Permit • C ITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00524
DEVELOPMENT SERVICES DATE ISSUED: 12/2/03
�'I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13670 SW 124TH AVE PARCEL: 2S103CC -07000
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 017 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,610 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,790 sf GARAGE: 630 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 341,116.00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,400 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 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: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
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: 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: $ 5,877.35
This permit
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Mu is subject , the regulations contained C o i the
T
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 Tigard other r applicable Municipal Code, State work will Specialt Codes and
al
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 all other applicable law All wok will by done i
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
5 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
L
Reg #: k3877 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp & Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanica Plumb Top Out Exterior Sheathing Ins l 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
2
Issued By : / L 9///Y1 /),&___ . Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
jE; FT /7- - /•-n3 (
• Building Permit Application
�" ' ,� i' City of Tigard 1.- o , Date received: f/ /5' 0� t no.: y 5-
�= r Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR `9123'
Phone: (503) 639 - 4171 A, Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 NW/ 1 2003 Case file no.: Payment type:
om
Land use approval: CITY OF TIG4RD 1 &2 family: Simple p Complex:
‘ '
T PE OF PERMIT ,, _ . .,
GI
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family , .New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler/alarm ❑ Other:
,r t. r,h. „, ,' , .3. : JOB SITE INFORMATION x i1
Job address: 'r 7 ro ' Bldg. no.: Suite no.:
Lot: I - I Block: Subdivision: \j\},/ wii ',CD Vurt V_-_— I Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
cN
OWNER FOR SPECIAL 1NFOR1IATION, USE CHECKLIST
Name:' A B , --,,,,e 4Floodplain, septic capacity, solar, etc) .. Ilk
Mailing address: 'fi 4�ra 1 & 2 family dwelling:
City: wirammomml Env_ ZIP: ' 'Z1, 3. Valuation of work $
Phone:. r II=ff , 'r No. of bedrooms/baths _____9_ 0 t V
Owner's representative: , aa Total number of floors ink
Phone: Fax: E -mail: New dwelling area (sq. ft.) V,
APPLICANT ., = s C :rage /carport area (sq. ft.)
Name: V ly\ V ► J Covered porch area (sq. ft.)
I Mailing address: ` , a5 cc ,,, Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industriaUmulti- family:
CONTRACI OR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: Aki d tip rill ib
Address: `i New bldg. area (sq. ft.)
City: State: ZIP: Number of stories
Phone: l Fax: I E -mail: Type of construction
CCB no.: Occupancy group(s): Existing:
�7 New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCI I ITECT/DESI GN ER licensed with the Oregon Construction Contractors Board under
Name: ( -ia, tL1„ A, L , —.. � provisions of ORS 701 and may be required to be licensed in the
Address: c .bl CL. c . IcieN jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: 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. A . rovisions of 1 ws and o dinances governing this ❑ Visa ❑ MasterCard
work will be compl wt •', whether s cifietiiierei r Credit card number: _ / /
✓✓✓ ��� f Z Expires
Authorized Si: atu. , 1 A ..1 e. - 1 t ( t,) '�� Name of cardholder as shown on credit card
Print name: 1 �` ” �' "i I ( �/ ,,, $
` K 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 (6sV0/COM)
One- and Two -Fay Dwelling
Building Permit Application Checklist Reference no
Associated permits:
City of Tigard City of Tigard g ❑Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960
TILE 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 platllot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. j(
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 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,
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. ' X \
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. X
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 (6ro0/coM)
A . Mechanical Permit Application
Date received: /5 G / Permit no.: i�51v5 �gZe f
-� aqui.
RED
�, j. �.I � City of Tigard � VED Project/appl. no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard OR 97223
CiryojTigard
2003 -
Date issued: By: Receipt no.:
Phone: (503) 639 -4171 NtiV 1 3
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD Building permit no.:
tiUILUING DIVISION
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial Cl Multi - family O Tenant improvement
X Iew construction 0 Addition/alteration /replacement O Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE - -
. Job address: , ' v 70 4 ,2 1 03 1 I . 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: - 7 Block: Subdivision: WW: A ., ' 0 'See checklist for important application information and
Project name:
VI jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICALIINDUSTRIAL 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? 0 Yes 0 No Alteration of existing HVAC system
• MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name:
CAM= . ..Boj 1 / _ HP Tons BTU/H
1 Address: ����bma Fire/smoke dampers/duct smoke detectors
City: Vit Ll� State: 'M ZIP: ���a 1 Heat pump (site plan required)
Phone: 2 � Fax: E -mail: Install/replacefurnace/bumer BTU /H
�'Y� y � Including ductwork/vent liner ❑ Yes 0 No
CCB no.: '�r t
� '7(,t' 1 Install/replace/relocate heaters - suspended,
City/metro lic. no.: N/A wall, or floor mounted
Vent for appliance other than furnace �—
Name (please print): ' i ��f�Z(_
CONTACT I'ERtiON Refrigeration:
Absorption units BTU/H
Name: # 1 - A`,f-kEL. Chillers HP
Compressors HP
Address: 1 MX-- CIA ( Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
I Phone: Fax: E -mail: Dryer exhaust
OW N E R Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: I �NM ) eg—.46 Exhaust fan with single duct (bath fans)
Mailing address: • 1 Exhaust system apart from heating or AC
r sy
Fuel piping and d (up to 4 outlets)
City: ZIPR �/)
■ Type: _LPG NG Oil
Phone:. _, 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
Phone: Fax: E -mail: Woodstove/pelletstove
Other:
Applicant's signatu" .A, ,W' Date: NM C.. Other.
Name (print): f, ( ;f'i- f Inol'ht' I I .
T
Not all jurisdictions accept credit cards, please call jurisdiction for more informa Permit fee $
Notice: This permit application Minimum fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number E i w 180 d ays after it ha been Plan review (at %) $ •
Expires State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount , 440 -7617 (6/00JCOM)
Application _
Plumbing Permit � $ { t � , .,', :
Date received: / if, Permit no.: t f . 3 X5494
, tt� I'• City of Tigard, Sewer permit no.: Building permit no.:
� Address: 13125 SW Hi1T . '' � \E O3
City of Ti phone: (503) 6394171 Project/appl.no.. Expire date:
Fax: (503) 598 -1960 NO 1 r.3 2043 Date issued: By: Receiptno.:
Land use approval: Case file no.. Payment type:
CITY OF TIGARD
'fiPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
b: New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB S1TEINFORMATION FEE SCHEDULE (for special information use checklist)
Job address: a t 70 (- j� t_i N. Description Qty Fee(ea.) I 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 t' ) Block: Subdivision: �lr SFR (2) bath
Project name: \W , l, SFR (3) bath
City /county: ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est date of completion/inspection: Drywellsileach line/trench drain
Footing drain (no. lin. ft.)
PLU\II ;ING CONTRACTOR Manufactured home utilities
Business name: Q ..___1101 L. i Manholes
Address: /�
�s� 0 Rain drain connector
City: gs-itilig.1111111 State•M J ZIP: Sanitary sewer (no. lin. ft.) ,
Phone: ,y ,-4•' Mallillill E -mail: ' Storm sewer (no. lin. ft.)
y r Water service (no. lin. ft.)
CCB no.: (, '• - 7 l.- I Plumb. bus. reg. no:
♦ Fixture or item:
City/metro lie. no.: N/A �' — Absorption w valve
Contractor's representative signature _ /, o preenter _�
Back flv
Pont name: �- I U.
IA Backwater valve
Basins/lavatory
Clothes washer
Name: P\•..- ( � Dishwasher
Address: i • du e , / b 1c, Ai " ' Drinking fountain(s)
5 City: l State: ZIP: Ejectors/sump
Phone: Fax: E - mail: Expansion tank
Fixture/sewer cap _
Floor drains/floor sinks/hub
Name (print): ;>� fa - 15��� T Garbage disposal
Mailing address �{� ) C7,1 �P�T • ' " ° Hose bibb
City: L -0 , State jilha ZIP: / Ice maker
Phone:. ? - Fax: 7-7 f E-mail: Interceptor /grease trap 1
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 _
Tubs/shower /shower pan
Urinal
Name: ' Water closet
Address: Water heater •
City: State: ZIP: Other:
Phone: 1 Fax: E - mail: Total MI I
Minimum fee $
'No( all Jurisdicu m
ons accept credit cards, please call lunsdicuon for more infoauon \ Notice: This permit application $
C Visa Plan review (at %)
Susie C rd expires if a permit is not obtained State surcharge (8 %) • . $
C.e it card number: w ithin 1 30 days after it has been $
Expires TOTAL accepted as complete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount , •450 -16l6 t &COM)
Electrical Permit Application
• Date received: /l /0 D Permit no.: tOpir 03 5
�,4 A4 City of Tigard n � > Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 NOV 1. 43 71.'09 Case file no.: Payment type:
Land use approval:
Cis'
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
' New construction Cl Addition/alteration/replacement ❑ Other. _ ❑ Partial
JOB SITE INFORMATION •
Job address: ` � j Z ' • • .'_ A -e Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: l Block: Subdivision: / ' ��( e_____
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: •
CONTItA(1Olt " APPLICA l R)N .. . FEE SCHEDULE _ -
Job no: -) 0 Fee Max
Business name: /� Description Qty. (ea.) Total no. Insp
G L New residential -single or multi- family per
Address: `� _ f �tL sena � dwelling unit. Includes attached garage.
3 . 0 ZIP: • Service included:
Phone: ., .j - I ,j Fax: E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: y Elec. bus. lic. no: _ 0 O � (.1... Limited energy, residential 2
C Limited energy, non - residential 2
Each manufactured home or modular dwelling
nature of supervising electrician (required) Date �'►] Service and/or feeder 2
Sup. elect. name (print) i C ��'� License no : , ' < 3 Services orfeeders — installation,
�Ij< alteration or relocation:
PROPER'I•Y OWNER 200 amps or less 2
Name rin[ : 201 amps to 400 amps 2
(P ) ` �- ' ������ 401 amps to 600 amps 2
Mailing address: � � � •1IG[ J 601 amps to 1000 amps 2
City: c AIL State 11. ZIP: / 76) Over 1000 amps or volts 2
Phone: , jr'%' I Fax: - ) ---) I%r -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders- -
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 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: [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 Perinspection 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 jurisdictioo 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
S
Cardholder signature Amount 440-4615 05rOQ.COM)
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• CERTIFICATION STR EET TR H E I■
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, Ow ie r / Ag ent for ,0 /� i“ � /74),-/L;:5
►
I , Bo xy �A E P (PERMIT HOLDE ►
(PLEASE PRINT)
1 ► ■
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4 Do h ereby cei-i that the following location ■
44
1 meets City of Tigard /Washington County
1 ►
land use and development standards for street tree installation. ►
, ►
4
A ADDRESS: /6, 70 St,,/ /may A/ O
1
1 LOT: ii SUBDIVISION: G✓ 57Z4%5 G
■
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A t
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I BY: _ DATE: c z5 --DV
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,/ �I'i DA'I'I � =dam ►
RECLIVLU ICY: �� '; i� _ �
CITY OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503)'639 -4175 3 400 INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested .3 — ? 3 1) (- AM PM BUP
Location / 3 (0 70 l a LP" A-L) Suite MEC
Contact Person 424 d.1.-- Ph ( ) 57f- 6,( .1JIA
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
Roof
Other:
Final
PASS _ P T FAIL
Post &Be
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
1 Shower Pan
Other:
ma
SS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
ough -In
G/Slab
Volta
Ira Nam
Fin 1 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA QQ
Approach/Sidewalk Date 3 Z3 ( o 4 Inspe ctor Ga "V 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 -4(75 4903 -,'Z9'
INSPECTION DIVISION Business Line: (503) 639 - 4171
'' // BUP
Receive / V F")6 Date Requested 3 - 2 - O AM PM BUP
Location 1 (,' / Z ci '" ) Suite MEC
Contact Person �� 't Ph ( ) 379 ����� PLM
Contractor i/Lil :�AL1 Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam '► A'
Shear Anchors 1' � P,o)
Ext Sheath/Shear Z3
Int Sheath/Shear
Framing L✓.u�tc� �; "Jcyt v n� �r�� rrr — �2r.�� r✓r' r�2� ,�- �.�
Insulation
Drywall Nailing
X� /,' �''� re
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
ART 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
ampers
at FAIL
ELECTRIaAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3° 2S — �� Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL