Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00397
j DEVELOPMENT SERVICES DATE ISSUED: 10/1/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11020 SW 111TH PL PARCEL: 1S134DB-05800
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
REMARKS: Single story addition. Path 1
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 365 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT:
VALUE: 40,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 365 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 4
MAX INP: btu FLOOR FURNANCES: VENTS: 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: 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: $ 1,084.04
This permit is subject to the regulations contained in the
YUSEM, GUSTAVO JAIME + WIN CONSTRUCTION Tigard Municipal Code, State of OR. Specialty Codes and
SUZANNE HELENE 12112 SW WESTBURY TERR all other applicable laws. All work will be done in
11020 SW 111TH PLACE TIGARD, OR 97223 accordance with approved plans. This penn it will expire if
TIGARD, OR 97223 work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #` LIC 148436 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control lnsp 8 Underfloor insulation Plumb Top Out Gas Line lnsp Plumb Final
Footing lnsp Crawl Drain /Backwater Electrical Service Insulation lnsp Final inspection
Foundation lnsp Footing /Foundation Dr; Electrical Rough In Rain drain Insp
Post/Beam Structural PLM /Underfloor Framing Insp Electrical Final
Post/Beam Mechanical Mechanical Insp Low Voltage Mechanical Final
4 Issued By : �L�� - Permittee Signature •►
Call (503) 639 -4175 by 7:00 p.m. for an inspection neede • e next busin : day
do,
7o gs ry -/� --d Z , a7
A .- Building Permits tjgn
5/r _ 4 39
Date received: 9 /O 0.9 Permit no.: ,
�"'' w, City of Tigard 2002 3 -
- Project/appl. no.: date:
CiryofTigard Address: 13125 SW Hall Blvd T OR 9' 223 � ` ,,/ ,
Phone: (503) 639 -4171 y� r u y L itJ:t ' .� Date issued: eceipt no.:
% Fax: (503) 598 -1960 /l �J 6x•. '' ''r /v/ a. C ase file no.: Payment type:
Land use approva . /, > /A lilt L /0 1 &2 family: Simple Complex:
1111111/11111
TYPE OF PERMIT
O & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
s Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: J/ 1 0 . ii/ P or (; P Bldg. no.: Suite no.:
Lot: I 14 I Block: Subdivision: Tax ma /tax lot/account no.:
Pb Project name: Pr — r
Description and location of work on premises /special conditions: i _ .. • ! _ .,>`1 _ . - .L._ f - �?y: •
• r
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (, c -..; tc U / U Se el \ ( Floodplain, septic capacity, solar, etc.) -.,.
Mailing address: / `G a 0 S I,,j + j (t '• p /Q c e I & 2 family dwelling: ,r
City: t i (74 r d) 'State: 012, 'ZIP: g 1 �). 3 Valuation of work $ '7'0 dd°
Phone:
_ (, :), °I 3 7 6 7 1 Fax: I E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
Name: SI c U n n 1 vN f h u v■A Covered porch area (sq. ft.)
Mailing address: l 1, t t 1- S t.� w r S t by e y }e )(' r Deck area (sq. ft.)
City: I-, (, g, IP I StateC R I ZIP: e 1). 3 3 Other structure area (sq. ft.)
Phone: Joel ( ci 0 Fax: , y 6 3 3 E -mail: Commerciallindustriallmulti- family:
CONTRACTOR Valuation of work $
Business name: tJ , t , N c o >'s �' r U c +-t d v) Existing bldg. area (sq. ft.)�
Address: 3. )1 �, S W W e S f-' ' U f -/ +-t y' r New bldg. area (sq. ft.)
Number of stories
_ City: -, 6 u r d I State:O4 ZIP: 9 1 2 - a - 3
Phone: Type of construction .
(, y c t j I Fax: 5 3-V (, . 3)I E - mail: Occupancy grow Existi
CCB no.: f 4 ' t 3 G 1 -2 3 - 3 New
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 0 o r t. k E R v 6 6 e e provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: I State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: q , ) 6 ' Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: 'ZIP: Amount received $
Phone: I Fax: I 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 ❑ Visa ❑ MasterCard
work will be complied with, whether specifie herein or not. j, Credit card number: / /
Expires
Authorized signature: Date: 9/ ° � -- Name of cardholder as shown on credit card
Print name: . p m( 3 C- U h I n 11 a $
Card holder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (600/COM)
One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard ❑ 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
building 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.
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 (6/00/COM)
•
. " Electrical Permit Application _
Date received: y . 40 Oi Permit no.:6,j,cs- ;%t'J„j,2
: `:l'h1' City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I 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 ❑ Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other: 0 Partial
JOB SITE INFORMATION
Job address: 1/ 0 (/ // 1 h (P Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: 4 I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: / ee e /e . - J G _ Description Qty. (ea.) Total no. insp
f New residential - single or multi- family per
Address: f _ C / 6 $ % J 1 U e't'I r 0 . dwelling unit. Includes attached garage.
City: 664 , pc f 0 n I State;G/ I ZIP: 'a 7 0 7 ' Service included:
Phone: 2 C 1 y/ I Fax: 44/3--,)374 E -mail: 1000 sq. ft. or less 4
6 j Each additional 500 sq. ft. or portion thereof
CCB no.: "; 4 S F �,Elec. bus. lic. no: 3 1' / / S c 2
(2-#41- � . Limited energy, residential
City /metro lic. no.: 'O - I - 0 Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date to ' "C' Service and/or feeder 2
Sup. elect. name (print): License no: /57 _ Services or feeders
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): &J/ S y (0 5 ei1� 201 amps to 400 amps 2
401 amps to 600 amps
Mailing address: ` a S f,�/ / / 14 Pk, C 601 amps to 1000 amps 2
City: 7i 61 v. t / () I State>tre I ZIP: 912 .)-3 Over 1000 amps or volts 2
Phone: 0 3 9 3 iC 1 I Fax: E -mail: Reconnect only I
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, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I 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 sign or 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
Submit sets of plans with any of the above. Investigation fee
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)
Mechanical Permit Application
Date received:7 /p % Permit no.:14j" 1`,f29,..V7
l A i' City of Tigard Project/appl. no.: Expire date:
City ojTigard 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
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / 1 Q.2.0 5 t,.j / 11 'IN C e 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.: profit. Value $ .
Lot: I Li (Block: I Subdivision: *See checklist for important application information and
Project name: — jurisdiction's fee schedule for residential permit fee.
City /county: -/-/ G s I I ZIP: e 71 a. 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
C t it f 2e +' t ✓t State boiler permit no.:
Business name: S P 2
HP Tons BTU /H
Address: I S a fs 3 L Fi 6 f f of 5 Fire/smoke dampers/duct smoke detectors
City: f / U U it d' I State: I ZIP: 9 7 Heat pump (site plan required)
Phone: (gal p S 6 '/ 0 I Fax:5 9g o 7 /2,-1E-mail: InstalUreplacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes ❑ No
CCB no.: G G '$ -7 5/ Install/replace /relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Vent for appliance other than furnace
Name (p lease print): Refrigeration:
CONTACT PERSON Absorption units BTU /H
Name: X., '''../ iv c U h h 1 1t u'� Chillers HP
Compressors HP
Address: / 1 7 / 1 5 t✓ /A/ �Qy1 Environmental exhaust and ventilation:
City: f 1 i e 1„ d I Stat k ZIP: GI -71.2 3 Appliance vent
Phone: 209 , `l C , Fax: 5.. 9 3 - E -mail: Dryer exhaust
OWNER Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: (j U 5 / U S e i -I Exhaust fan with single duct (bath fans)
, Exhaust system apart from heating or AC
Mailing address: // O.L o S w l l 1 .1 � CP
City: h .-- o'1 I State :o(� I ZIP:q 7 a a 3 Fuel piping and distribution (up to 4 outlets)
y / 6� Type: LPG NG Oil
Phone: 6 3 1 3 - 7 6•7 Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature: Date: Other: .
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
ID Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at %
Credit card number: E
Expires wit hin 180 day after it has been ( %) $
x
p 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 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 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit 6.80
$1.45 for each additional $100.00 or
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. C **
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU _ 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 .5 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 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101A to 500k BTU 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 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
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 piping 1 - 4 outlets 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.
i:\dsts \forms\mech - fees.doc 02/11/02
Building Fixtures
Plumbing Permit Application OFFICE USE ONLY
Date received: /c' /D U- Permit no.:F/yr.�on� -603
t ,� �� � - City of Tiga 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 information use checklist)
Job address: /6 $ l J /// 1-1 / c e Description Qty. Fee(ea.) Total
Bldg. no.: / Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: r (, Block: Subdivision: SFR (2) bath
Project name: / SFR (3) bath
City /county: ,'/ 6 Q c>/ ZIP: r' 7 3 Each additional bath/kitchen
Description and location of work on premises: / Site utilities:
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: 3 /yl 0 (/ Yl t 0 I L1 5 P u YN hit, y, Manholes I=1 Address: p ./ ` g 6 ® Rain drain connector
City: h e W tc1 C I Stater " ZIP:1/ 1 VD Sanitary sewer (no. lin. ft.)
Phone: Fax: E -mail: Storm sewer (no. lin. ft.)
CCB no.: V.4 I 1 ' 1 Plumb. bus. reg. no: 'y y- 369 r 3 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
Name: /" / a, ,1 Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: State: ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
fy t --70 s u Floor drains /floor sinks /hub
Name (print): G o S
Mailing address: / a a d 5 / /) '�-� P/G c Q Garbage disposal
g / Hose bibb
City: ,Gci, cx.epi I State: dot I ZIP: 9 7 a a 3 Ice maker
Phone: L. 3 `j 3 "7 6 7 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: Water closet
Address: Water heater
City: State: ZIP: Other:
Phone: I Fax: E -mail: Total
Minimum fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application o
0 Visa ❑ MasterCard expires if a permit is not obtained Plan review (at o /o) $
Credit card number: / 180 days it has been w ays after 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 Newt 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
16.60 for each utility connection)
Lavatory One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 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 3" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical 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
Drinking Fountain 16.60 Water Closet
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
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
S torm & Rain Drain - each additional 100' 46.40
C ommercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
C atch 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
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
* *PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* 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.
i:\dsts \forms\plm- fees.doc 12/26/01
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140
Plumbing Signature Form
Permit #: MST2002 -00397
Date Issued: 10/1/02
Parcel: 1 S134DB -05800
Site Address: 11020 SW 111TH PL
Subdivision:
Block: Lot:
Jurisdiction:
Zoning:
Remarks: Single story addition. Path 1
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
YUSEM, GUSTAVO JAIME + 3 MOUNTAINS PLUMBING
SUZANNE HELENE PO BOX 386
11020 SW 111TH PLACE SHERWOOD, OR 97140
TIGARD, OR 97223
Phone #: Phone #: 503 - 925 -1342
Reg #: LIC 141187
PLM 34 -368PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X /
Signature of A h• i ed Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
MST G 6d
INSPECTION DIVISION , Line: (503) 639 -4171
BUP
Received / Date Requested .3 AM PM BUP
Location ` 1 D- I// e1-- Suite 170 MEC
Contact Person Ph ( ) ' -6, 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
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / D
Roof l�
Other: /1/1
final
ART FAIL
MBING
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 insp tion. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date f 3— spector 1 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 • INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received Date Requested 1 ' ` ' AM PM BUP
Location 1/02-.6 /1 / 'L — Suite MEC
Contact Person Ph ( ) c7/6 ? - 6 FD, PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam E'.1
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
I 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
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date O(j. P• A OA, Inspector — r • . 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 ° 77
INSPECTION DIVISION • Business Line: (503) 639 -4171
/ BUP
`
Received Date Requested v /° / AM PM BUP
Location / / °R. /// f L Suite MEC
Contact Person c: :) /t ,: n Ph ( ) cP-e j -6 9D t" PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �or- (z-at8) — SIT
Post & Beam
Shear Anchors v / y/ / f )
Ext Sheath/Shear C - ��'�h Pi >rl /
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire Sprinkler Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: / c
Final ? �Y P4
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In 6112
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
oug
UG/STab
Low Voltage
Fire Alarm
Final
44CD PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE LI Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date C � 02 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 a �l 39 7
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
/
Received Date Requested ! / /VZAM PM BUP
Location 116 Z l) 1// / Suite MEC
Contact Person Ph ( ) o �— rio �! PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access: �,
Ftg Drain v / ELR
Crawl Drain 47/_ ; l i l _
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 Drain
Shower Pan
Other:
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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date f Y 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 2 _ d d 3 "
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / /a ( AM PM BUP
Location / 1 C) 2 ' 6 11 / -- Suite MEC
Contact Person -441 Ph ( ) v l -69e PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: Ftg Drain / 7 — L` ( ELR
Crawl Drain
Slab Inspection 'Notes: Q 6 r*--1, Pa q 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
i/r
PLUMBING
Post & Beam
Under Slab
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FA
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: Unable to inspect – no access
Fire Supply Line
ADA /�
Approach/Sidewalk Date I 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 ./0 39 9 7
INSPECTION DIVISION Business Line: (503) 639 -4171
/ �y BUP
Received Date Requested l e / ?S AM PM BUP
Location / / 60- /1/ - pL_ Suite MEC
Contact Person Ph ( ) 4� — (.09 O
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Cr Drain ���� ELR
Crawl Drain
Slab Inspec • 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
PLU
ost & -
n er Slab
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi
• PART FAIL
CHANICAL
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: 111 Unable to inspect — no access
Fire Supply Line
ADA 7/�
Approach/Sidewalk
Other: Inspector /`' ' / /J Ext
�/
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 0-03
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received - Date Requested //( Z " --- AM PM BUP
Location 2 Z //l Suite MEC
Contact Person Ph ( ) p ' -' 9Ge 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
Int Sheath/Shear -
Framing ���is�a�ss�� A _
Insulation
Drywall Nailing -0' . _Jun:
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
4i
PASS PAR FA
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
. ,.PA2ART FAIL
�ANICAb
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
ECTRICAL
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 / � �4 —
Approach/Sidewalk Date #731X 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 397
INSPECTION DIVISION Business Line: (503) 639 -4171
SUP
Received Date Requested / ° i 2, AM PM BUP
�
Ny��__
Location / / U 2i/J /1 / 7 ` 1 PL- Suite MEC
Contact Person Ph ( ) I -ea ?or PLM
Cotractor Ph ( ) 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
Fr a , I , �l„ . ,,,Ai S 7_ U �� �
tourrnmi. FraShemin• th/Shear , A 1 m 1 J[/�/ �T
I 1
Drywall Nailing
Firewall v a , e.._.------
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ----b Ot l
F a CS Gam. c>- 4..,,2_.v-\ PASS PART FAIL ,/7 ,,
BING U`/ -
Post & Beam a � L \ // `---
Under Slab .' f �` -`= \ Rough -In kb
Water Service
4 ),
Sanitary Sewer6
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan J ` A. _ 1 ✓� v ���5�
Other:
Final A. 'il I % .ff• - -- -- —
PASS PART FAIL • - '
MECHANICAL ■‘ %__.-Q 4
Post & Beam
V/ Rough -In s'/
633 flo-- M/A—
Smoke Dampers
Final
.j* PART FAIL
ELECTRICAL
Service ILO
Rough -In 'Y‘ G
UG/Slab t�
Low Voltage 6. S
Fire Alarm \
Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line /
ADA 1 ' D 7-7)(6 -�
Approach/Sidewalk 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 Qe
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested !D 1 2- Z AM PM BUP
Location / ` 0 Z() /// Pt Suite MEC
Contact Person 94.41Lis Ph ( ) lag —h n6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain a /
Crawl Drain KaT,e2 - �a G��t� ELR
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
su>riT''►
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
IJU, PART FAIL
• '1 r,
Post & beam
Under Slab
ough -In
• - - ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
AS PART FAIL
ANICAL
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 D / / 7 - L fO H Inspector Ext
Approach/Sidewalk � / P
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 3 �
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / 0 /7 AM PM BUP
Location l / -D I l 1 - f L- Suite MEC
Contact Person 04Al., Ph ( )4:7-0 d 1S PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing C 4 i. SOT b./S:1 4,4 D (7/,i' --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS FAIL
-
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
�.� CHANIC.
. -os :eam
Gas Line
Smoke Dampers
Final
- 4.5 111 P - T 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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / D Cl _
Approach/Sidewalk Dat 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 • 66377
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested W A M PM BUP
Location 1 / 0 7, //1 MEC
Contact Person Ph ( ) D 6�D PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
ea
ear nchors
Ext Sheath/Shear
Int Sheath/Shear fc
Framing r7.:, 1- )`Sra �� J ;7 1.1 Arr
Insulation
Drywall Nailing ' \) N A • Su/-'Po2TiA-t
Firewall
Fire Sprinkler 4 60 /A157 C to i�2n ' '" w ` -1^ 1 'i 44.1 T�.a ct)
Fire Alarm
Susp'd Ceiling
Roof 5 t-L� C .
Other:
Final
PASS PART it, L
PLUMBING s
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
u -
GasZine
Smoke Dampers
Final
PASS PART r)FAI
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 1O —� 0
Approach/Sidewalk 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 Od.� 7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /b/D, AM PM BUP
Location l) 0 2 d / / / PL Suite MEC
Contact Person 477 Ph ( ) J 9 - 9 D:9 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
• otin • ELC
Access:
g ' rain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing / 5771-1- C, // C L - S z '' s77.4-c i S
Insulation
Drywall Nailing S
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PART FAIL
PL SING
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date /6, — Z —,e? Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL