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Permit , s4y /5e.,‘24„....,e, -4 ,,,,2_,,,0 ../. c y-.. ,‘..,-_ ,e.,,,,,, . . ..a.g.e..4. A T C I T I ®F TI GARD M TER PERMIT PERMIT #: MST2004 -00244 h I DEVELOPMENT SERVICES DATE ISSUED: 9/9/2004 '--� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 08464 SW BONAVENTURE LN PARCEL: 2S112CC -13100 SUBDIVISION: TANIA PARK ZONING: R -12 BLOCK: LOT: 006 JURISDICTION: TIG REMARKS: 368sf. family and living room addition.Other mechanical is duct work and fireplace. 1:0713/04, adding c limited energy for audio /stereo wiring. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 0 FIRST: 411 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5 VALUE: 37,976.40 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 411 sf REAR: 12 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: CO SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1.00 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: X 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: $ 917.86 This permit is subject to the regulations contained in the SHOKRYANI, ABBAS CRAFT MASTER OF OREGON 8464 SW BONAVENTURE 6663 SW BEAVERTON -HILLS HWY. ;Tigard other Code, State of All work Specialty il e o ne i n and all other applicable laws. All work will be done in TIGARD, OR 97224 PORTLAND, OR 97225 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 - 888 - 0132 Phone: 503 997 - 7172 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 117061 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 Footing Insp Post/Beam Mechanical Framing Insp Electrical Final Footing Insp Underfloor insulation Shear Wall Insp Mechanical Final Foundation Insp Crawl Drain /Backwater Exterior Sheathing Insl Final inspection Foundation Insp Mechanical Insp Fireplace lnsp Post/Beam -- - - Electrical Rough In Insulation lnsp • Issue ' By : •� , _ Permittee Signature : - / -----K--------) _ ....___ _ -- Call (503) 639 -4175 by 7:00 p.m. for an inspection neede. the next business day ...... 1,/ .G. •-• .e.a. CI r■-e ..., Ca 1 a •-• V.,. , .../ L- a a 1 f r • 4 l ' LV . 7 1-. ti / 1/6 A 1XT-* e'Q A, 6 rl'S/ Buildino Permit Ajnt - - tr n -,, : -,-- _,,± r.,,..:•.-.- v4.F.OROFFIcE USE ONLY Cty of -, • . : ..• - ,5-•:•... — i W Hall 1;lvd., Tigard ird, OR 9722 WED „..:‘,.„. ..: • . . ..,...... .• H >:.,,,,L, III 25 S Tga3 Phu) Rt !S. Mo L i eq ..- 2. e.• ) -1 t )thyr Vt., ,eli I 1.11 "`"' 51639 l'*"‘ 1 S." 'AUG 1 9 200 4 1,j,i 7 s "'' fAll . .. ... _. _ .. . . in0 ° I ,tii,• .%() i 6. •I I 7% , '1 - , • . 1 mt.- 16,110 IV ' . , .)3 1. ! bi N■•■• At tn., hrd l ' hr.' klid: 10 r Inturrktt: www.,..i.rit,aut,or .,,, L :tuAtiturtAtQutod .. i I 4 i N,,,........ I tiformntiusek . _... CITY OF TIGARD BUNI21,1\1 A, _.......... • - • %MON Rwvilimi) 0 ‘1• .v 1 041,2,It'AN111.1 im'El,i.iNr.; I t •-•-, .. _ Pennist lees' are basud on the value (tr' the work perfor ritc-NJ L j New construction 0 Demmiitiof: . . Indie=te the value, (rounded to thc nearest dollar) of all ition?alieratiosi 0 (Mho • l'quipulteill, materials. labor, overhead. and the ,,,,n, for the . . . wilt, Ind icated on ihis implication. _ ( WI' plcoRY 0{... CONS171RUC1 ION ' Vniu.sti on : S 2671,05 1 2 dwelling El c.,.„,,,,n0681:ivon,trim I r_.1 .. . .. ... .. If hoLlr, ■■ mu.. builtlitu!.. D khaki-tinnily ....._. Number of bathrooms: 0 Master builder 0 01.§ier: 10II strI.; INI;0101 VtION AND 1,0CATIors:, Ttvaa) handler of Mors: 116.7" E4/4 .. . . .... . .. ...... ... . . . .. .. . . - Job Nitc add': ' 8444 •Sl f t:I. on c L Num, itwallin,Li, area: 3-i,-$-- ,yilivc feet .. _ CityiSiiitoM I P - 770,0„, C C i 7 ••431-2 (;it:71fisoft ■I Iva: sciuttre fcel Suite/bldg./Urn. no.: I Protect MUM: ScrieN04,C,V1*■.3V. A4■41ii4Con Cuncie4t !NMI area: Stillitt■: 1 . ...., ...__ ._ ..... . . . Crt Si rect iclircctions til site: \1,0„A 16\18 I' . .1 Doel urea: square feel , -$ ........ L "t..•..) % 32,....N4 . ..., ..()diet structine area: simitre feet . ... ...... . • REeiltRED DATA.: CONINIERCIA1-11 rSE (11ECKI.D.4"1 SiLhcliv,,,,,,tv [i.01 ii - 1' , ...:nurt rci;:;' ;uv. int•KAI tul lift: i':Iitit: Indic:mu: the Value (minuted tii the tienrest dollat) of all fax niapiparcel no.: cquipurcal, materials, labor, overhead. and the pttitil for Elie .... , „ DIQS( RIPTION OF A.11010%. work ind kuted on Ibis applicatir at . ...... .. _ . .. .... . . .. . . . .. 4 f Vi littaillOn. S L v4 i. ..„ ... ...1../y........p.vo. 4:k.a ti.. loin Existing building urea: square feet ! ______.__ ...._.... ........ - . . . I Nctw luoldittp, area: squaru feel . ........._____......... . . . ilfr 4 1 ID TEN.VVE Nurniber astories: Nauru: AN:00 CX.S vipe of construction. . . .. Address: $ 44- 6 q sA...., $p.„,-,c,..,... L City:Stale/ill' th,..:. (c ) 5 8 € i 52_ _. c , / 51.1.1,1(..ANT C;12. 1..w::( cr R c)..1-S ) i.e, ,,,,x. r : ,C, i> , : e . 4. I....A ek . (.1 PERM)INI ee3 ovl ... . ....,.. .. ._ . . Ounutpancy groups: Existing I New: .. . . l'irYCK'F. lit . . . .. ..... ... .... .. , „ , .... .. . —..."... ' .. .. . All i.....114CIICIA■IS ;Ma N i t I K' t 1 1 1 1 r a ■.: !, 11% ate. I etitli red to be ti w the ()Neon ( instruction Ciintractors I ioard Contact name: jc,,k • - undeir.ORS 701 and may he required to be licensed in thc- A1 i I Iress: a 6,,a. 3 wst,....5 , _, AA *,... ,ti 2,Zo jiltrsinictio, I 11 MI Idl %L'ork is being pet Psi inial If the .. i iptrlicatit is exempt from lic cut ii ing, the rolli vint:', reaN"J"" CilYi81■ItV7.11':.por,ttci ,...... dve... 9 aa 5 a PIIIK• _ .. ----- •-• •• -- - Fax: - .(.(57;7 . 3 ) 2,9z — \,.. • • I-mail: ICK:460,,N.d. Q., •,.... VA e_± / 0:0 og ( 'ONT rtm'TOR ) , 1 tusincs% tutuu: '', [ s• 0.••••■■ive,. A S C pP 1 '''.. - /- _ . _ _._ ..., ,„,,,. Addis Please refer to fee schedule. . . . . C:it y/Stri(er/IP . . .0 • . • , • • • .. • . • • - Fees .--1.1ile moil ifiplictition Phorio. I ) \ U' i !ax:( ) C.C.I1 lie:. 6( ..i Amotant received ___. ... . . . .. .. , . . . 1 I )utet itreceived• Alit horize.d :•.1t4naltire: ii.-:fj".7504-"s-tr-.....„...1.. 'nth. ',tenni' upillieutioil v`Cpii'Vx Wu permit is not obtainant within 1!0 days after it has been accepted HS cvntplent. r Print name: ,& „,k, L,,,, I Di, ,,8 ...-/x. -,,,, . 1.1,-.„,,1-1„i.,„,,,, lw It-( 'minty 1;110(111w, Industry li..rttyr...,titutard . Electrical Peri to ► . ° � U 0� _ Ai 3-" T i 1 W' MEM reciivid: y • ;k inn: City of Ted Pol}cctJag7t, no.: Expire date: Cio o f T 1 1 v r d Andrew: 1312$ W Hatt Slv41$ly 9R1 t ' 3 Phone: (103) 639-4171 -I' 1 Wired,: ttocetptno, Fax: (503) 59849960 Caere ftto no.: Paytnneat type. CITY OF TIGARD 1 use m ust: BUILDW C DIVISION - •. 4 - .�• . t Oi ali R fyi _ - ? ' i 0 1 4f.2 family dwelling or scceiesory 0 Commercial/industrial 0 Multi- family 0 Tenant improvemcntt ID New conat1UCtion O Additiodaltcration{rcpl ment 0 Ozee, , 0 Partial ^ - •' ;1011.S111.' I tiI Ott'.l t 1 -i ;1S - - ' lob address: - g ,t7 'i V I e LA) IMEIRSuite no.: Tax map/tax lot/account no.: Lot: Block; ?Subdivision; Project name: _.i a Dcocuption and tocati of work 011 . tithe s: T /;•s Estimate(' dxtc of completion/inspection: (-.ON 1 ii \t.1t ► 91.1I'PI 1t. '11t►ti' ° = _ , . . : � ' ; � -:,.11 f:.tit 111.111 1:1 .. ,.. . 1. • .. _ Business name: A / /.(7 . 00,04 too __ Address: - 7 N . S i Nov • *W.or a�u•rrinar r .► S) city: R,iJ ..e., .. State: 4 • zrP:.* � r , w . (S,; Phone: - D •,e 171, - ltxow criers. _ CCB no / / / ec. bus. lit. no: , r. ;: �>t� /� E.azt .Glisiiond +'t , . n. or • n.thereof - -_'1 t.imitrs ,rgy, residential 1111111111111111111111111:11111 C i t /metro tic. no.: /V - —Oy Linder •nereresidential M_1 : .rte/ Ev , T 2 . M t•lpe(,ye n0 . a. P1t0P1.1 11 U »% 11 11 Name (print): Alba & 5 Y. 1 ammo ' °m°• _1111.11111111E1111 401 ... • 600 amps ___i 2 1411tii1n _ addfCSs: • --- / — o Ci 601 anilrvto I • �' lump ��_ ;© St ate: 2 2 P : over 1 1 : 0 0 ) . * • s or volts . rte__ Phone: . Fax: E -mail: IONI__ Owner installation: The installations 'Is being trade on prvporty i own • • , • eer rkateorrealer" - which it not intended for sale, lore, rent, or exchange according to ttlotwitflola, etttk liow O1tS aa7, ass, a7A, 670, 70t, MO �.taaa a 2 • 1 arterimo 400 a • __�a Owner's si • tttufo: Dace. 411 la ,'..0 ain • NEM. 2 I ;1t It •_ * rtllt me�r+ca io - law al toel►awtr 1 Name: *rot ysl aatee gg A. Peefer ;branch circuits wick purnlrae of r; Address: strike or feeder fee, each branch cirw it . '' 1 2 State: • ZIP: B. FootnIntnenca cuatilgwtmoutptr mil PlltMe Pam; lirrlall or saviice or (color fee, tint bn►nch circuit: losi Bwrpr _ MIMI . : I'1.1 1311II:i):(Pt.Ra cticc)talla nliith) 0 Service ovcs221amps- aommaro►u Fr 0•akrt rectal, ■■- 0 Service over itmprruting of 1 ds2 0 lrasetdo,tt+!mafiosi each sumer oudi..e, u . t•,nn __— femitydwellinge U fluidinl over 14,040 aquese feet tour or Sip,al mtrvit(s) err a tindied energy portal• 111■- ❑ Syslrnt orvr 600 vo1rs tx7mlniil atom recidential unite in one Attractive aiteratletwor extension" 0 Building evar thrwadralniaa O Ywed«1, t pO Or mbro , O Ott upant iota Ovcv 99 parson. Q Maly rretir°d.wcmr°a nr RV 1 .nel .89nsta.d tospee ion ewe the ■llow bk Its erg writhe ulnow ; U 0.srbu/lighti rig plan U Outer: _ Pa: in.. - •.; an 1111111.111110111111101.1 !1111Brat - � Ma of Aa with *ay (tithe above, invoaGR tion fed The above are pot s1pp1CAble to tam • . comeltltllbls nervier. • not an Ju.iackliang error 1-71 ■. p►srweaatc}tutsdbtWe tar mere irt°,ir Alin et. Notice: This permit sepliceiirin Permit fee $ Q Yip il MasaIniarti rinser if 1 Hermit in nt anima Pla mvi sy ( del . s tanifrAdk BpsIwr. — Am* ' , ' 4.O.Nirs so ccoroM) Mechanical Permit Application E FOR,OFFIC ONLY : City of Tigard .. i. Receive Permit No.: - U _ / 1 '/ t' a 13125 SW Hall Blvd., Tigard, OR 901 EIVE® Date/By: Plan Review Phone: 503.639.4171 Fax: 503.59..1' ii yi..„, i Date/By: Other Permit: Inspection Line: 503.639.4175 Ins p e .' I �_� Date Ready/By: lw'is 8 See Page 2 for Internet: www.ci.tigard.or.us AUG 2 3 2004 Notified/Method: Supplemental Information r <,' 4 x . ml gsst . '`" l ,71 ,� i tit ,,, ,. ,: ",, .�„ .�.• ,:�, � -•x� ,_.::�. x .y, `' . e 2. z r > v >T . �i 4�� '` - k= ' a n"�` ; ; . �, �a.: E *,.: n£g .: e +.r, . .. ., . C . .-ttR 'K .t,.., . a t ? , .s.a .' ,.� . 1,eu ? ; ', _. '. • , � ,,41 ., 0 1 , S'C ,.G.. ,. . , CHEC[Q'IST ❑ New construction 1b` e a 1 re 1 k al§N - P lacement 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. ?'a -.w = ==rte'-::;,:,.- ; :. ,.ic.., >.�-„ra;;;,- �_:; - ^r - ` - - r:,z:r..;. >= �;, Value: $ P: �. . t ° CAT GORX OF °COQ STU OIONa-., :.>,.. . ` . ... , '' , r , <--,, D ;_ > -, ,-„ ,,,: 5, . , . E - • a nd 2-family dwelling C /industrial . N - TIAL Fr . .,, , ,EI�T' />SYSTEIVIS,FEES* 0 y g ❑ ❑ Accessory building " ❑ Multi - famil Master builder For special information use checklist. ' y ❑ E Description Qty. Ea. Total J , ,. ... g: , J O B $ITE FOR A D ®C ? a._ _: :, , . , '' ;'�i Hea !` Air conditioning or heat pump Job site address: 6 `/ '1 ,'S O y• 1-- L (requires site plan showing placement) 14.00 City/State /ZIP: i i � _ p72 7C90)-<71 1 Furnace 100,000 BTU (ducts /vents) 14.00 Suite/bldg. /apt. no.: Project name: t�� Md t }l. � h Fumace 100,000+ BTU (ducts /vents) 17.90 Gas heat pump 14.00 Cross street/directions to job site: Duct work ' 14.00 '4'7./ Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 ' Other: 10.00 Tax map /parcel no.: Other fuel appliances -sari ';I.•ii' ri 41 ;I3 ,',, : -;� .ss - ,:,«:�, _ + •� . .;i:':.sa; ' „ ta•� Water ter 10.00 $• r ,.� ` , 'I D -,,, ION OF,; E WORIC ... � �."5� 'i ate a Gas' fireplace 10.00 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 i. . , r : :: e v is i:F . , ;; Chimney/liner/flue/vent 10.00 'z 7 1 i ROP, O NER� , t ,w i u 4 'k T E]�IAN , a. , , Y ;.�= s „:„4-,,;i � ._,__., -. >:�.�., _� .���..:,. "��..... �. �, „r ��,�..,� . � �� °� '�aii. Other: 10.00 Name: Environmental exhaust and ventilation Address: Range hood /other kitchen equipment 10.00 City/State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 FAH >t. ,� . ry ' :,":;} • �y�^ue -'. h?' Zvi ” =5 . s :�t:r '.. ,:' r � ` °-' ,€E xy,.. Attic /crawls ace fans 10.00 APPLI NrI,, >R: GONTTRS.ON .',:ii " p a"',4 to. - .G.. krevsu11A +� 1it:r -1 ..Y8 .. ((1 1 Other: 10.00 Y Business name: - v - A -- \e 5 e i-- a 4 Q l s^ Fuel piping Contact name: Pi' qbca. k - 3 -- 4,b\ >• $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: Wall /suspended /unit heater . Phone: (5 ) -79:— - -/' L . Fax: : (rv�) 25 Z — // 7.� Water heater Fireplace E - mail: Range 4 � C O N 7'R C OR ,� , ' M 4 t "-' Barbecue Business name: Clothes dryer (gas) Other: Address: ti= `;t; `'4 evil -, IC � I, - ... -.,�k -� _ ., rM, ' a�sMECHANICALYPERiVPI 'I';F *�s�` City/State /ZIP: Subtotal Minimum permit fee ($72.50) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 'y�G1C J4.-.1....c.....---' Date: * Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Permits\MEC- PermitApp.doc 12/03 440 -46I7T (I 1/02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: yg $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 Aug.10. 2004 11:52AM CLEAN WATER SERVICES 503 6814439 No.2640 P. 2/2 File Number I ,45.9s 1 leani►'at�rervie AUG 0 3 2004 J Ou.c eoeith ;l.msnl is hear /. Sensitive Area e- Screening Site Assessment By Jurledidlan /I8 Dais v' c RECEIVED Mup & Tex Lot I /d0 Owner a r r► i Site Addrei9 R ! � ' ts;a car,ki .ys., rte ' •�. __ _ ' _ _ Contact AUG 1 9 2004 Propeeed Atitivity �- Address �rdb'S Si.) 0. c.ve , 1.14,11 1 ti,A1 I''U ML'1u.r. `r, e a ✓ CITY OF TIGARD :.iegt 4,4t ' Nhone BUILDING DIVISION Official use only below this lino Y N NA Y N NA ❑ ❑ Sensitive Area Composite Map Stormwater Infrastructure maps Map •�.S/,f El ❑ [' QS# 5/6A1 0 0 ' I Locally adopted studies or maps ® ❑ - Other Specify Specify 2o22. a,,,.tcJ Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. 64 Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development, NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. . Comments: Po tntfla//y .,(4•41447; ve _ a.dt 4.B.Gelsrs 7n , r ,y:eggel /„. /„. Reviewed By: Date: $/0/0 4 Returned to Applicant Mail Fax Counter Date O O By_(,_ 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 Phone: (503) 681.3605. Fax: ( 503) 681 -4439. www.cleanwatcrsetYlemaug CITY OF TIGARD 24 -Hour BUILDING Inspection Line: 03) 639 -4175 MST� 0/J 'Oa INSPECTION DIVISION. Business Line: 03) 639 -4171 BUP Received Date Requested l c AM PM BUP Location -Aa -1 • - Suite MEC Contact Person Ph ) PLM Contractor Ph ( ) f 7 - 7/ 7.-� SWR BUILDING • Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: j{�%L � .� �N�TC;�G 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: f' 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 4 TSB 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. A S PART FAIL SITE . Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA ► Approach/Sidewalk Date Inspector Ent Other: Final DO NOT REMOVE this inspection rec d fro the Job site. PASS PART FAIL