Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00212
111 DEVELOPMENT SERVICES DATE ISSUED: 7/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13776 SW ALPINE VIEW PARCEL: 2S109BA -08800
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 014 JURISDICTION: TIG
REMARKS: New SF detached dwelling. •
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 31 FIRST: 2,077 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,184 sf GARAGE: 466 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 312,640.20
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,261 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: 0 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: 1 VENT FANS: 3 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: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: 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: $ 7,950.34
HEIGHTS CONSTRUCTION HEIGHTS CONSTRUCTION LLC This permit csubject to the regulations contained in the
Tigard Mu
ard Municipal Code, State of OR. Specialty y C Codee s and
P.O. BOX 91249 PO BOX 91249 all other applicable laws. All work will be done in
PORTLAND, OR 97291 PORTLAND, OR 97291 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: 503 291 - 2550 Phone: 503 - 291 - 2550 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 133745 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp & Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Foundation Insp PLMfUnderfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
i
Issued By : 1:;_44 Permittee Signature IF
VI
Call (5 3) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
- Building Permit Application) - FOR OFFICE USE ONLY
Received ' Building
Date/BV: - z / Permit No/ 7.57;200 - 40
Cl of Tigard 00� Planning Approval Other 3 - Ot7 /-7
`J g -
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review /Z j Other
Tigard, Oregon 97223 4i 9A1304:-Ii Date/By: 7 - 2- - &. 3 Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 w /eke, ";j "I' jii'`' Post Review Land Use
�-
Internet: ww.ci.tigard.or.us L - . DateBy: Case No. Contact J 17: See Page 2 for
24 - hour Inspection Request: 503 - 639 - 4175 Name/Method: - Su pplemental Information
YPE'UF- WORK`
.,.'. T � � � � " � t REQUIRED „DATA _,_
r1 New construction ❑ Demolition Y 1 & 2 FAMILY DWELLI . =
0 Addition/alteration /replacement ❑ Other:
.. : ;,m`:: CATEGORY= OF. CONSTRUCTION:: = =-.:,,. : Note: Permit fees* are based on the total value of the work performed. indicate
N I & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work in dated on this application.
J Accessory Building ❑ Multi- Family z�
Valuation �
❑ Master Builder ❑ Other: . 2 C y o'
$
JOB SITE INFORMAT : ION and; LOCATION: ?',,: , z; : No. of bedrooms: _ rooms: No. of baths: VIt ,
Job site address: S11(%. 1,,S t ,, Total number of floors i' 2..
up
Suite #: �Bld /A I tJKt. #: - New dwelling area (sq. ft.) 3Z Cr i
g P Garage/carport area (sq. ft.) 4 CD(.. 1 0
Project Name: 0 a IL. aULA--. Covered porch area (sq. ft.) —
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.) —
_ . . N � CO, I IZGUA 't�z�`[iS : (ytl>gC Ic tiIS4 � = : '� ,.gi
Subdivision: b oa /� -(c.c. I Lot #: /r _. . .- . :.. .�
.,,.,, :v,,�._,, :a * $- ,F, �.„ w,...-.., ._. ... -s ,-
Tax map /parcel #: aS /O9S¢ 2 /f2 7) Note: Permit fees* are based on the total value of the work performed. Indicate
..z....5,_, ... ", 'Mit0ESCRIPTION3OFKWORK ` "` ^ ` I, '' the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
N -\ SF tom•
Valuation $
Existing building area (sq. ft.) ..
New building area (sq. ft.)
Number of stories
r Type of construction
E; >PROPERTY�OWNER�- >���y;<� l ®�TENAI!iT;�i' ==�r'� � °W,��� :��: �:.: YPe
Name: wevPtPer5 ce)05- c(t- 'c- -Ct01■. Occupancy group(s): Existing.
New:
Address: Po. iz,14. ■Z
City /State/Zip: ?og.:Cl,tNAJ• t n t'- q 7A 9i -
Phone: 5 --, - 75 Fax: fro 3 -Za Z I NOTICE: All contractors and subcontractors are required to be
EEI C' `' . _ -l'22 -i .`M; .'� z , :`.. C ®NTACT 7PERSON -Wi : = 7;
licensed with the Oregon Construction Contractors Board under
- - � � provisions of OILS 701 and may be required to be licensed in the
Bus Name: ' {(! c x,.. Sch }rmt ' pGwi•S•It- ko C.. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: Qpecti -. -5 r from licensing, the following reason applies:
Address: 612(4 Ski I. 5
City/State /Zip: foil: 1A4,0 , oit. g12.-t
Phone: .1 Fax: 5 Z4 3 a � .. ..m- _ ,., ,4p,,;. 4 ,, I; : kA= . t; , L ti ,.�4;.�- - _ .; : -
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E -mail: � ; .:,, r.; «.max ;.„ � �� ;��: - -,� �' �. :.. :� -_, : +: .
n' tWo referitolfee s : -:. ' ti w th
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�� ���� '�;CONT },��. i, �.OR � -<�. �;�i :��.�..�. ,�xt����; :`� -4.. _ � �.z.., :;�;�_�., __ _
Business Name: Wsv rq c,c.i t o� Fees due upon application
Address: Fe>. a,>< lt2A°t
City/State /Zip: At..- o.Z `/ VI' Amount received $
Phone: 50', -7,11 ?A90 I' Fax: So3 - n7- .Ftl1 Date received:
CCB Lic. #: 1S q-5
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
I r•-1 a --- . 1'("A *Fee methodology set by Tnri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
,. TI: 7- 7 --c72 /
A l ik Mechanical Permit A lication ° `' - , • •
.� Ca of Tigard
{�, EC NED Datereceived:S 2k ,s r;s ;'ermitno.:/yfr , i3 /0,24
City b Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti i OR 99,722 3 ']
Phone: (503) 639-4171
Al LW. � J Date issued: By: Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION Building permit no.:
� ,�,� ,� � ;. •ia ��} �� .�,,4,�� k � � �..' E k t�h�:N `�" g; MTYPE:.OF PERMIT�•����,�,�,���:� g�:� z �� �,��� �,� n£�:- ��'���, + • N
A I & 2 family dwelling or accessory ❑ Commercial/industrial LI Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement Cl Other:
''' ' ' JOR SITE INFORMATIONf , `` !' k ='COMMERCIAL VAL`UATI`ON S CHEDULE`"
Job address: '"Z`j , � pl, 11.E t1E.oJ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical mate als, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ n7 .
Lot: d , Block: Subdivision: *See checklist for important application information and
Project name: 'i;?1, , CAL. t'r 11.A• jurisdiction's fee schedule for residential permit fee.
City /county: „ p,12.0 ZIP: '` VIA, 1 & '2 FAMILY DWELLING PERMIT FEE ; SCHEDULE '
Description and location of work on i remises: AND COMMERICALIIND EQUIPMENTSCREDULE
.3 I S Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. onl
Tenant improvement or change of use: NVAC: ■ --
Is existing space heated or conditioned? ❑Yes ❑ No Air handling unit CFM
Air conditioning (site plan required) ME
Is existing space insulated? ❑ Yes ❑ No Alteration of existing NV AC system _
Y 4 , ,,? :' ::` ,MECHANAL`NT,T
IC , a , ,: „ Boiler /compressors
Business name: 1 ., L LS e 1.11G,p+v State boiler permit no.: ■
HP Tons BTU /H I
Address: ) - Fire /smoke dampers /duct smoke detectors —
City: 1 l. EMS ZIP: `t'iZ 30 Heat pump (site plan required) —
Phone: , , ( , j Fax: -434 I E- mail Instal /replace furnace/burner BTU /H ■--
Including ductwork/vent liner CI Yes ❑ No
CCB no.: 35 > 5 Install /replace/relocateheaters- suspended, ■--
City /metro lic. no.: wall, or floor mounted
Name (please print): •A p n,S V U Vent for appliance other than furnace —
-. ti Abfriger III
' ' , . 2 > . : ' � > ` PERSON , . y
5. � - n • Absorption units BTU /H
Name: ' 4 t 1Z1 r" I - Chillers HP I
Address: 6) ace S �`�j AG �*(1 p "r. C HP —
exhaust and yenta hot: ■ --
City: i '�11,-.A6.10 State:8(l,. ZIP: • � "j21` Appliance e vent
Phone: ( . ' f i Dryer exhaust -
r�'' „ ` '* =`'' " , OWNER rte „, . ' " '' '_ 2 .9; ' Hoods, Type U lures. kitchen/hazmat ■ __
hood fire suppression system
Name: YV (l,/ MA:1 Exhaust fan with single duct (bath fans) - __
Mailing address: • P, L 0) - 24°1 Exhaust system apart from heating or AC _
City: go '((, A State:ptr ZIP: ••• 1
Fuel piping and distribution (up to 4 outlets) ■ --
Type: LPG NG Oil
Phone:1M I -2 0 IEEMIMEE E -mail: Fuel piping each additional over 4 outlets —
,o - . r a ', : -.- ENGINFER, ' - , { s < , Process pcpmg (schematic required) - INE
Name: Number of outlets
Other listed appliance or equipment: ■ -
Address: Decorative fireplace
City: State: ZIP: Insert- typ iiii
e
ME
Phone:tINIMII E -mail: Woodstove/pellet stove
Other. MI
I
Applicant's signature: S/ / Date: Other:
Name (print): gig p t ym MN
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
O Visa CI MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ TO $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440.4617 (6/00/COM)
Building Fixtures
Plumbing Permit Application OFFICE USE o"
v s �+ �r Date received: Permit no./yS j� ) 2f
t 11- Citt J o i igard I � �,( � ' °� Sewer permit no.: Building permit no.:
� ,� Addres 13125 SW Hall Blv i J LI
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 MAY 2 R 2003 Date issued: By: Receipt no.:
Land use approval: CITY OF TIGARD Case file no.: Payment type:
- '-' 4--- TYPE OF ,PERMIT e.
0 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family CI Tenant improvement
New construction ❑ Addition/alteration/replacement ❑Food service 0 Other:
`' -. '- .JOB SITE`INFORMATION ' - . s` 4 -° �', - FEE SCHEDULE (for special information use checklist)
Job address: 17 <P. - Att. I. li.40 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: VQ:. Block: Subdivision: SFR (2) bath 111111
Project name: • . f p • U,,, SFR (3) bath _
City /county: (, - , t40,4,1, ZIP: 912 A- Each additional bath/kitchen M
Description and location of work on premises: Of. L) S1.t _ Site utilities: ■ -.
Catch basin/area drain
Est date of completion/inspection: Drywells /leach line /trench drain
-
%: t :• PLUMBINGX01N.TRACTOR: • { •, , , '',. _: -' Footing drain (no. lin. ft.)
• �• Manufactured home utilities 111111
Business name: 1 frt. , t.() C w Manholes
Address: ' 0 1'., . , Rain drain connector
WWI, A TMIIIIIIIIIIIIMIIIII State:rnt ZIP: " l , _ 7 Sanitary sewer (no. lin. ft.) -
Phone: (p .i - 4, 3 4. EMMEN E -mail: Storm sewer (no. lin. ft.) OM
MI
CCB no.: `, , 0 Plumb. bus. reg. no: , _ `8(p ' Water service no. lin. ft.
City/metro lic. no.: Y. . LP : 5 All11.1111111111.11 Fixture or item: ■ -.
Contractor's representative signature: ._j Absorption valve ,
Back flow preventer MI
Print name: • %41;:b0 Date: Backwater valve
t CONTACT `PERSON x'- r ' '
_ Basins /lavato ry
IZZIONICIAMIIMMIIIIIIIM Clothes washer MI
Dishwasher 111111__
Address: S LC, SW pt i / 5 l Drinking fountain(s) -
City: ', '( ..A,G> State:ptl, ZIP: '11. ' Ejectors /sump -
Phone: 7( B ' S 7 3 Fax: Z46 3551 1131M `• Expansion tank 111.
'.W,;i : ; OWNER ,':7, ' ` �° Fixture /sewer cap MI
Name (print): �O,SP p1,t,. Floor drains /floor sinks/hub -,
Garba a disposal
Mailing address: , 0 4 , 1 Hose bibb MI
City: ', •(htatjo MEM ZIP: - Ice maker _
Phone: ' - ZSSa LEMORThil 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 I
ENGINT ER ' .. Tubs/shower/shower pan _
x Urinal -
Name:
Water closet = ==
Address: Water heater •
City: State: ZIP: Other: a_�
Phone: Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at u %) $
Credit card number: / w 1 80 days after it has been State surcharge (8%) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount 440 -4616 (6/00/COM)
Electrical Permit A lication
RECEIVED rceived: Permit no.: ,c7:2 BV a ,
ib
14 City of Tigard Project/appl. no Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tifit OR g7/103 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION
TYPE OF 'PERMIT
1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi - family O Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
-- Rig grit INFORMATION >` %. b '
Job address: 3-7 , cU ■ • 1.1 ■‘l r to Bldg. no.: Suite no.: Tax map /tax lot/account no.:
' Lot: • Block: Subdivision:
Project name: l p,-, i qt., 1 W Description and location of work on premises: i IA L .
Estimated date of completion/inspection:
CONTRACTOR APPLICATION - h.EE SCHEDULE : w _.._; " ..
Job no: • as CEO Pee Max
Business name• Description Qty. (ea.) Total no. insp
• New residential -single or multi-family per
Address:
'SO `T dwellmgunit .ladudes attached garage.
State:Q, ZIP:'" 1L ' Servieeincluded:
E -mail: 1000 sq. ft. or less 4
Phone: ( ,'. 5 Each additional 500 sq. ft. or portion thereof __
CCB no.: coc>5t Elec. bus. lic. no ttic Limited energy, residential ___ 2
City /metro lic. no.: Limited energy, non- residential —__ 2
4 t)3 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder ■■ 2
Services
Sup. elect. name (print): License no: orfeeders— Installation, IIII
alteration or relocation:
'`PROPERTY O'%%NER 200 . amps or less 2
Name (print): _AL p • 201 amps to 400 amps ___ 2
9 401 amps to 600 amps __� 2
Mailing address: - 1„ 601 amps to 1000 amps MOM _ 2
City: • , -( Statep(L ZIP: 'T7& ' f Over 1000 amps or volts MI= 2
Phone: VI I - ZS d E-mail: Reconnect onl ___ 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 us ta llahon, alteration, or relocations
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps ___ 2
Ow ner's signature: Date: 401 to 600 am .s _ NIII _ 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: State: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: • 111111 2
Each additional branch circuit: —_
' : PLAN REVIEW' (Plea check all that apply) , , Misc . (service orfeeder not included):
0 Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle ME ■ 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting _ __ 2
family dwellings O Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* ■ 2
0 Building over three stories 0 Feeders, 400 amps or more •Descri . lion:
❑ Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan 0 Other. Per inspection MI=
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 iwdic
istion for more infatnetion. Notice: This permit application Permit fee $
0 Visa O MasterCard expires if a pennit 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 (000ICOM)
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
DAVID JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2003 -00212
Date Issued: 7/21/03
Parcel: 2S109BA -08800
Site Address: 13776 SW ALPINE VIEW
Subdivision: DAFFODIL HILL
Block: Lot: 014
Jurisdiction: TIG
Zoning: R -
Remarks: New SF detached dwelling.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
HEIGHTS CONSTRUCTION DAVID JEROME ELECTRIC
P.O. BOX 91249 PO BOX 751
PORTLAND, OR 97291 HILLSBORO, OR 97123
Phone #: 503 -291 -2550 Phone #: 648 -5144
Reg #: LIC 36051
SUP 2877S
ELE 34 -119C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
•
X e
Signature of Supe ising Electrician
If you have any questions, please call 503.718.2433.
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Owner/Agent for
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Do herebygeffdy titi400 fizill4wing location
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meets ,City.qfifTlgard/Washuitgiton County . I>
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land use and development standards for street tree installation. CI>
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -
INSPECTION DIVISION Business Line; 1503) 63 MST
c, BUP
Date Requ sted — / AM PM BUP
Location / 3 (...--6L— .) Suite MEC /
Contact Person Ph ( ) ��� `T —00s(-1 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 1- 4- ra, S e
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 _ WAIIIIILVIr
Rain Drains
Catch Basin / Manhole
Storm Drain -
Shower Pan
V 4'
Oth - r:
pr v.
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 i ('
y
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
, BUILDING Inspection Line: (50 75 MST� a J
INSPECtION DIVISION _ Business Line: 5t 4 ' - ( BUP
Received Date Requested — AM PM BUP
Location / ' 7(' 0 / # , r LIA p Suite MEC
^
Contact Person r Ph ( ) D (--- / - 79 ( 1- PLM
Contrac Ph ( ) SWR
ILDI _ Tenant/Owner ELC
4 —Fabling
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain •
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear • Int Sheath/Shear ,, . , L ` I ` ` ® U
Framing / �i _�
Insulation 4 �A- (L�� 0 1 7 7 ``
(15)
Drywall Nailing _
Firewall S - - � _� _ `)
Fire Sprinkler 9 �� �
Fire Alarm _. * • % e„..),(--;\6_,...A. £z
Susp'd Ceiling
Roof
Other
- RT AIL
1111 c
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower �P�ajn�
O /ems 1 v`'
m
PART FAIL
HANICAL .
Post & Beam
Rough -In
Gas Line *I c
•Smoke Dampers �f
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
ow Voltage
Fire Alarm
Final El 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 r' �6 7LA1/4 ADA - / "l Approach/Sidewalk Date v 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 MSTaq /—
INSPECTION DIVISION Business Line: 503) 639 -4171
BUP
Received Date Rue ted _ ( a ` '7 AM PM BUP
Location _ Suite MEC
Contact Person (31 ' I Ph ( ) 0 9'J��j PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof
Other:
Final
PASS PART FAIL
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 \)A 1 / _
Rough -In �? � C \ 1 ^ l' t> C < M4 �rX
UG /Slab
Low Voltage .
F' Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
1 7A - - PART FAIL
SITE. El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA :•' 1/1„..4e_e� ' Ext
Approach /Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this inspection recor from th Job site.
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour �
BUILDING Inspection Line: (503) 639 - 4175 MST �O `-CX�a��
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 7) AM PM BUP
Location / 3 7 ll L)-< -Q,(..) Suite MEC
Contact Person Ph (_ ) c: � 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
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:
Fin-'
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Fin
PART FAIL
ELECTRIC AL
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 / �� 3 .��.�t— Inspector Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL