Permit •
CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2003 -00101
'l DEVELOPMENT SERVICES DATE ISSUED: 10/7/03
� �' li 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13720 SW 122ND AVE PARCEL: 2S103CC - 09100
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 038 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,581 sf BASEMENT: sf LEFT: 15 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,819 sf GARAGE: 420 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 324
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,400 sf REAR: 36
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O S VC/F DR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BRCIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601+am ps-1 000v: 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: $ 5,735.37
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
4230 GALE WOOD STE #100 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 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:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
p forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Rag #: LIR 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8< Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation lnsp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing InsF Rain drain Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line lnsp Final inspection
Foundation Insp Footing /Foundation Dn Electrical Rough In Gas Line Insp Appr /Sdwlk Insp
Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final
Issued By : �� � ' _ � / Permittee Signature : Cw
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
J �
A Building Permit Application
' I . to received: ''/ I , 05 Permit no.: i '4 S -Qp /O
j a i City of Tigard
- ± n ojecdappl. no.: Expire date:
Address: 13125 S W l�B 3 a )223
City of Tigard Phone: (503) 639 -4171 7 Date issued: By; Receipt no.:
Fax: (503) 598 -1960 / Case file no.: Payment
MAR 1` / y
Land use approval: „ 1 &2 family: Simple Complex:
,,T U T r l �a
l _
"i ]'PE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ›'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: k 1,014E Bldg. no.: Suite no.:
Lot: 'tea' Block: Subdivision: /ra IM Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
; : A .. A ., .,:•w. Aso, ~MA.— .> ••.;. ' .', ' ,< :.z ... FORNPFCIAL INFORit k' N; UtE C1IEChLIST
_LM ��: ; (Flood [lain sc tic ca rcity,solar etc.)
Mailing address: AeriercuramalMILATtiall I & 2 family dwelling:
32 t1V
�/J
Etzmo Eam'� ZIP: ♦ rn Valuation of work $
Phone: __ OPNNo. of bedrooms/baths
Owner's representative: . A ' L I _ Total number of floors _'
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
� .1W105r 1at31 Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industriallmulti- family:
CONTRACTOR Valuation of work $
.�nt� L ��� �� Existing bldg. area (sq. ft.)
Business name:
Address: , &v &� New bldg. area (sq. ft.)
Number of stories
City: State: ZIP: Type of construction
Phone: Fax: E -mail: Occupancy group(s): Existing: N
CCB no.: r New:
City/metro lic. no.:
Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
REMO iii,� provisions of ORS 701 and may be required to be licensed in the
Address: • `� jurisdiction where work is being performed. If the applicant is
' ' c exempt from licensing, the following reason applies:
City: State: ZIP:
Contact person: Plan no.: ,
Phone: Fax: E -mail:
ENGLNEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: 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. A • rovisions of 1 ws and oldinances governing this ❑ Visa ❑ MasterCard
work will be compl - • wi • • , whether ified Here'i'n t. Credit card number: / /
� � ) 7 Expires
Authorized Si y atu • , i 1 f At
yZel I ✓ fD� Name of cardholder as shown on credit card Print name: r _ S ( � Cardholder 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 (MJICOM)
One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
City of T igard Cl of Ti gar Associatedpem►its:
J g ❑ Electrical ❑ Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TIIE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. s
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. x
8 Soils report. Must carry original applicable stamp and signature on file or with application. x
9 Erosion control 0 plan LI permit required. Include drainage -way protection, silt fence design and location of ,/
catch -basin protection, etc. J�
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 t/
if copyright violations exist. J�
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 x
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, X
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.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
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 (6A00/COM)
Mechanical Permit Application
Date received: 1 Permit no.• i. ?.4
sY l
-•) �� City of Tigard � t t ; « t'J E L) Project/appl. no Expire date:
City of Tigard Address: 13125 SW Hall 1 31 ERA; Pigard, OR 97223 Date issued:
Phone: (503) 639 -4171 By: l Receipt no.:
Fax: (503) 598 - 1960 I�� AR 1 3 2 003 Case file no.: Payment type:
Land use approval: 80 Building permit no.:
CI I ■
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement •
,New construction 0 Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ` l • _ , Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
profit. Tax map /tax lot/account no.: pro Value $ '
Lot: '?7fp IBlock: (Subdivision: `&4I\ 'LQxj 'See checklist for important application information and
Project name: wA.-A jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FIE 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? 0 Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? CI Yes 0 No _ Alteration of existing HVAC system
MECEIiIN CONTRACTOR Boiler /compressors
State boiler permit no.:
: Business name: I= t: t N,& (/ - - HP Tons BTU/H
Address: 0 [ Fire/smoke dampers/duct smoke detectors
City:Vrt Li Y1 Stater ZIP: 9 1 0 6 Heatpump(siteplan required)
Phone: ji _ Fax: E-mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: '? '5r1) Install/replace/relocate heaters —suspended,
City/metro lic. no.: N/A wall, or floor mounted
(please print): t
Name (P P ' 0 t : ,t p , ' (���(___ Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON
Absorption units BTU/H
Name: - '- CtZA -EEL , Chillers HP
Address: , 1(W" -Q ~ CIA Ct -1 '
Compressors HP
, _ ` IT ' Environmental vironmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust _
OWNER Hoods, Type I/ lures. kitchen/hazmat
hood fire suppression system
Name: 1111 gia i uJL ∎ Exhaust fan with single duct (bath fans)
Mailing address: IWRIADMWarldraffnarAIEMPA Exhaust system apart from heating or AC
City: WM , State' V ' ZIP -- xi s Fuel piping and distribution (up to 4 outlets)
_ Type: LPG NG Oil
Phone: ��ilri� Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
W oodstove/pel let stove
Phone: FaY: E -mail: Oth er:
Applicant's signatu /) ' ( - ,m /' Date: 3)13 Jl ) ' Ot her.
Name (print): W (2, i yr f 1)!f'l rr_'J (
Nrx all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Not Th permit application Minimum fee $
expires if a permit is not obtained Plan review (at _ % ) $
Credit card number Ex i w i t hi n 180 d after it has been ( •
Expires een State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 440 -4617 (600/COM)
Plumbing Permit Application
Date received: r? , , i. '„;" Permit no.:) j, ,,,/,.> ; y
11,v City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223 date:
City ofTigard Phone: (503) 639 -4171 Project/appl. no.:
Fax: (503) 598 -1960 Date issued: pr; 1;' l Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
b ew construction 0 Addition/alteration/replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
y
, C—, �' - 1 21111. Job address: ��
Description . Qty. , Fee(ea.) Total
� 'U [
New 1- and 2 -family dwellings only:
Bldg. no.: I Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: j j'O Block: Subdivision: N, , LL SFR (2) bath
Project name: (L.- - SFR (3) bath
City /county: 1 ZIP: 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
Footing drain (no. lin. ft.)
PLUMIIRING CON I RACfOR Manufactured home utilities ,
Business named p N 1..0 r--03 i rib Manholes
Address: ? TR■_ 1 • A Rain drain connector ,
'� ZIP: Sanitary sewer (no. tin. ft.)
i! —v I— "� Storm sewer (no. lin. ft.)
Phone: -r At Fax: E-mail: —
� •vi Water service (no. lin. ft.)
CCB no.: [ "Z 1-- Plumb. bus. re reg. no:
� Fixture or item:
City/metro lic. no.: N/A �/� ,' Absorption valve
Contractor's representative signature ���C� Back tlow preventer
12111 • i .14111[117 1 Backwater valve
CONTACT PERSON Basins/lavatory
Clothes washer
Name: 1 Dishwasher
Address: 'AAA , I b c \/ — Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks hub
Name (print): , et ' , :iSit t x-�` Garbage disposal ,
Mailing address: 4{ - • • '1 e.k 1 • d ' Hose bibb •
City: _ InriCaFEILib7WMI Ice maker
Phone: -7' N7 —�j Fax: i ,7 . 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: I State: I ZIP: Other. -
Phone: 1 Fax: 1E-mail: Total
Minimum fee $
Na all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑MasterCard expires if a permit is not obtained
Plan review (at %) $
Credit card number. / / within 180 days after it has been State surcharge (8%) .... $
Expires TOTAL $ ------
accepted as complete.
Name of cardholder as shown on credit cart!
$
Cardholder signat ure Amount 4404616 (6i t cOM)
411,0 Electrical Permit Application
Date received: ` r, f 1 0 Permit no.: .& g ia. _ e0 /49
r , j;�,l1'Ir City of Tigard Pro J ect/a pP
1 no.: ...ire date:
City of Tig ra d Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: IED/1 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
Cl 1 & 2 family dwelling or accessory Cl Commercial/industrial ❑ Multi- family 0 Tenant improvement
►' New construction Cl Addition/alteration/replacement 0 Other. 0 Partial
JOB SITE INFORMATION •
Job address: 1 , , O I a - a. -e Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: !7L I Block: Subdivision: \)\.) ,t I A -7 )j j �
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CON I RAC I OR .v'hl.lC.A r►ON FEE SCHEDULE - •
Job no: Fee Max
Business name: CA aEc\- - t -' < Description Qty. (ea.) Total no. hasp
New residential - single or multi- family per
Address: 11 • � � olio. "-J dwelling unit. Includes attached garage.
Service included:
-'� , : - ��: ZIP: i � ■ � 1000 sq. ft or less 4
Phone: 7j - I OA/j Fax: E -mail: ii, ... ' � Each additional 500 sq. ft or portion thereof 2
CCB no.: y Elec. bus. lic. no: c r Limited energy, residential
Limited energy, non - residential 2
. Each manufactured home or modular dwelling
ure of supervising electrician (required) Date /y _ / Service and/or feeder 2
q Services or feeders — installation
... Sup. elect. name (print): ...,a. 2.,,,. License no 1 � 1 a alteration or relocation: ,
PROPI:RI'Y OWNER 200 amps or less 2
o 201 amps to 400 amps 2
Name (print): `, .. ll��� -vr1>• 401 a mps t o 600 amps 2
Mailing address: ������( �),� *a 601 amps to 1000 amps 2
City: . ii r State vo ZIP: 70 Over 1000 amps or volts 2
7
Phone: , „0 ,� Fax: _- - —/ .rh -ma Reconnect onl y 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: 2
200 amps or less
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):
irrigation circle 2
i
i
Each pump or rrg
❑ Service over 225 amps- commercial ❑ Health-care facility Eac 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting
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/lighting plan ❑ Other. Per inspection I I _I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / 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 (6AOICOM)
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• THE E CERTIFICATION
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• ( ASE PRINT) I (PERMIT HOLDER) ►
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Do hereby certify that the following location ■ ■
i meets City of Tigard /Washington County ■
y ■
1 land use and development standards for street tree installation. ■
■ ■
, ■
1
t ADDRESS: i 31 St9 i 21- ■
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1 LOT: ' SUBDIVISION: W» /S 776/LS 1, -4) - ■
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1 BY: — DATE: 1 -2 z -6 3 ■
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A DATE:
1 RECEIVED BY: ■
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MS/_ -0� j D /
INSPECTION DIVISION Business Lfne: (503) 639 - 4171
/ BUP
Received 14' • Otte Requested ( 2 Z -0 AM PM BUP
Location / 3 7 20 / 2- a '`C Suite MEC
Contact Person d Ph (- ) aoq -4 "'J 2 PLM
Contractor // Ph ( ) SWR
f!e Tenant/Owner ELC
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
Roof
• . - r:
T FAIL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•
� PART FAIL
. T ► `.' ICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fir-
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Z Z — C
Approach/Sidewalk Date O ' 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 73 —0
INSPECTION DIVISION Business Line: (503) 639 -4171
J/ / BUP
Received ` < < l ' Requested / — 2 2 79 M PM BUP
Location / 3 7 2 0 / 2 2 Suite MEC
Contact Person o�l.Q_ Ph ( ) b 9- ��,3 7 MM eZz -
Contractor Al ‘SWR
Ph ( )
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 1, 006 -1 SIT
Post & Beam
Shear Anchors tk . Ft Ii C; _
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
C 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
�Pl al
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 El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ,r
ADA D / 2 Z L / Ins actor / Ext
Approach/Sidewalk iP
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL