Permit CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00290
DEVELOPMENT SERVICES DATE ISSUED: 8/6/03
L.f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13690 SW 124TH AVE PARCEL: 2S103CC - 06900
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 016 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM190 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 30 FIRST: 1,710 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,790 sf GARAGE: 680 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 344,356.20
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,500 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP <3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5
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: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL 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: $ 5,922.80
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 GALEWOOD 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
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: HP 8737 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Issued By ?c �Gl 4 - - .--e r . , 1,J Permittee Signature : Jd _A. / ■ .. I 4 i`!.' 4i .
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
n
J l 7—-05 To ?T 7-3° -03 4642 3 -ex)
. A - Building Permit Application
Datereceived: W Permit no. :1{y( _p0 lb
;,u City of Tigard E.cift ry'E.. ' tD
Address: 13125 SW Hall Blvd i 97223 Roject/appl.no.: Expire date:
City ofTigard
Phone: (503) 6394171 ,�`,Y 1 By: 1 Receipt no.: ,,
Fax: (503) 598 -1960 �UI 3 V 20 • Date issued: B C< file no.: Payment type:
Land use approval: ITY OF .J. f r 2 family: Simple Complex:
... LC N&�
,,..,, te e . w • TVPE Oi�' ZMff
❑ 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: i, r ` Bldg. no.: Suite no.: in,
Lot: Block: Subdivision: rIP7 - . r-. WCO, r Tax map /tax lot/account no.: r-
Project name:
Description and location of work on premises/special conditions:
01A NIA FOR SPECIAL INFORMATION, L SE CHECKLIST
Name: Name: Ira Arlikall ( Floodplain , septic capacitY, solar, etc.) .. M.
Mailing address: Twgran',amrt 1 & 2 family dwelling:
City: ,, I , StateaLi"ZIP: i ' ,r1 Valuation of work $
49 3
Phone: T ` - 7- 775 Fax: jtii• -7 mail: No. of bedrooms/baths
Owner's 7 --�s ntati 14 - 4 2 ` ;4- "'a (:,...../ Total number of ors
Phone: Fax: E -mail New dwelling area (sq. ft.) WO
-'' ;ffi• -40W , APPI AN ow • _-, * ;. Garage/carport area (sq. ft.) Kt/
Name: & 1� , Covered porch area (sq. ft.) 3 /
Mailing address: , WV__ a ce , Deck area (sq. ft.) I JG
City: . 1 State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industriaUmulti- family:
CONTRACTOR Valuation of work $
• Business name: Existing bldg. area (sq. ft.)
i'� r-t' �=�= fi1� � New bldg. area (sq. ft.)
Address: .4 L v` & AMT., Number of stories
City: State: ZIP:
Type of cons r on
Phone: I Fax: I E -mail:
CCB no.: 5 5 _ Occup.. group(s). Existing:
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: Cites i,` 't - provisions of ORS 701 and may be required to be licensed in the
Address: -■p C( )) LariN4 jurisdiction where work is being performed. If the applicant is
City: State: I ZIP:
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
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. A r rovisions of 1 ws and o dinances governing this ❑ Visa la MasterCard
work will be compl wt is , whether ified ilereli
j —� Credit card number: / /
�
Authorized si 11 atu • , ,1 A t {'1(i ` ( Name of cardholder as shown on credit card
Print name: �>, t 7 Expires t .r_._ 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 (610n/COM)
One- and Two - Family Dwelling
, _ , ' ' Permit Application Checklist Reference no.:
, Building Permit Application Checklist
Associated permits:
City ofTigard City of Tigard City g O Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, 04 97223 O 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. V
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 Cl plan Opermit 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 r/
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. J � \
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 ". k
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 (6/00/COM)
A • Mechanical Permit Application
� � Date received: Permit no.: V�y� c .00,2
a,,, City of Tigard .:
X1,1 ;IL ty g Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.: _
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: , Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement •
X 1ew construction ❑ Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: I , 470 `)N,A% l L ` - Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: t ( o 'Block: I Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMEN'TSCIIEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use:
HVAC: r handling •
Is existing space heated or conditioned? 0 Yes Cl No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? Cl Yes 0 No _ Alteration of existing HVAC system
N1ECF CONTRACTOR Boiler /compressors
�}� State boiler permit no.:
/�fi ��.1 HP Tons BTU/1-1
Address: -- Fire /smoke dampers/duct smoke detectors
I-M ZIP: .11fieffi'1 Heat pump (site plan required)
-
Phone: .. 'Fax: E -mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: '?j 9C7 —j(1) Install/replace/relocate heaters— suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): • , i'.1-- PIiV' (1/4-1.8_—/__. Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: - Qt'�t—k Chillers HP
Compressors HP
Address:
1M—Q C/A CtAXVer Environmental exhaust and ventilation:
City: J State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type I/ IUres. kitchen/hazmat
hood fire suppression system
11=11i _ /l> • Exhaust fan with single duct (bath fans)
Mailing address: IW j r
/, � 7 Exhaust system apart from heating or AC
______ lA
City: State I ZIP q---x)5 ? Fuel piping and distribut (up to 4 outlets)
Type: LPG NG Oil
Phone:. 7— „IP Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: Fax: E -mail: �r Woodstove/pelletstove
PP g € ii2 ��PS� Oher. Other:
Applicant's s si natu" = Dat
Name (print): (.([ , ` )'Y { I l i n' l
T
Not all jurisdictions accept credit cards, please call jurisdiction for mote information. Permit fee $
Not Th permit application Minimum fee $
0 Visa ❑ MasterCard expires if a permit is not obtained
Credit card number / / 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 4464617 (6100ICOM)
Plumbing Permit Application
Date received: G 0 3 Permit no.:12 3 Agin
,y, City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 9 7223 Project /appl.no.: Expire date:
City ofTigard
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Date issued: By: Receipt no.: y
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family Cl Tenant improvement
►: New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SUEINFORMATION FEE SCHEDULE (for special information use checklist)
J1,- .41, 0
Job address: Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: _ SFR (1) bath
Lot_ l / Block: Subdivision: A 1 SFR (2) bath
Project name: L j . SFR (3) bath MEI
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.)
I'LLT \I RING CONTRACTOR Manufactured home utilities
Business name: ..__11/ L i Manholes
Address: .Walir�ilEg__.. Rain drain connector
City: . ��
�'� ZIP: Sanitary sewer (no. lin. ft.)
.tV� �
Phone: Storm sewer (no. lin. ft.)
Fax:
�/ _ . �. E -mail: s - •� Water service (no. lin. ft.)
CCB no.: ( R l_ Plumb. bus. reg. no:
V Fixture or item:
City/metro Tic. no.: N/A % \ ' Absorption valve
Contractor's representative signature •r r Back Clow preventer
Print name:
• i ' Ay� Backwater valve
CONTACT PERSON Basins/lavatory
\\ �'1 l�__t Clothes washer
Name: l E Dishwasher
Address: sk i 0 0 ti , Ai Drinking fountain(s)
City: 1 State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
_ Floor drains/floor sinks/hub
Name (print): .�tt Garbage disposal
Mailing address: _ • . "∎ gb .. . , 117Preal Hose bibb
City: .. �� � � I Zan Ice maker
Phone: / . - A r Fax: 4 , E -mail: Interceptor /grease trap _
Owner installation/residenttal maintenance only: The actual installation Pnmer(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 ,.
Tubs/shower /shower pan
ENGINEER. Urinal
Name: ,
Water closet
Address: Water heater
City: I State: I ZIP: Other.
Phone: Fax: E -mail: Total
Minimum fee $
Notice: N« all jurisdictions accept credit card:, please cell Tuns licuon for information. more information. Ni This permit application
Plan review (at _ %) $
C visa titisrerCud expires if a permit is not obtained State surcharge (8 %) .... $
C.edit card number. w ithin 180 days after it has been a
Expires TOTAL �—
accepted as complete.
Name a cardholder as shown on credit card
S
Cardholder signature Amount 440 —3616 (■(COM)
• i Electrical Permit Application
Date received: , , 0 Permit no.:}/ j 9 poi, - e✓ ,
w* 7) is
�;}:.'Iil 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 ❑ Multi- family ❑ Tenant improvement
''New construction ❑ Addition/alteration/replacement Cl Other. ❑ Partial
JOB SITE INFORMATION
Job address: 1 10 t L' H" • Bldg. no.: Suite no.: Tax map/tax lot/account no.: -
Lot: [ / Block: Subdivision: , A,, 0 . `,% 'r
Project name: Description and location of work on premises:
Estimated date of completion/inspection: .
CON I RA('l'OR .\1'1'1.1(.',A HON FEE SCHEDULE
Job no: r7f, Fee Max
Business name: AA .40' rl Description Qty. (ea.) Total no. insp
_ i `/ I�. New residential - single or multi-family per
Address: g/ • `■ sew_ • - dwellingunitlncludesattachedgarage.
City: 'r (...A(aCg- State: 0 ZIP: C1 — 2 p 7- Serviceincluded:
Phone:L .3 - jC2 Fax: E -mail: 1000 sq. ft. or less 4
' l � ` � n C Ea ch additional 500 sq. ft or portion thereof
CCB no.: l-10.4.1_, �
Elec. bus. lic. no: l0 ` L ited energy, res 2
lr/ Limited energy, non - residential 2
� Each manufactured home or modular dwelling
nature of supervising electrician (required) Date '? Service and/or feeder 2
L icense no q
Services or feeders— installation,
... Sup. elect. name (print): .. .a_ 1 ay 21. L� I alteration or relocation:
PROPERTY OWNER 200 amps or less 2
1' 201 amps to 400 amps 2
Name (print): \
M(� , , ` _ tl[�.�.a/� 401 amps to 600 amps 2
Mailing address: j ' ! 'et10 S". ' f , 601 amps to 1000 amps 2
City: c r State �' ZIP:q 7D Over 1000 amps or volts 2
Phone: , ,17 ,2 Fax: - - 4. a r -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
iastallation,alteration,orrelocation:
which is not intended for sale, lease, rent, or exchange according to
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: Email: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over Each pump or irrigation circle 2
225 amps-commercial 0 Health-care facility 2
O Service over 320 amps- rating of 1 &2 O Hazardous location Each sign or outline lighting
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure . alteration, or extension* _ 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other. Per inspection
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
0 Visa 0 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 (6■0000M)
UNITED ENGINEERING, INC.
Consulting Engineering * Civil * Structural * Environmental Engineering * Planning
922 N. Killingsworth St. - Suite: 1A Telephone : (503) 381 -3749
Portland, OR 97217 Fax : (503) 289 -7775
USA Email : jaimelim @asianreporter.com
Project Name Lot 16 Whistlers Walk
Project Address 13690 SW 124th Avenue
Project Location Tigard, Oregon
Project Code DMH 190/2786
' 8111 1 11
j °
G � MON 2, RECEIVED
4). 14, 19
14/111 J. �. JUN 3 U 2003
EXCLUSION OF LIABILITIES CITY OF TIGARD
(2- -. 3 / _ 0 4 BUILDING DIVISION
I. DISCLAIMER AND RELEASE
Buyer hereby waives, releases and renounces all warranties (express or implied), obligations
and liabilities of United Engineering, Inc. and all other rights and claims and all other
remedies against United Engineering, Inc. with respect to any nonconformity, improper
installation, workmanship or material.
II. EXCLUSION OF CONSEQUENTIAL AND OTHER DAMAGES
United Engineering, Inc. shall have no obligation of liability, whether arising in contract
(including warranty), Tort (including active, passive, or imputed negligence) or otherwise,
for loss or use, revenue or profit, or for any other incidental or consequential damage.
Date: June 23, 2003
United Engineering, Inc. Lot 16 Whistlers Walk, Tigard, Oregon.xls Page 1
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I (PLEASE PRINT) (PERMIT HOLDER) ►
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I Do hereby certify that the following location ■
meets City of Tigard /Washington County ■ ■
land use and development standards for street tree installation. ■ ■
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I ADDRESS: ?i/ SVJ J a , ■
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RECEIVED BY: _ DATE: ■ ■
—. JrT`IlrVTrYYTTYTTVII®♦II®•® ®`iIl•TVVYTT*VVTI'VYVTI ®I®YOTTYVYTTVaOII'1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 dlliD 3 --00 Zf?)
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received 3: �f �/3 Date Requested / /4 PM BUP
Location /3 L l 2.-(/ Suite MEC
Contact Person Ph ( ) 2-0 C d 3 7 PLM
Contractor /)/ Ad'YJ'- -S Ph ( ) SWR
BUILDING —let. 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 l
rnal
PART FAIL
L 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
MECHANICALreQ
Post & Beam
Rough -In
Gas Line
Smo 4ers
PART FAIL
RICAL
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: Unable to inspect — no access
Fire Supply Line T 7� �
ADA D / Z ' / --0 3 In s ector ' " 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 r 00 O
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / ( o AM PM BUP
Location / 3 Co 9 /aV Suite MEC
Contact Person Ph ( ) v — PLM
Contractor "fr . i ur Ph ( SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR V \ e7 c73 `av C7J
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
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
Fi - m
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'Q PART FAIL
SI fl Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA Date // / Inspector 72 ry 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: (:03) 639 -4175 MST 3 r
INSPECTION DIVISION 'V Business Line: (503) 639 -4171 —
BUP
Received Date Requested / ( — a AM PM BUP
Location / 3 co 1O / a T Suite MEC
Contact Person ` — - Ph ( ) • C - [ PLM
Contractor M _ • • # i e �� Ph ( SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR V003 -- 0:2A2
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall C
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:
Anal
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fi- -.m
[1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Cite*, PART FAIL
S El Please call for reinspection RE: [] Unable to inspect — no access
Fire Supply Line
ADA
Ext
Approach/Sidewalk Date // /) Inspector —I • _ •
Other:
Final DO NOT REMOVE this inspection record from the job site.