Permit � � + CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00108
�I�; DEVELOPMENT SERVICES DATE ISSUED: 5/12/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09041 SW BLACKOAKS LN PARCEL: 2S111AB -GP384
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R -4.5
BLOCK: LOT: 084 JURISDICTION: TIG
REMARKS: New SF detached. DEMO CREDITS FROM BUP2003 -00521 APPLIED TO THIS PERMIT.
BUILDING
REISSUE: PH2226C STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,341 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,398 sf GARAGE: 585 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: I THRD: sf RIGHT: 5
VALUE: 269,855.50
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,739 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: a8 q 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: 1 VENT FANS: 2 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: 5 201 - 400 amp: 201 - 400 amp: let W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL 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: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,932.19
FOUR D CONSTRUCTION COMPANY FOUR D CONSTRUCTION This permit is subject to the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes
PO BOX 1577 PO BOX 1577 and all other applicable laws. All work will be done in
TIGARD, OR 97075 BEAVERTON, OR 97075 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.
Phone: 503 - 590 - 0805 Phone: 720 - 7445 MOBL ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: m0805
/ 1037 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You 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( 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 lnsp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk lnsp
7 / V ..../
Issued By : X Permittee Signature : = .........../.
Call (503 ) 639 -4175 by 7:00 p.m. for an inspection needed the nex `• usiness day
Bui'�tdin Permit A lic • ,\e . „. FOR OFFICE USE ONLY
City of Tigard B /� , L �� Permit No.: i" /Og
13125 SW'Hall Blvd., Tigard, OR 97223 Plan Review •
Phone: 503.639.4171 Fax: 503.598.1960 \Ap y ipfli ' Other Permit: ,
�
DateB N 3 — -•,.!/ Allyb
Inspection Line: 503.639.4175 C? `11 � ' I Date Ready/By: m See Attached Checklist for
...us. �Y
Internet: www.ci.tigard.or.us 0\1\1 0F Notified/Method: M Supplemental Information
7 ,L � ;: alvt;. r RII,'V,6"1W.I�tdiTIVL ))1 � s. c±s,W,Ilc, „. �s . 1r,, j , .. ±. 1 r q I, , `I I `kl,` . ;7., r; '' ra 'u.4 �, l L;.
,y : at,. 4. �' , ,, '- ' ',, � ' 4 4T i;,; , ' ,(, „ . , :, REQU " A ° T A 1 ,AN I
` 2 F AMI Y DWELLING ` LLN
(Z New construction ❑ Demolition Permit fees* are based on the value of the work performed.
�+ Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the Q
. ; ,_ ;..nr ;:: ,.. ;r J < :,a< ,; .;_ .:. „ r M °', `ka *f work indicated on this application.
°z.;t .,L ' d ,." 4c" `'. pr >s�:1 »a "a' �'E .;iiF4 «" .� , ,prµ,y;r � i ".' *i ., ,a i. - , ,,k. i :� a �;
1 `"t p.et:w" =,. g' .. tflyiCONSTRUCTI03N'i C' .. ,� . ',e ; a. 4.
Valuation: $
cil 1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family /
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: Z
_,.<•�. ",r4r;.* -.:t'"at.:. w^t.�-eu , ;;"a1'aa"t:a . „ % » :;z, u'`t..: �y, =v:.x -:F? :f� ., ;n;
bgSi ";.t ,. ; : ; ” .. „ „ M' �:, ',' yl t `. ,. Total number of floors: D
,:, ^ ' :/ : .i,: i , „ ” FORM TI ^ , At 'A, a tLOCATIOI „ = f,, , .,5 w.,,K
r ��� ;�s M t, JOBgSITE IN �. '� h '� �ri�` i
�'AS,t - ..: . � � s . .,. , ��e l ��n.,fl.�'dx§.a",�,5, 6 ..'`�,p�r5� "e3&£;.'9°� °Fffi �•E d ... u�.n., . F?„ , � _5K +_,. . , »s��
Job site address: 9O i/, Se !N� ,6 , ,9 gs z4 //�„� New dwelling area: 273 9 square feet
City/State /ZIP: �/ p /9 1 fix ? 722 4( Garage /carport area: S�� square feet
Suite/bldg. /apt. no.: J Project name: Covered porch area: 1SG square feet
Cross street/directions to job site: Deck area: square feet
c /o /G.Sdh Other structure area: square feet
�, ,REQUIRED DATA }COMMERCIAL { USE CHECKLIST
a'u. ,���,.,,,,z, :,. .,,., -< .,t . - m ., ,, 9,,,,,,i,,,,&
Subdivision: K.:2,, d + W 244f/ / Lot no.: 69. Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
frC 4 1 . , N , " ” ii i DESCRIPPIION OF £ WORK , ' r 5 !- , # , „< : `v , work indicated on this application.
T C jj / � J Valuation: $
e�t.�G� Existing building areaglap square feet
New building area: square feet
. ; ° =,• ', ; .s„ .:; , �, , ^r •s •<a ,, .%, : :,,) ,.. °?, <:., 4i',7r s;4°': - m,; a,,1 ,, ' , a s1� t: ” t i S' s; ", `ti's ai?gt_) 1
`,' PROPER ,''OWN �.'. i0t".;�:e.1,t.,. N + ,r,,, Number of stories: "--........,
Name: ce 4 / /(40.. � $T4 e cre Type of construction:
Address: Cp. V 2 A3-7 7 Occupancy groups:
City/State /ZIP: 'T(ph14 Ox. 2' 7C7 S Existing:
Phone: (J) .s1r,0 — O cPOS Fax: (5 LS -17�- New:
...., „�; ,.�., ,,;,,R,, -r�.�:� "�rca� <cr�: d ;r�:c�;«m� � ;�'d
:,� ,_ «s,.a. ,a" o . :,,,. �� :: :�..':. ,fir �;,:,e ,y,P,.. =,�� ,.: =, r ry'4,,,,,,.,--..,;.=4,,, 9:' - s.;ru z , s ---:; - :•,:' a - x.0 6 ��., mks. _ ; A r.fri .^ '..''. '.,
,.'x.., .1 s> '"`� ", - + x "i:' "Pig: %;z5" �!g , g ,• : „ �:”. @s >A
NT ACT = ` PERSO : , `
�.. ® 'NC O ..�s'��
.`ice: . � »,R :`14` ".:!'�+t� 4 :, "#.. t : ,., t, `
,,, °PPI:ICANT : �r � _;: , „�,:hr , _ 'I`,.
G .::�t•�', �ItX7� `���w �., :'•: ,�. ,:,;� tit» ��'F ^��:F.���a,v,:y„ §:�:§:? ^:� �.a3�k. .- .��:..:'d�u�-': �.'� �t.:�. y� <:. .�•1 - .
..� > �, s��r��' �'3' i M: i. �..,.' s�'',' v. ' r, �. 5<S;'�L4�±e;:3r"#:":.s �:'_ � :� ; ' r t,�` . .r.rn tx., 2....r ;zss ., 4 <......�. ",r = -.:zC , �� '�:"
Business name: ,S;efry e AO& 4� 6 &-f..... All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: apply:
Phone: ( ) Fax:: ( )
E -mail:
h - i.� P 4 � �x '' ^ v s>a.- ;X P �. - Y •e # sa - r < "”. its §,. c.% .r t-, e9
P ' �i t s ;CONTRACTOR �' a Av
Business name: Sht -ere. „9... / 9,1 5 (ti2i {; " " :. t r 4 . j -" :i BUILDING';PERNiIT'YEES* , ”
Address: Please refer to fee schedule.
City/State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.: 7 i V ? 7
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:2)1,-2e .,_ p f Date: --,2 /......—e::.5./ * Fee methodology set by Tri -County Building Industry
, ,,,,, e7 -
Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T( I I /02 /C0M /WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY . i
City of Tigard Deceiv
Permit No.:
Y
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 n �� wjlo�'pN�� f � f'+ ❑ Electric a l ❑Plumbing ❑Mechanical
24- Hour Inspection Line: 503.639.4175 1♦. ,
Internet: www.ci.tigard.or.us ❑ Other:
THE 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 plat /lot. ❑ ❑ ❑
4 Fire district approval required. Name of district:
•
❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. CI 0 0
7 Water district approval. ❑ ❑ ❑
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 if
copyright violations exist.
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 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.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering, standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and detailsshowing placement of rebar. For engineered ' ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore: on and shall be shown to be applicable to the .ro'ect 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 and 22 above. ❑ ❑ ❑ .
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings .
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03
Building Fixtures
I PluMbin Permi teatio 1k • • FOR OFFICE, USE ONLY
City of Tigard vt Blvd., Tigard, OR 9 li Received iew
Date/By: Permit No.: )-Erspev -, /0
13125 SW Hall 0
r4gkl) Plan Rev
Phone: 503.639.4171 Fax: 503.598.1960 i \--- 0 t No.:
1A 170 A Date/By: Other Permi
24- Hour Inspection Line: 503.639.416W( .111_ Ali Ions:
1-A1\10, ...c-1%.911P.. r" %......a Date Ready/By: 0 See Page 2 for
___
Internet: www.ci.tigard.or.us
0...A - Notified/Method: Supplemental Information
Emi‘;g a:41provit ypEts , , , A , e,f"ollp , .,, , ,, .- SCHEDUEE''''''"'""',-:-
titt%§t tita- ANNA, 1.414,::alZigt.'2240':101 414i6, , , , e;-3;'.51 7 ,','S.n..:J0 , ....., , ,,:;i7.:,.v.,W.,.,f,,, ,, '
X New construction 1=1 Demolition For special information use checklist.
Description Qty. I Ea. Total
111 Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
S ° 1 ,F.MillentiK ei ? - 6 l rifarik4 1 5geoMilral5ge w , : :WAVAFIFT SFR (1) bath 249.20
:,s; ti
gl 1 - and 2-family dwelling 1=1 Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
I=1 Accessory building 1=1 Multi-family
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler ( sq. ft.) Page 2
.t. ,, ::v;4N . :4akiik':dili'f■iFVWirftWUNikfffdK'icAINIr:' , '' ,
,e ...:.,:- .T:] .1 Site utilities
Job site address: 9671(/ A - a) 22/kit 4/li (--
S Catch basin or area drain 16.60
City/State/ZIP: -7-< me,,c (..A.... ? 7 2.2_ Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: .
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
e 9 7:-( 4- / '7) t.404 Z Rain drain connector • 16.60
Sanitary sewer (no. linear ft.: ____) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: ... e . e ..47 s^‘,.., e z ? Ace .3 I Lot no.: Water
or item
Tax map/parcel no.:
orptio sn valve 16.60
NtVVP Mie6f.%454aCVNIVIM-44' ' ',1,7
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' rt filtilitIC, bt klfiFMRMk9:4tI!mr--EikiE;-iweo $1::, Drinking fountain 16.60 '
'i,;' , V. ACRAO U,i1 4 t., :7' ■2,"' ,,,,MX ' :■';',"9V : '' '
Ejectors/sump 16.60
Name: I- r. b 6 s72Rcec77 evo de - Expansion tank 16.60
Address: 76 0 Fixture/sewer cap • 16.60
City/State/ZIP: 73,e4,9a1,-4,-, / 6 .. A.. 2 7 075- Floor drain/floor sink/hub 16.60
Phone: (,_ c)30,5 Fax: (S7),3)S7c>-/ 7.5 ( Garbage disposal 16.60
,, i '-,:is > 57.V.a. , wezaguazz4,:afgewi , o eggrz-vggrimy;,11 U
,1w, I-ai; aisl , wgketakvia Hose bib 16.60
i*INKM"Ria,V.MtAge;=::=4:14 AtWY-5,.:ANY",1%.":3RVNi ice maker 16.60
Business name: S 41-d 194 d C1-4--' Interceptor/grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax:
Tub/shower/shower pan 16.60
E-mail:
ri, U nal 16.60
;t agiaterdvmlic :KAwit'v
mez:74'Ylmav6'A,,gAAezt Water closet 16.60
Business name: .r7 ep/- E 226.1--.44 41:13 Water heater 16.60
Address: s e s/ sr Other:
Subtotal
City/State/ZIP: /ZZS4i6, 6,-/L. 7/2 1 Minimum permit fee: $72.50
Phone: (563) C. v -23// Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: /797 Plumbing Lic. no.: (‘--g,4/Pi, Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 1/1„ge.hita 641,....ei--
TOTAL PERMIT FEE
Print name: A4/4 „Z' Date: s -2 C 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.
i: \Building \Permits \I'Lls/IF-PermitApp doe 12/03 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information `,.
Fee Schedule: Residential Fire Suppression Systems:
' $1 - ,eer e a Toia S filar
Site i) t l l t ><es _�. tY � E ..: ; _ . q fie o o tg ge.......,,x P Fee - .
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 • -• -'w = ._;._p ° i• ' ° ' = , :, ' ^
Storm & Rain Drain - 1st 100' 55.00 41
u " „•, �,,,,; P,g _ .
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
s • or A " ': Qty "> e
eiea�jc Ibta additional $100.00 or fraction thereof, to and
xture I *E i4 ... ... : M 2. i J L :- , K ,
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 - $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00. .
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
• and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
•
Fixture Work: . .
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
a Quanfrtybp (Ftzure} R'orklaerfuriiild
Frxt preIType ? r i . . " R eplace
s r k F Mol ;sag t ii d Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool -
Car Wash -Each Stall • •
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial . •
- Domestic .
Drinking Fountain '
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory Quantity Total
-Bradley Isometric or riser diagram is requir if fixture quantity
- Commercial
Service total is >9. . - '
Swimming Pool Filter .
Washer - Clothes
•
Water Extractor Plan Review ,
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: '
i:\ Building \Permits\PLM- PermitApp.doc 3/03
Mechanical Permit Applicati �1� ® FOR OFFICE USE ONLY . , ,
Date/By: City Of Tigard Received
Date/By Permit No.) /i _ /D g
13125 SW Hall Blvd., Tigard, OR 97223 ' ° y ...„44, �
Phone: 503.639.4171 Fax: 503.598 -1960 Plan Review
�I / / ,W�4 ;Ibp���� ,'1� Other Permit:
Inspection Line: 503.639.4175 r" ■ I Date Ready/By: Juris: H See Page 2 for
Internet: www.ci.tigard.or.us G` O /� v S 1 ON Notified/Method: Supplemental Information
u ^"55,g'e - ..,E b 3 '<'.n`e.- S 'i, "`@ ".Q 1�lC��\v ; " . .4 $• . =. ° f;w�fi» 3'.4,: l' "a;:akF.' - Y.;
, _ „�•a i? :` ,- A .k I, `a .':r':F "'11'. .a = ,y,g`1 �"_':: ,, w'`. fir,: ' if m . , i .-
' ; �f» rill :ss ,''-" ,� T e x ' :s I . e , �, , a ., a . .'.t�5 .�.4 e V, a - d _ _ < *, ilS , - � =; ,
��. w� �� .;�;s -.. <_:�.,;T£., - Js e OR r`� �a ,1�£s�'� �.,. r;COMMERCIAL�FEE S.GIIE'DtiJLI+ tjSE C
„ ?� <s �a8:�� �rr�u.''C9�fR.ark,_u.':� a=..z' �,*fi. +. '� t:'_ -5 ?n J >.., -... . e "as">. �_
wn_ -.rosa� w ,.:��r,. c.-sY.�a, _ ..=5... . re: � -....� _l.- .:..:' a , .., .-
14 New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
; ' rF ; 'xz„�- ?. z j :, A'',.4 '6f
Value: $
4. ,,, 00,1 CATEGORY OF4CONSTRUCTIOl . ; r 4v
.A ,,.:.a=a,1 .; h `� , ..a ....�....,. AZ-..,, 3 z ovr, - ,, ,, c.;Z:`-sa:.x - ,. .�• i -. '.r -, a,,, - - - ,
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
s ^ RESI ANTI :E.'%QUIPMEI�T / SYSTEMS4FEES*
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
F
Description Qty. Ea. Total
{ °'i },:. !*.6N x &'", .f;fi:RSRU^',g e. .d..vi,'<:r. ,, n•.; +?;."�a -.kid 4'4"x',;:.,.:".; r£ .�*„ L ` ' Sg �` i' � :y
g'.�:C `ll .:. '' '' 4:14 a te £ ;'�= ; a" o'.� #:� €ti��'»�', ^."jai,
- 4 - , OB STPEnd=TN QN; ,, L s 'ON. - ?,
�� t "° w � -� .,,;.�- .»_..yam. Win. � �d .�� "� � � ��� - ^ „a�x He a ting/C OOling
Job site address: 9 S. �. 7 ie 6�/� LINE
Air conditioning
fires S to plan or ingtplace placement)
14.00
re uires site lan showin lacement
City/State /ZIP: f , . D . 9 7 2zv Fumace 100,000 BTU (ducts /vents) 14.00
Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
a A 74- Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
'�,,� az �du in -wall, in -duct, suspended, etc. 10.00
Subdivision: _ 944e Lot no.: �� Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
V ti4r ,, 4` ,'.R.1,4
„ .. r DE.SC.,. RIP ION. a OB�W,ORK ' 4 . 5 »� � ` �� Water heater 10.00
u`s.c?< '3;�., -aa�. �� .� .. te =. r. - .i a,.. -,�: «..a=te. ,;.. �� . .�..�.: �".-,. ,�,.�u +, f... vii
Gas fireplace 10.00
°"t,i61 L2") l�Q C,u- Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
rf.;4, rNa.;,: .ua =r -•:. „:,, t .aa, €'.w; ., Chimney /liner /flue /vent 10.00
' ,$ 1 R PER`TYiOWAiER . "'FEN T - -'' ; ' x
�kStf>.�,.��_ . m. .- �- .��;�,es ^ �- �:F., ���.d � ;�r_- .,��.�• �.^ ,.. `s� Other: 10.00
Name: / 4 2) t/ Yi,-7 772 e?-e e? D A)) 4.s' Environmental exhaust and ventilation
Address: R V 0 ( /3- 7 Range hood /other kitchen
equipment 10.00
City/State /ZIP: Igaitt)...kj---&a._. ! a .L- ' 7 e� 7 N Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:5 3) S - p ,pog* Fax: (J 3) t SPo -/ 7S/ toilet compartments, utility rooms) 6.80
'r' .. APPI TCANT ,. t.:',1, ti. , ' �' } �
�krz�N .., � �� t�, s �, '�?� �_"' 1•..,_u. GONTAGT; �, �' r�,:, Attic /crawlspace fans 10.00 �
£ .x ., �.' a . Mme, s.�,7�.; �, .' � ;�.a�,'» ..-, x �. , ��.kv ;�xyai=,"�
Other: 10.00
Business name: S - / IPS Pi:" t% u -4 - -1 Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
J 4, 7W/in jix y ' -.0 `s 5 . r L Wz: ,. Barbecue
/�, . _ DI / 4 /# Clothes dryer (gas)
Business name: s
"�� i '� J Other:
Address: /t7" D / S .. � r. a,� : ,.' « „ r
� '_`. ��% IVIEGHA�N� )CAL'PERiVlFT4FEES * "
U-� sat .l;a�?w >T�z'm.aen'�a,�=s, a..,,�c -.w •emu - �✓ -.�x�.
City/State /ZIP: I�Iz s „vet, a/1! Ci 7/2_ Subtotal
Phone: ( - 0 ► 4/3 Fax: ( ) Minimum permit fee ($72.5
Plan review (25% of permit fee)
)
CCB lie.: 6 ,5-7? State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: a yyV "..21--0-444) This permit application s bs if a permit is not obtained within 180
days after r it t has been accepted as complete.
mplete.
Print name: / 6 A41'TN Ml 4-71 4cS Date: ,9 v ( * Fee methodology set by Tri- County Building Industry Service Board
i:\Budding \Permits \MEC- PermitApp doe 12/03 440 -4617T (1 l /02 /COMJWEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total ?aluation :: E „ ¢
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
•
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or - •
fraction thereof, to and including
$50,000.00. •
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
i:\Building\Permits\MEC-PermitApp.doc 12/03 2
Electrica Permit Application i G FO OFFICE USE O NL Y
'City of Tigard t` Received
Permit N.1 J
�� Date/By: t t iO -410 I/ d g
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � ' / f Date/B Other Permit:
Inspection Line: 503.639.4175 r" l Date Ready/By: Juns El See Page 2 for
Internet: www.ci.tigard.or.us R1 Notified/Method: Supplemental Information
� r -
a . - ;; � #i� TYP�E� O � y .� "�,.,, '�jt.��'�:,. <.;� L= � f� :. �;' �t;
� ' .,; ' 'ij »C��r��a�,.� a n � �'i: <. : h r'pI;A1�IW RE�VIEW .. .
New construction ❑ Addition/�1tn/ replacement Please check all that apply.
['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑Other: ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
s �, C ,�T E G ®Rl'� OF COI �S TRt1CT I 01 �1 1 g of 1- and 2- family dwellings 4 or more new residential
1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
* ,,,_ ,._,„ ['Occupant load over 99 persons EManufactured structures or
# ., 70BS '°INFO TIOIV A NN D OCATTUN . ° ,. w u , . E ess /li htin plan RV park
Job no.: Job site address: 9 � Lw, ,e s 1N 11 Health-care facility ❑Other:
// Submit 2 sets of plans with any of the above.
City /State /ZIP'�7 G y U/ 9 '72� 1 `' The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: ✓ Project name: l =li k5 ' ' ' i ll*E- SC_HED; ...I.E w', ,°: : . '
Description Qty. I Fee. Total
Cross street/directions to job site: cP9'7,Y/¢ /1yie Ja� -- New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: �1�p�yi SG,/ 41.4. 2 . 3 Lot no.: c?l, Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
° ° .` » A,, . t3:: > ,: s } �,3.._ -.w s >,.a t , ; . > < t,- ,�< Limited energy, non - residential 75.00 • 2
. �, . rn IIESCRI tro t ( lWO I ., ;:, • =:' - - t
x '�.' ��- � = ��� � ,.���� ���. <�d..��� .��� .., ,��..8.._ H " �iR's<r� �. "� �. Each manufactured or modular
�JW �� ' e��� dwelling, service and /or feeder 90.90 2
�LGG� ( Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
n
s.:= . fit.. ' <f' m ii 1: -,,� r i
c�,;:<� _ _ -� ; ',r<k � :. ; €_: 201 amps to 400 am
li 1 r,E I OWNE+,R < , a° .. a". , ,. ❑ TE N . .,4 , , - ;== `: s 106.85 2
P P
€,�'3raT�+ ":.rm.:...s.�.-e:�.. _.?„°;'%.,<,.. ... .axw.. �.,.,,..'aC:.�°�. .,� ..as
Name: 9 L 4 C_S72. e 6W o .V at 601 amps to 1,000 amps 240.60 2
Address: CPC). g 2 e s- 9 7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: ,�p� ,`� Z)' l am' ? 67� Temporary services or feeders installation, alteration, and /or
Phone: (SS3 �� S �� p - C p 5 Fax: (6 3 7S1 relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
i� 3a n x .mss.. -.�' v� ,wk �� �' d k% `3� x, s w„ A. Fee for branch circuits with
i°° tP r �` CONTACT PERSON
."' ' ." ° service or feeder fee, each
Business name: .S /9 eiM /r1. 0 - 4 ' branch circuit 6.65 2
E% B. Fee for branch circuits
Contact name: without service or feeder fee,
Address:
each branch circuit 46.85 2
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
k. rt low �,r 4 owor TOR " t r ' t ., ost energy panel, alteration, or
�< r, k extension. Describe: Page 2 2
Business name: 7...„.6/2.4i,---A, ,EZ.. .e.. G , e1
Address: 3 - 7 S9 S Ai v 'W 0-e, Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP:' ,7442AJ,06 04 ' 7 22/ Investigation per hour (1 hr nun) 62.50
Phone: (5-63 2e/e/.. 776'4 Fax ( ) Industrial plant per hour 73.75
l.; ".53:001:004. k - ERIVI±IanktS* i ir71::r . -l .
CCB Lic.: <,S ea Electrical Lic. 3Q' 2 3. Suprv. Lic.: 3 ()pc:4:g S Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: rg56� 4-r ',lie. �iGt,�, Date: 3 9 (---.6 (� State surcharge (8% of permit fee)
"�� �� �-�' TOTAL PERMIT FEE
Authorized signature�� This permit application expires if a permit is not obtained within 180
y days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
r\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard •
Page. 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESII)11 IAA _ o WORK�O'NI% v . ;;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener* •
E Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
n Other: •
C :C.�� ja. w' RC , W O�RK d:WV t EEM
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
• ❑ Boiler Controls •
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
H Intercom and Paging Systems
❑ Landscape Irrigation Control*
H Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling •
❑ Other
Total number of commercial systems: • • •
*No licenses are required. Licenses are required
for all other installations
\ Building\Permits\ELC- PermitApp. doc 04/03
T EE C TIFICATION
E ..
R STREET R
:.
I, t / D v , ® wner / A ent for tZ Gt.) STi2(, cr zoN
(PLEASE PRINT) (PERMIT HOLDER)
, , . , ? 4 ii leC):°1'4". : 1 , 0-
F
Do hereby cent fy *a:tithe $ f location ��C� �S� ri
meets Cit , f i. and /Wahi s i on Count G �
44 land use and development standards for street tree installation. 4 '
44 • ADDRESS:
? �. < Y � �L � �-� � � L —S /1i.
(3 V • LOT: SUBDIVISION: --SPP
/,,/
• BY: - DATE: l 2 I — OS
RECEIVED B • • 1 4% /!�� ' DATE: /(2-/ O 44
AVVVVVVVVVVVVVVVVVVVVVVVVVVFFVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVN
CITY. OF TIGARD ,- 24 -Hour , z_ p'
BUILDING Inspection Line: (50 , ' < 4175 MST 't ({ -be) `d o
INSPECTION DIVISION Business Line: (-.a . •- 417,1
BUP
Received Date Requested — ° � � AM FPM BUP
Location 76 - Suite MEC
Contact Person Q...,( )--e -- Ph ( )7 D PLM
Contractor Ph ( ) SWR •
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain L 6 )
O K /< .• ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam •
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear — v s----- � Framing (EA) l S
Insulation e �.../r b
Drywall Nailing
Firewall L _n I/ ire Sprinkler � �► , .. 7
Fire Alarm . , I- c .t Q --
Susp'd Ceiling J
Roof
Oth - r:
V I PART FAIL
= NG
Post & Beam r 7 }
Under Slab
Rough -In
Water Service e
Sanitary Sewer
Rain Drains
Catch Basin / Manhole 3 ' •
Storm Drain , N . :
Shower Pan
Other: a„
Final ,
PASS PART FAIL . .
MECHANICAL
Post & Beam
Rough -In
Gas Line ,,,,.., I) - mpers ..`'
oirra
P: PART FAIL
• TRIC AL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall. Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line �7 /
ADA A
V
pproach /Sidewalk Date �� v �` v Inspector Ext
PP
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST ‘,700 601 n 2
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re.uested j °� AM PM BUP
Location • AP a. Su MEC
Contact Person "`e Ph ( ) 7 € i — 7 V 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:
�n
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
ADA
Approach /Sidewalk Date / J
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 ) 639 -4175 MST -lok
INSPECTION DIVISION Business Line: (5') 639 -4171
BUP
Received Date Requested 1 'g' AM PM � BUP
Location 6 ' _,< d ' ' :� Suite MEC
Contact Person D A-6)--Q -- Ph ) ??),c J 7 g tS PLM
Contractor P 4 ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC .
Foundation Access:
Ftg Drain ,e 2 I< i __ ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear n
Int Sheath/Shear
Framing l/ % )s t" � L E� S/0 /v F /■44 L
Insulation S --T` ( � &-
Drywall Nailing C�
Firewall 1"SU L /41-" D /i cT
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof p ia► - P .' ✓`I
Other: _
V ;S PART I .
PLUMBING. ; A O _ • S CZ-7 79 ' ' .c?
Post & Beam WV ; A cLJ S
Under Slab p .1►- t� o V J 7� C� < I . �iC 7 �
Rough -In °"l /7 j //V S p ---C-7-1V lJ L<
Water Service
Sanitary Sewer /z../ 0 '/ . r o ✓'`� G-,.2 g
Rain Drains
Catch Basin / Manhole 'Peo v / b C 4--b Q L J r9� (=----
Storm Drain
Shower Pan // i-1< ig- _ EC, l< T - , S t
Other:
Final CJ ® 'C / 1 .■ GZ ar■ ..M"' 6 ,' Lr - A 7"
PASS PART FAIL
'MECHANICAL ` #I _. -
Post & Beam
Rough -In
Gas Line
Smoke Dampers ^ 6T - / � ?, n ■ J� L LoG/C o UT (j
PASS • t RT I P (- /4-- //A 1-
Service
Rough -In
UG /Slab .
Low Voltage - I 0 , ' ■
F _- m y�
% E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(i PART FAIL
ZA 6 ' ' ' 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA Date D a i 0 Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this inspection roc rd fro the job site.
PASS PART FAIL