Permit A L___ CITY OF TIGARD MASTER PERMIT
.-14,DEVELOPMENT SERVICES DATE ISSUED: 3/2/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 PERMIT #: MST2004 00025
SITE ADDRESS: 15965 SW AVON PL PARCEL: 2S112CC -D0021
SUBDIVISION: DURHAM OAKS ZONING: R -12
BLOCK: LOT: 021 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: BVH 1605 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: 5
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: 4 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:
EAADD'L 500SF: 2 201 - 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: OUTDOORLNDSC 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 VISTA 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
Rey #: LIC 152235 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins F 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
Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation lnsp Appr /Sdwlk Insp
_ 4
�� C� ���J 1144r.. I
Issued By 1....0 / - Permittee Signature : / Al A-A J r ,
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the net business day
stoteaoDy -moo -3 /.5
�uildin Per n FOR OFFICEI'SEONLY
Received
Date/13y: ?�!�J Building
. _ " Permit No 32 ._ 6160 as
City of Tigard Planning Approval Other -
J AN 2 8 2004
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 nn Date/By: / 3_ /-Or Permit No.:
Phone: 503 -639 -4171 FaxP5ll �3 yy -�9 - Irr 4 RD �o„ . i : Post- Review Land Use —
0.. - •I Il Date/By: Case No.
Internet: www.ci.tigard.or. RUILDING D IVISI ! -�- - Contact Juns.: — I See Page 2 for -
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
TYPE OF WORK _ •: - .REQUIRED DATA: ,= ,
.0 New construction ❑ Demolition 1 &2 FAMILY DWELLING. -: :. "`-:.,` . .
❑ Addition/alteration/replacement ❑ Other: —
CATEGORY OF CONSTRUCTION - Note: Permit fees• are based on the total value of the work performed. Indicate
j I & 2- Family dwelling ❑ 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: . , B
• Job site address: j$'45 Ave, " 1 Total number of floors
' New dwelling area (sq. ft.) 0
Suite #: Bldg.IAat. #: Garage /carport area (sq. ft.) •
Project Name: u Covered porch area (sq. ft.) 2-4 S%
Cross street/Directions to job site: Deck area (sq. ft.) 0
C A ‘ 6 C1 l 1 1v CA 4 611\1 DIAN I^ G' 1 � n Po Other structure area (sq. ft.) ( b
REQUIRED DATA :: _ -- . • I t f ► I L ' .
COMMERCIAL -USE CHECKLIST, . ;
Subdivision: p ham O K S Lot #: 2 - —
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,
C �� �]�, y ^ �� ^ ��, overhead and profit for the work indicated on this application.
�� 1 l �J �' y
a (� - ' . i r I , f Valuation S
— Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
al PROPERTY OWNER l ❑ TENANT - Type of construction
Name: V \',S-ra \ Occupancy group(s): Existing:
Address: (pop so Cj �
, (m *-C:, New:
City /St to /Zi : PT l
V ) - 0 12 g �Zl
Phone:(
SC 44� L Fax: An > 3) 1 4 Z-1. ZJ- L Z NOTICE: All contractors and subcontractors are required to be
l w the Oregon Construction Contractors Board under
APP LICA
❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: E,VC jurisdiction where work is being performed. If the applicant is exempt
Contact Name: M\ �A Pk5 reason from licensing, the following reaso applies:
Address: XIYIP. a 1 t ' '
City /State /Zip: -
Phone: I Fax: .. - , ..... • •
E-mail ' � .1BUILDINGFERMIT FEE
- .. �.., ....
Please rr efe t ncee.itheduia -
CONTRACTOR .. - �... .. . .... ,. . ...
Business Name: ; , PA . 1I ifilli ! Fees due upon application S
Address: 6,4 JP M J /, /, /..,ii - 11- - 6 -
'gy%
Cit /State /Zi.: g ririm � Amount received S
Phone: Aro ' 0 , ►� � ! 3 Date received:
CCB Lic. #: I F2?
Authorized
Signature: Date: 1 2 Notice: This permit application expires if a permit is not obtained within
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
• 0
01/20/2004 16:22 5032537693 SUN GLOW INC PAGE 02
1-Utt OFFICE USE ONLY
Mechanical Permit Application Received Meebenieal
r.t te/By: Permit No.:
City Of Tigard — Planning Approval nodding
0_2_1 yeit • Permit Na.:
13125 SW Hall Blvd. Plan Review other
Tigard, Oregon 97223 »ateBr _ Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 pets`•ReView Lind Use
., r ,� oele Case No.:
)tmtert: vwvw•ci•t' ardor -us (`
_ p
tg � ,-� � Ch aetEt t
Curls.: See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 - ' - Name/Method: $upPletnentnl tnrortnotIon.
ipo New construction X t)ernolition Mechanical permit Fees• are based on the total value of the work
up Addition/alteration/re • laccxnent • Other peed- Indicate the value (rounded to the nearest dollar) of all
_ mechanical materials, equipment, labor, overhead and profit.
a ' :CONSTRIJETION i
1110,. 1 & 2 -Farm} dwellin_ II Commercial/Industrial 'glum S See Page 2 for Fee Schedule
Itil Accesso Buildin 11111 Multi Descri • ;on IMAWMTM11 Total
IN Master Builder I Other: me coor.ng
SOBS1TE ENTO MATION.aiid •LGIj„AttON '' Furnace • add-on air conditioning 4 14.00
Job site address: Gas heat . . 14,00
Suite #: B1dgJA.t. #: Ductwork 14.00
al g//14 , / H (Ironic het waters •tem 14.00
Pr0 CCt l�iarlte: / /I �S Residential boiler
Cross street/Directions to job site: for radiator or h • •nia a - =m III 14.00
�1 �� in wil, i heaters - (fuel, not electric)
D u,0 anq ' ? l ` t in wall, (f t, s o •wider ctn. 14.00
L Flue/vent for an of above 10.00 —
►•��rT��r�� Lot #: .'r units 12.15
subdivision: I . Other dud Ap litmus
..: Water beater 10.00
■ ESCRIPTION OP WO • � Gas fireplace 10,00 •
�� Flue vent water hcntcr / tlrealacc) 10.00
� ` s/ ,II Ara - , / / - . A Ig/1VI[/I Lo= li: , et :es 10.00
fl�7f✓�Pli� / , A LL Wattd/Pellet stove 10.04
NW� 11 0. 1 1 / Wood fire•lace /ittsert 10.00
Chime /liner/fludvent 10.00 MIN
PRO'P�ni�Y'OWI!1ER :
':- T IGEN- - "a...',;,,, ;•'
�c :, Other: 10.00 —
Environmental Exhaust & Ventilation . '.A ��r �lTl��i [I.� � � a ge hood /other kitchen equipment - 1 10.00
Address: EITAIM 1f1 /If /i F I ' Clothes dryer exhaust 10.00
��__ � �.W ! i�T�� Single duct exhaust
Phone: �1►6s- /� r �! �s . (bathrooltls„ toilet campartanents,
Ili ,A.PPLIC "i'1 I►-4 :CONTACT PERSON utility rooms) 6.80
Name: V �� ren D . Attic/crawl spare fans 10.00
1e1 %� �7�1 d er: 10.00 —
Address: , 1 ' / S / - 17■/P, Fuel Frain
Ci IS . te&Zi.: e2 5.40 for first , S .00 each adnitio. al
U �1 !i• r Gag heat gis i Furnace, etc.
Phon 0 Fax:
E 11 _A . ! 1 f l i •C 01 wall /suspertdcd/uttit heater
• • . ° CONTRACTOR Water heater
Business Name: ' A I 1 ._ A , Fire•lace
Address: 'L • 3 r �h nilliMMIN _ •
Ci /State/Zi • : 0 . A C Z b Clothes • : as 11.111i11111
Phone "1. - 26 7 ;' EMPAIMISMI Other — ---
Total:
CCB tic, $ #: 1-1-!'6, (? Total:
reregt'foie
Authorized . { Subtotal: S
Signature: �1+1n � — bate: ( Z(�1 0�-� Minimum Permit Fee $72.50 S
Plan Review Fee (25% of Permit Fee) $
/: /r OA It I State Surer t8% of Permit F ) S
(pima . e tee) TOTAL PERMIT FEE S
pew pP ' cF 'P� metbodaloy set by Tri-County Building industry Service Board.
Notice: This t a b`a`ton irte trn permit is not obtained within "Site plan required for exterior A/C waits.
180 days alter it has been olden` as complete.
if DSta‘Prrtrtit FomulbtecPermltApp.doc 01/03
01/20/2004 16:03 FAX 5036284633 THE MULLEN COMPANY Z002/002
E. OR Oi.i L'SE ONLY '
Plumbing Permit Application Received _ Plutnbing
Date/Br Permit No.:
City of Tigard Planning Approval Sewer --
aate/BY Permit No.:
L3125 SW Hall Blvd. plan Review Other
Tigard, Oregon 97223 DateIEy:- - . Permit
Phone; 503 - 639 -4171 Fax: 503-598-1960 ,,,,
and or -us
- Review Land Use
LutQrtlCt: www,ei.ri g t • , Date/ay: Cue NQ_: peat = a •� Contact Jowls.: See Page 2 for
24 -hour Inspection Request: 503- 6394175 ' " Name/Method: 5t1 'Menial tr
TYPE OP. WORT£ i •' ^''' . FEE *:sC uul1E (ibr•gpticfall'laetiit,tpa die dilttj • 4-
i ► d New construction ■ Demolition Descri • tioa I Q _ ree(a.) I Total
Addition/alteration/replacement in Other; ''' .1 ' " `,, � , , {' ,ii41 ' 'r•._
; EA'lEGO> :IDF ON . � Cfisctttiaiu0 r api iii ael 1, ; ,''.'••• '..
s '�' ; � "' � a SFR(1)bath _ 249.20
• . 1 & 2 -Famil dwellin_ Om Commercial/Industrial SFR (2) bath 350.00
Accessory Building I Multi- Family _ SFR (3) bath 399.00
■ Master Builder U Other Each additional bath/kitchen 45,00
..1013 SITE INFORVEkTIONasidLOCATION Fire sprinkler - so. ft.; _ Page 2 • Job site address: _ .. ::,:,-;•:•:,:::. . .. • ., . 'Site Uti1Eittes. _ °; } .,+,;;,• • .,. ' '
Suite #: t. #: Catch basin/area drain_ i 16.60 .
• brywelUleaclr line/trench drain 16.60
)='ro'ect Name: a �� %�.�'�7e1%1 Footing drain (no. linear fl.) Page 2
Cross street/Directions to job site; Manufactured home utiliiica 110,00
l t h /,l n 'a + lid n I I Elva • Manholes 16.60
�/ �\/ 1 U v 1 i l 1 J J/ti 1 Rain drain connector 16,60
. Sanitary sewer (no. linear ft.) Page 2
Subdivision: JMAI /i 1 �� MIN Lot #: in Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: Water service (no, linear ft.) J - Page 2
DESCRIPTION OF WO • Fnirrcor Item
. � . IE Absorption valve 16 .60
Backflow preventer Page e 2
ITES1911J�11 T �ibliMi un Backwater valve 16.60
Clothes washer 16.60
Dishwasher _ 16.60 ,
S:l. PROPERTYOWNER ' -•''.' ; 21.151' 1ENAN1 • Drinking (Outman - 16.60
Ejectors/sum) 16.60
Name: e, ( sA,rij(o Expansion tank 16.60
Address: I A ll / �i D1 Fixture/sewer cap 16.60
'tt Iil�Efa a IIIIMMIli t Floor d e dlspo o rl sink/hub 16,60
Phone:= 4 - LQO a INTIMELMIAMI Hose bib 16.60
IF..irEgIMIIMIENW CO l li_ •_, ' • ERSSON lee maker _ 16.60
Name: T. v1 Interceptor /grease tra1 16.60 ,
Address: - JVY) 1 / pi - Medical gas - value; 5 Page 2
Primer 16.60
City/State/Zip: - _ Roof drain (casmmereiaJ) 16.60
Phone:. a 9- !OZ. Fax: • 4 2 Slnkbasin/lavatory _ 16.60
72p fi r/ I WAD ' • • D Tub /shower /shower pan - 16.60
..... • • , CONTRACTOR • ' Urinal 16.60
Business Name: k Water closet 16 -b0
• f! �'� �• /•S ,
Water heater 16.60
Address: _ I • r. . ..,,e Other •
r / r Other .......-4 r�
Phan . 5 ' /.: : / 1. F F. - 5 �- .�1 t ,., Flea abligeteonftirai _ .
CCB Lic. #: " , . ` lumb. L'c. #: Subtotal 5
"Z�Q �� Minimum Permit Fee 572.50 $
Au orizcd - Residential Backflow Minimum Fee 536.23
_ Z �J -O
Signature; ' '- Date" `7� Plan Review (25% of Permit Fee) S
�� f' / Stara Surcharge C5% of Permit Fee) S
(Pleas print name) TOTAL PERM' FEES 5
Notice: Tbia permit appllwtlon aspire if a permit is not obtained within ' All new commercial buildings require z sets or plans with isometric or
I80 days after it has been aeoeptad u complete. riser diigratil Or plan reV1tw.
*Fee methodology set by Trl County Building Industry Service Hoard
i:\ oats\ Permit Forms\PlmPermiiApp.doe 01/03
01/20/2004 16:08 5036425815 ROSS ELECTRIC INC PAGE 01
Electrical Permit Application } (�,1 01:1-1(1:: <')N i,N
Received Electrical
Date/SSji: Permit No.:
City Of Tlgard Planning Approval Sign
13125 SW Hall Blvd.
Plan Review Permit No.:
Tigard, Oregon 97223 Plan Review Other •
Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
Internet: www.ci.tigard.or -us t t Case No.:
24 -hour Inspection Request: 503 -639 -4175 _AL' -4 M - j' ' Contact tuns- pee Pag 2 f or
Name/Method: , — Supplemental Information.
•
-
TYPE Off WORK H ' ,. ::
aw 'tease ctieClt;11E.tlitat`' ;,';
is New construction II Demolition • Service over 225 amps. III 14ealth-care facility
• Addition /alteration/r- •lacement
commercial
• Other: ❑ Hazardous location
❑ Service over 320 amps-rating of ❑ Building over 10,000 square feet,
"' CATEGORYORCONSTRTJC ION.' .:• 1 & 2 family dwe l li ngs four or more residential units in
■ 1 & 2 -Famil dwellin_ Q Commercial/Industrial 171 System over 600 volts nominal one structure
III Accesso Buildin �� ❑Buildin aver three stories ❑ Feeders, 400 amps or more
I II Master Builder; ❑ Egress/lighting pant load aver 99 persons ❑ Manufactured structures or RV park
1 ❑ Egr plan ❑ Other:
.`. •TO$SITE INFORMATION :: - . Submit sets of plans with any of the above.
Job site address: The above are not applicable to temporary eonstrnetlo n service.
Suite #: $Idg. /A. t. #: FEE* S ULE.: .�_ . k
Project Name: r, Number of inspections per permit allowed
�i A Y te i' IG( /m / Description Qty Fee (ea.) Total
-- Cross street/Directions to job site: Yew tesideet d- aingle or mold- family per
mil � 1 / /l/ � 1 dwelling unit- Includes attached garage.
`ki �/ / •
�/1 ! n I � r /�/� ► I R / l/ t � l/� / ti I I a V Service Included:
less sq, 145.15 4
Each additional 500 set it or portion thereof 33.40 l
Subdivision: Pi n Lot #: Limited energy, residential -- 75 .00 2
Tax map /parcel #: ' Limited manufact home en m modular dwelling 75
... '" DESCRIPTION OFWORK • :: : • • • • :.• • • service and/or feeder 90.90 2
201 Services or feeders - installation,
��jj►►��` �' a�I � I Ali I �,I �� I •'I-,��:�% ,I alteration Or relocation;
■sold � iTA Mi 6 di / , 200 aam.s:d00 amless 80.30 2
mps to ps 106.85 2
' 401 amps to 600 amps 160.60 2
4'.4 •P.ROPERTY OwNR. • - .; RI ' _ • :. 601 amps to 1000 ads _ 240.60 2
Name: �,. ` +U p C Over 1000 amps of volts 454,65 2
lam Reconnect only 66.85 2
Address: gr 4. LIMWEMIN Temporary services or feeders - installation,
P I I E ► i pr alteration, or relocation:
1 200 amps or less 66.85 1
Phone g► rw Ji� f M�_ �� 20l am . to 400 am 2
:D '' ' ' CANT ` . 1Y:•CONTAiCT :PERRSON. , 40I to 600 am ps 3 3.7s 2
V � u . a r . xt n n per p new. alterntion, or
yr 1 extension per panel:
Address: . (A,Q a,5 a 1 0 V • A. Fee for branch circuits with purchase of
City/State/Zip:
service or feeder fee branch circuit 6.65 2
B. Fee for branch circuits without purchase of
Phone: [Q Q 7 Fax: � Z 4
service or focder fee. fast branch circuit 46. 2
„ Q a., � O N Y /t E ach w ine branch circuit
)v -mail: .
N
ail: ' [ 1[(► l yr � 2 QS . G . Misc.(,fSe Servicc nr feeder not in 6,65 65 2 • ' `: - .: ' :.C4 l CTOR,.' • Each pump or irrigation circle 53.40 2
Job No: Each sign or outline lighting 53.40 2
Signal circuit(s) or a limited energy panel,
Page
Business Name: OSS w ■ , alteration, or extension 2 2
0
Address: .2 370 543 Description:
C1 /Mate /Z1 • : y-, S 60r6 DR T71 P ? � Each additional inspection over the allowable In any of the above:
Phone:.5 3 ( z ()O P itt on p hour (min. l hour) 62.50
Fax: M7 1, qZ nl s - investi x:
investigation fi
CCB Lic. #: 8'789 / Lic. #: 3 9-413&c. _other: —
Supervising electrician, Fait iettl:PeriSub tal :nt ::,;a '
$i afore re•uired Subtotal i
$
Print Name: (/ 4/23,2_,S Plan Review (25% of Permit Fee) $
j e. j Q $ L ic. #: state sur
Pe rmit Fee � S
Authorized TOTAL PERMIT FEE $
Signature: Notice: This permit application expires if a permit is not obtained within
Date: 180 days alter it has been accepted as complete.
"Fee methodology set byTrl- County Building Industry Service Board.
(Please print name)
is \ Costs \Permit Forms \E 01/03
S TREET TREE C ..
4.4 ..
i ..
F ,
/ ,,, ,, .
I, K , ,Owner /Agent f or "teA v (.esker �?Me5
(PLEASE PRINT) 1 (PERMIT HOLDER)
{'
* 0.
Do hereb certify thEat the following location
:ti ,, ., :. ,
• "gi g"'
meetsGt�yof�7�i�gard /�Xlash n�gton Count y
:��:�a. �� •.�,�; „�,. _ �� Wyk
land use and development standards for street tree installation.
ADDRESS: 141 6 5 5w II-Lim. 7 ( 0.
0.
LOT: SUBDIVISION: ► 1 1 a u
s 0.-
BY: s DATE 7/-2 U if
RECEIVED BY: �1,� DATE: �' '"'.--- c:"/ 0,-
44 4
CITY OF TIGARD 24 -Hour •
BUILDING * Inspection Line: (503 - 175 %
MST p?DD (
--800 5
INSPECTION DIVISION Business Line: 639 -4171
BUP
Received Date Requested AM PM BUP
Location / 5 `"f Cos Suite MEC
Contact Person 1 —e_ Ph ( ) n — / �e 6 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
Ina Framing /Shear �� � a �. Za-
Framing /� �'�f
Insulation ���
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
ASS PART FAIL ��
P 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
MECHANICAL
Post & Beam
Rough -In
Gas Line
z Dampers
4 . .... -
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 -
ADA
Approach /Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this inspection reco; from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
MST 4\ C q—D61O
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 4 ° AM PM BUP
�
Location / et- Suite MEC
(
Contact Person Ph ( ) 6 Lt D- 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 Nailing
Fire wall
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
Fire Alarm
� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
SITE . 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA D 2 Ins ector - ` 2 N Q v Ext
Approach/Sidewalk P �+
Other: V
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour ,.
BUILDING Inspection Line. 03i 39 -4175 — 66 a�S"
INSPECTION DIVISION Business Line ( 1 6 ! --171 BUP
Received Date Requested _S AM PM BUP
Location / S 1' l r l PL- Suite MEC
Contact Person Ph ( ) 7/° SUS" PLM
Contractor Ph ( ) /5� lO y 0 033
BUILDING Tenant/Owner L ELC 3 /� /o 'I 0/
Footing
Foundation ELC
Access:
tg Drain ELR
Crawl Drain ,1�
Slab � Inspection Notes: / SIT
Post & Beam oLJ�
Ext Sr Sh ea Anchrs
th /SSh ear / S� / Q G . e,
Ext eah/h /
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:
P 4 1
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 ri Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line S ,� J ' C/ '
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL