Permit # CITY OF TIGARD + C MASTER PERMIT
PERMIT #: MST2004 -00022
1)41 DEVELOPMENT SERVICES DATE ISSUED: 4/9/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15940 SW AVON PL PARCEL: 2S112CC -17600
SUBDIVISION: DURHAM OAKS ZONING: R -12
BLOCK: LOT: 012 JURISDICTION: TIG
REMARKS: Const. new SF detached residence.
BUILDING
REISSUE: BVH1605 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 22 FIRST: 616 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 989 sf GARAGE: 307 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 15
VALUE: 156,293 30
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,605 sf REAR: 15
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: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 W000STOVES: 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 FOR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 2 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: 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: $ 7,228.18
This permit is subject to the regulations contained in the
BUENA VISTA HOMES BUENA VI STA HOMES Tigard Municipal Code, State of OR. Specialty Codes and
6932 SW MACADAM #C 6932 SW MACADAM HOMES all other applicable laws. All work will be done in
PORTLAND, OR 97219 PORTLAND, OR 97219 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: 503 443 - 6033 Phone: 503 443 - 6033 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 152235 may obtain copies cif these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Low Voltage Storm drain lnsp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Service Gas Line lnsp Water Line lnsp Plumb Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service lnsp Building Final
Foundation Insp PLM /Underfloor Shear Wall lnsp Insulation lnsp Appr /Sdwlk Insp
Post/Beam Structural Mechanical Insp Exterior Sheathing Ins[ Rain drain Insp Electrical Final
Issued B Permittee Signature : \ /� G�w
Y
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next et siness day
l3
Building Permit Application FOR OFFICE: USE ONLY
Received Building
'' Date/By: / —)-Co ._OL/ ilop Permit No.i/y157 05/- 00C OQ
Cit of Tigard Planning Approval Other
131`25 SW H all Blvd � v Plan Re ® �^ M Plan Re: view
Permit No. : a0,0d .—OOO jY
Ti gard, Oregon 9 72 3 IVED DateBBy :inn t/ y 7 - ec/ Other
Permit No.:
Phone: 503- 639 -4171 Fax 503 -598 -1960 - --" I . , Post- Review ! Land Use —
g LIA ., _,j I) Date/By: Case No.
Internet: www.ci.ti art7! s - -- Contact lu ris.:
I lo 4 � See Pa 2 f —
24 -hour Inspection Request: 503 -6 -4175 Name/Method: _ 176 Supplemental Information
CITY OF TIGARD
BUILDING flt
TYPE OF . : .REQUIRED DATA .. = . - : :-.. _ :• - .-`.'..,. .
.J New construction ❑ Demolition 1 842 FAMILY DWELLING.'' : . ':• . - -k.,
.
0 Addition /alteration/replacement ❑ Other:
-
CATEGORY OF CONSTRUCTION . Note. Permit fees' are based on the total value of the work performed. Indicate n n
1 & 2- Family dwelling El Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi - Family
❑ Master Builder ❑ Other: Valuation S
. JOB SITE INFORMATION and LOCATION No. of bedrooms: 7j No. of baths: 5
Job site address: i 59go Ai/ Q l Total number of floors
New dwelling area ` (sq. ft.) 0 SF
Suite #:
Bldg.. Garage /carport area (sq. ft.) 7 g t. } . SF j,
Project Name: RuyylaAfn V� 1<5 Covered porch area (sq. ft.) ? Sr
Cross street/Directions to job site: Deck area (sq. ft.)
��vl CA \ 7 w D��vhG; ;nn � Other structure area (sq. ft.) pS
�i ► ' . - -. RE DATA:. :, : : •• • ` - ;
Subdivision: pjki' \(2X(\ Oa <S Lot #: �, COMMERCIAL ,=USE CHECKLIST,_ - .
Tax map /parcel #: Note: Permit fees' are based on the total value of the work performed. Indicate
• DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
• eAjJ n D) (i - ^ � I^ � f � p �/� overhead and profit for the work indicated on this application.
�' t ll �;{ (�/�.0 F tit\ e all 1 I ` ` ' , C R 1 rs . Valuation S
{ 1 Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
[`} PROPERTY OWNER -. { 0 TENANT. - Type of construction
Name: VZj, \J \ � . \•v� , �/ Occupancy group(s): Existing:
Address:
l.Q"l 2 � C r *-- , New.
City /St to /Zii : � ?uy , kl 0 dl X2.19
Phone: ?O 144 i p 0 , Fax: (5-)i)3) 44; 2.14-1-1:2- NOTICE: All contractors and subcontractors are required to be
❑ APPLICA CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: EVC■11 jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 1\A\ }n(,1 m1 PAS from licensing, the following reason applies:
Address: a(Y1e a e-, tubuVe,
city/State/Zip: ■
Phone: I Fax: .
y � BUILD FgEs..
E -mail: :a. e - ;.:�* > - = :....-.J - - :
l 1 1 111 �� y,A r] I G 1 t� l ► t � � • : :- .P[esse i•ef t .; `,- . .:, ; :'::::...
CONTRACTOR .
Business Name: r O IV1 WJA \- I .LS Fees due upon application S
Address: 1pG(� ..'V\1 ar Q C. a,vn - A- -
Cit /State /Zi • : v A ,A / %1! / Amount received S
Phone: A ir. ' 1 M tare Date received:
CCB Lic. #: f F.,27,y
Authorized
Signature: �� Date: , Z � No This permit applicatiaa expires if a permit is aot obtained within
J` a 180 days after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \BldgPermitApp.doc 01/03
•
01/20/2004 16:22 5032537693 SUN GLOW INC PAGE 02
•
Me Perini RR Y Received FUR OFFIC 1.. l SE ONLY
Mechanical
'JAN 2 6 2004 Date!) - Permit No.: s ad2 . •AY
Planning Approval _
City of '�'>�gard l : FEMIIIMMIll
13125 SW Hall Blvd. CITY OF TIGA I Plan Review Ousel
Tigard, Oregon 547223 bate/B , ?ain't rn't No.:
BUILDING DIV •ION Pottaeview Land Use
Phone: 503 - 439 -4171 Fax: 503 -59s? .., : •. patrlB : U s .:
Internet www.ei.tigard.or - ' :'...:1-1'
1 Contact Sorts.: e l See Page 2 for
24 - li,our Inspection 503 - 639 - 4175 "" Name/Method: Supplemental raforaatton.
OF WO lac :.. COM ERG`TAL FEE'. SCHTiotr1LE .CON US I". •., k;.
10 New construction M Demolition Mechanical permit ices" are based on the total value of the work
11 Addition/alteration/re . lacement • Other: perfbrmed. Indicate the value (rounded to the nearest dollar) of alt
CA.T1Et ]Y�,F a :CONSTRUCTION ' ■ ; mechanical materials, equipment, labor, overhead and profit.
M 1 & 2- Famiil dwellin _ ■ Colnmercial/Irtdustrial Value: S See Page 2 for Fee Schedule
iill Access() Buildin: III Multi-Famil L.- '' . 1S ASIENIS E .
Descr . . on rI3 )r runt
11■1 Master Builder - Other; ilea5ng/Cooriag
' JOB SITE L FORMATEON.sid-L.- , 'ION Furnace - add-on air conditionln - " 14 -00
Job site address: Gas beat . ' ME 14,00
Suite #: B14. /A.•t. #: Ductwork • 14.00
Pto'ect Name: .J �I / < Elyd onic hot water' system 14.00
/ / f Residential boiler
Cross street/Directions to job site: (the radiator or hydronio system) 14.00
IiL
�, I J► /h G ^� 1 �� (i it heaters d electric)
(fuel, ot etc.)
K ` (in wall, act, not 14.00
Flue/vent (for any of above) 10.00
- .:'r units 12.15
Subdivision: IN / I IL, AL4 P 1 / ' — Other kilt' Aa ti,enters
Tax reap /parcel #: Water heater - 10.00
. • r • r t ' ! " 9 'A Gas fireplace 10,00
4 -/ WA ,14 ,MVI[/11 � Flue vent (water hcateri ass fireplace) 10.00
Lo: limier (Ras) 10.00
������ - �I1 Wood/Pellet stove 10.00
/ 7 mlin Wood fireplace /insert 10.00
1.1111 Gtlirttncy/llner/fluc /vent 10.00 _
„13 .CEN . ':,. Other: 10.00
Name: , M ASTIVI`�r'�l WIRIM �I 1 Environmental Exhaust & Yenhlation
�y�,� w R ange heod/other kitchen equiprnem 1 0.00
+L' EWIF
Address: •I IMEIll /I�I�. i. I t, ►1. Clothes dryer exhaust 10.00
" re21 �_.N/ISI Single duct exhaust
Phone :keep Ms MIN& : (batlhroott . toad corrtparments,
fig .APPLIC NT I >i COITFACT utility rooms) 6.80
,., /
Name: � tri 0 . MI Attic/crawl space fans
Other 10.00
Y 1 /1e1! ■ !
Address: ,CA 0 S / - INC, Y Fuel Pipiost_
Ci IS . te/Zi o : 'S$5.40 for Sirs' 4, $:1.00 each additiOtl�e)
Fay:
wa ' Gas etc.
P heat lion- � I r,. Cad treat • • 1111111111=11
E 11 -,1 I , 'J /. r. a mra, _ . PI Wall /suspended/unit heater "
. i "- . -- . - CONTRACTOR : .. • Water heater
Business Name: , : i 4 . . ._ A , Fireplace •• 1E
Address: Z , 3 r t a
•• 111111
Ci /State/Z1 • : • . A it 6 1 -b Clothes • _as II.1 " MIMI
Phone �10 - Z5 71 ' ". d IPA Other. Total: � ��
C C$ Lic, #: i (3 Meca2a 1 PeimIt Fens"
Authorize4 Subtotal: S
Signature. ., �� b ate: I Z() �� Minimum Permit Fee 572.50 S
b Plan Review Fee (25% of Permit Fee) $
1 c / 1) l ; 1 i(pim State SurcharyeO PERMIT FEE S
(pima a 'tame)
P pit �F 'Fee asethodoloeY set try Tri- County Balidrog Industry Service Beard.
Notice: This t application expired If permit Is net oblalntd within "She plait required for exterior A/C milts-
ISO days after it has been accepted as complete.
isDDsts \PermiiPema'MccPermitAPP.doc 0
I
01/20/2004 16:03 FAX 5036284633 THE MULLEN COMPANY 0 002/002
}'' Plumbing P'+2I' XOn FOR O Tl('I USE:.O_NLY
Received Plumbing
Date/By Permit No - :I 15TOcV f - J - '
C ky of Tigard Pa /fi Approval Sewer
g JAN 2 6 2004 oare/,a . Permit No.:
13125 SW Hall Btvd. plan Review - - Other
Tigard, Oregon 97223 Date /OY:' Pe rmit No.:
Phone; 503-639-4171 FzC T D Podt- Review Land Use —
�
Lnter/let: www.ci.tigard.or 1 1 $•�
D ION ,:y �u�r: Case NQ -:
J 1 I� Contact Julia.: see Page 2 for
- -
24-hour Inspection Request: 503- 639 -4175 � . -' Name/Method: 8upp! emental rotorwation.
TYPE OP. WORK. tst 1' 1 ' ° '. .. ' FE Obr'specfal'ta[olrm efscctie�d •1-
6 New construction • Demolition Deseriptioa I Qtr. Ocefta•) I T
AdditionlalterationheTlacement ■ Other; • ' r '`''' 'e''' . 242ml`7 , a �- :'aT''-'
;�A a, a R OP io:.► :.u:�o . ON `,. :ELi,crikk"ea'loe. 'fo 4Zia p ;, .:` . , '••F
M 1 & 2 -Farm[ dwellin_ SFR bath l _ 249.20 _
I� Comm ercial/Industrial SFR (2) bath 350.00
• Accessory Building ■ Multi - Family _ SFR (3) bath 399.00
IN Master Builder Li Other: Each additional bath/kitchen 45,00 '
'J0BSI•TR E PORMAaTIONaudLOCA:TION Fire sprinkler - sq. ft.: - Page 2
Job site address: . .. :: . . 'site UtBfttes -- ;4'iyat's } titiw; :;, • .,
Suite #: I Bldg. /A.t. #: Catch basin/area drain 16.60
DrywelVleach line/trench drain 16.60
Pro' cot Name: • , i / / A& 4 Footing drain (no. linear ft.) Page 2
(
Cross street/Directions to job site: Manufactured home utilitiea 110,00 •
V t r U -o. 'r 14.-all &1 Va • Martltoles 16.60
Rain drain oormectar 16.60
. Sanitary sewer (no. linear ft-) Page2
Subdivision: J / �iT 17n 1 I Lot #: PA Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
T ax :..: , �, ;
DESCRIPTION OF WO Rata reorltem.`' ^ ;
� Absorption valve .
16.60
'Z � 1� i /. I� , t /I Backflowprevextter Paget
refill /i�Jillia Wu (1111161 MIT ryYj Backwater valve 16.60
Clothes washer 16.60
pishwasher 16.60 •
PRQPERTWOVi .R ; , N 1ENAl'IT Drinking fountain 16.60
' ' Ejectot6lsump 16.60
Name: So A 'Al la Ir. i Al II ' itii If - Expansion tank 16.60 •
Address: I f 11i h / /.RI 1= Fixture/sewer cap 16.60
�t /JII �I� 1� mpr Garbage disposal sirtk/hpb
Phone: �► L - LQO, n I Hole bib 16.60
I!' llo coo...,_,. -saws '. fee maker 16.60
Name: �►� MUFMAII I h Intercepter /grease trap 16.60
Address: /4 /I / ACPA Pi Medical gas - value: S Page 2
Primer 16.60
C1t /$tt3te/Zi•:
Roof drain commercial 16.60
Phone: . • - 9-10 /'7- IMMIEMElin slnle/basin/lavatorr 1.6.60
617 77 1r pep'. • 0 Tub /shower /shower pan - 16.60
' • , SOtETRACToR • • • ' • ' Urinal 16-60
Business Name: L I water closet 16.60
G `'� „fa,. Water heater 16.60
Address: / , r . _.t _ • . Other:
City/State/ ills h-r-/) t 9W x3 oher: - -
Phon- �d' : r Fa SO . �. ., . .. a:.. ,..,�Ylatablita'PerinFLBe`itit.. r . . • .
Subtotal 5
CC$ Lic. #: " : ' lumb. L'e. #: -26O ti - Minimum Permit Fee S72. 50 S
Au orizcd '' - Residential Backflow Minimum Fee 536.25
Signature; , Ai Date:/ Le a''f- pieta lisv 2S� of Permit Fee S
a ep � , ' State Surcha:ye (S% Of Permit Fee) S
/ (Pleas print name) TOTAL PERhfT FEB 5 .
Notice: This permit application expires if a permit is not obtained within ' All new commercial bundles. require 2 setae of plans with isometric or
Igo days after it has been 1010pied u complete. riser diagreio for plan rcvidw.
'Fee methodology set by Tri- County Building Industry Ssrvlee Board.
i;\ Rsts \ Permit Forms\FlrnPermitApp.dee 01/03
`'
0?./20/2004 16:08 5036425815 ROSS ELECTRIC INC PAGE 01
Electrical Permit WO
Receive Electric
Date/By: Permit NoMS TOGO, - co a --
City of Tigard 1JAN 2 6 2004 Planning Approval Sign
13125 SW Hall Blvd.
Date/By: n Rev Permit No,:
Tigard, Oregon 97223 CITY OF TIGAR'd Dan Permit Date/HBy: y; P Permit No.:
Phone: 503- 639 -4171 Fax: 51ROpDIV1 0 Post- Review Land Use
Internet: www,ci.tigard.or.us T� 1 t Case No.:
'
24 -hour Inspection Request: 503 -639 -4175 Contact Juric. pee Page 2 for '�—
Name/Method: Supplemental Information.
:. TYPE:OF WORK New construction N. REVIEW --- •
if ,, • �• �•' ' �: '(` < ` PLA ' ltbrts c4eCki7E';tltst: ';, � ". ...
�
�� Demolition al over 225 amps. i Health-care facility
M Addition /alteration/r- .lacement ❑ Other: location
commercial ❑ Hazardous 1
❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet,
' `:CATEGORY ORCQNSTRUC'IToN.. 1 & 2 family dwellings four or more residential units in
LI 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure:
III Accesso Buildilt • Multi-Famil El
over thrcc stories ❑ Feeders, 400 amps or more
I Master Builder ❑ Occupant load over 99 persons 0 Manufactured structures or RV parts
I■ Other: ❑ Egress/lighting plan ❑ Other
30$53TE INFORMATIONInd'EOCATION' Submit sets of pions with any of the above.
Job site address: The above are not applicable to temporary construction service.
Suite #: BId . /Apt. #: • PEEr •S ULE. . , i ' ....
Pro "eat Name: Number of ins cations er ermit allowed
♦ I A i� AV I <5 Description Qty Foe (ea.) Total
Cross s to job site: New residential-single or mold-family per •
� /� � dwelling unit. Includes attached garage.
�k/ t/ " ` / Y\ street/
' t ire " ► Rd 1 I 1\ -- RV /� v 1 I \ Ut// t . Service mended=
1000 se, ft. or less 145.15 4
@sch additional 21 . R, or rtion thereof 33,4 I
Subdivision: L imited ester ,resid
.�h�� ► L #: 75,00 2
Tax map /parcel #: E a c h manufactured nufact non residential �5 00� 2
Each manufactured home or modular dwelling
"DESCRIPTION OF WO R K : • • .. .. service and/or feeder 90.90 2
_ ...
g Servtces or feeders - installation,
/ / I Ii /1
(�� ��,/ . altaratFna orreloeaNen;
eia�1>t►I� rl /T' « IIIW I 200 am.s or lase 80.30 2
201 am>,s m 400 a mJrs 106.85 2
401 amps to 600 amps 1 2
b.3 PROPERTY fI1'RT1[Ei R..' IRS .' ',' .• . .. 601 amps to 1000 antes 240.60 2
Name: ;1 /� � >. u Over t on or volts 454,65 2
Address: 2
Iii � U / / �� / j , � � T emporary service, or feeders - installation, 66.55
- ; aM■ /` . ' ) alteration, or relocation:
J 200 amps or less 66.85 1
Phone ► M w► t i�� G0 M �� 201 am , to 4 am 100,30 2
� 1111 Ir.i:.Q'oN'.FAc r PERSON': '; : 401 $ran t` ch i4 t - new. alteration. or
�� � 1 1 133.75 2
t ei)\■fn VEML,
extension per er panel:
Address: . ,Altai & S Q
k Fee for branch circuits with purchase of
CitCl less: /Zl � service or feetkr fce, each branch circuit 6.65 2
y/State/Zip: B. Fee for branch circuit: without purchase at'
Phone' , 1 D service or feeder f�txanch circuit 6.65 2
46.85 2
E-mail: a 'V / Z4 4 II Each additional branch circuit
J /I IS I e It t tS . COM • Misc.(Servicc or feeder not
. ,;:.•: intruded); • .. .. .C RAcfroR:: Each pump or irrigation circle 53.40 2
Job No: Each sign or outline lighting 53,40 2
Signal circuits) or a limited energy panel. T
Business Name: 056 alteration, or extension Z
. Description: Page 2
Address: ,Q g7o 5 Li3 ezaj g' _ "a/
Ci /State /Z4.: y-i S 601-.6 0I" e?—l. a3 Each additional inseectiou over the allowable In ant of the above:
Phone:Sb3 (o Z 2 .800 ax: _ Per insyection per hour (min. t halt 62.50
.Z• inv _rots don fee:
CCB Lic. ##: i$7891 Lic. #: 3 36.4. _other:
Supervising electrician ,` :- . •£leEtrieitPettiSu oet !_; : ' : ;7: : r... _ .. c
signature require& '" ' Finn Review o S ubtotal " $
Print Name: Sjt-ee ROSS Lic. #: L) 2 (28/° of Permit Fee) $
oZ,s State Surcharge (8% of Permit Fee) $
Authorized TOTAL PERMIT FEE $
Signature; Notice: This permit application expire, if a permit is not obtained within
Date: 150 days alter it has been accepted as complete.
*Fee methodology set by Trl- County Building Industry Service Board.
(Please print name)
i:lbsts\Permit Forms 1ElcPermitApp,doc 01/03
V
1 at-
STREET TREE CERTIFICATION ..
..
�A..
A x
il Et \N
I, , i io- 5 , P Owner/)gent for 71.17 \ _
PLEASE PRINT)
'
1 , (PERMIT HOLDER)
� � u 4
. y
D o here 3 e t h l f l ocation
meets ' it yx Tggard /Wa n gton y
Count
l and use and development standards for street tree installation.
ADDRESS: t 514 lJ � A �:�,,. 17 i "'F r, -4 i O p.
r 0.
Oct LOT: I SUBDIVISION: V,,,kdten O Ii 0.
1 to-
BY: DATE: i �
RECEIVED BY: 1 .1111b DATE: ` ___7 dizt
A FVFVVVVVVVVVVVVYtVVVVVVTVVVVVVVYTYTYVVVVVVVV4VVVVVVVVVVVVN
CITY OF TIGARD 24 -Hour
CITY., dp Inspection Line: (503) 639 -4175 iv MST 07: it 2 Z
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /ite PM BUP
Location �51 d MEC
Contact P erson C � Ph ( leP� 7 PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Othe : sE
PART FAIL
PLUMBING
Post &
Under .214N,A
Rough -In 14P91.W7
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
•A PART FAIL
EL CTRICAL
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 Cy
ADA q' 47- Approach/Sidewalk Date I nspector ■1111", 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
INSPECTION DIVISION Business Line: (503) 639 -4171 MSTo�d �� ���
BUP
Received Date Requested g ( AM PM BUP
Location / 5 z16 A"Vsz,Y■ Suite MEC
Contact Person (' _Ln Ph ( ) 6 Ll PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT AIIPAIK
Post & Beam
Shear Anchors wiry
Ext Sheath /Shear
Int Sheath/Shear MEI
Framing
Insulation i D ,�, , K_ � Fi -
Drywall Nailing �`V V C/ v �! l �
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
FireAlarm
�Y Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'ART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
Approach /Sidewalk Date J� Lr Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL