sprinkler rough -in _ Backflow preventer Roof nailing .__,. Firewall Framing I a — 112 MFG -Home set -up ` Insulation q -/0- 0'� A)6 ,Drywall nailing P , 40, / Sk-A-cr- V Rain,drain Sanitary sewer Water service '7/1 (i © -- z 1 Pump /fill septic tank Approach/sidewalk Street Tree Certificate - Grading final Mechanical final 1 k/ c 8 Z_ Plumbing final I l �cct2 Electrical final I VS76 _Z Final inspection Special Reports SWR - Sewer Permit -J Inspection Description Date Passed By Notes Sanitary sewer Final inspection Inspection Record — MST (Master) Permits i:\dsts\forms \InspRecordMST.doc 04 /17/01 MST — Master Permit Inspection Description Date Passed By Notes Grading Footing /Setback Foundation walls Slab Footing drain Waterproof basement walls I Plumbing underslab Crawl drain Post/beam plumbing Post/beam mechanical Underfloor insulation Post/beam structural — Shear walls /anchors Exterior sheathing Plumbing top -out Gas line & test Mechanical rough -in Electrical rough -in Electrical service Low voltage Sprinkler rough -in _ — Backlow preventer Roof nailing Firewall Framing MFG -Home set -up Insulation Drywall nailing Rain drain Sanitary sewer Water service Pump /fill septic tank Approach/sidewalk Street Tree Certificate Grading final Mechanical final _ Plumbing final — Electrical final l Final inspection _ Special Reports SWR - Sewer Permit Inspection Description Date Passed By Notes Sanitary sewer Final inspection Inspection Record — MST (Master) Permits i:\dsts\fomuUnspRecordMST.doc 04/17/01 CITY OF TIGARD •. 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST °Z — 6e -2. 77 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Received Date Rice uested « ` AM �PM BUP Location 1 3' q5 / a a- -na Suite MEC Contact Person 1 , (Ai/Pr( (( ) 7Z1 8 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: 641 - ELC Ftg Drain 4(_. /' ELR Crawl Drain Slab Inspection Notes: T � J` SIT m Post & Beam c � 4 Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole 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 l r� PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date /unja � � 02 Inspector Ot Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD _ 24 -Hour BUILDING Inspection Line: (503) 639 -4175. U s21-7 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 7 (, AM v PM BUP Location - s D a // : ' , uite MEC Contact Person Ph ( ) _ 0 d 9 Contract Ph ( ) SWR DIN Tenant/Owner ELC Foundation ELC Ftg Drain ACC @SS: _ co / (%/ Crawl Drain 413:0 Jl 0 Slab Inspection Notes: C, K (- G'7 C SIT Post & Beam She- - o 1 ` r '•, . Drywall Nailing Firewall L V / 2 42/Le l V 1./4/ ' - e4 Fire Sprinkler Fire Alarm O / e L G - c c 7 j ,4 -,4d4 (A---- Susp'd Ceiling \ Roof Other: . MA-) I V �7 11'r PART FAIL ING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain • Shower Pan Other: A Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final P T FAIL CTR Se • g -n a. ow Voltage & Mt PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date / f/ Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL