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Permit ••r.'" f, CITY OF TIGARD MASTER PERMIT PERMIT #: MST2006 -00075 l DEVELOPMENT Tigard, R ICES -639 -4171 DATE ISSUED: 4/5/2006 Hall �� PARCEL: 2 S 104DC -06600 SITE ADDRESS: 13814 SW FERNRIDGE TERR ZONING: R - 4.5 SUBDIVISION: MORNINGSTAR LOT: 007 JURISDICTION: TIG Project Description: Orig. plans show as finished basement. Adding sheetrock, insulation and electrical, plumbing, and mechanical(fireplace insert.) BUILDING REISSUE STORIES' FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK ALT HEIGHT FIRST' sf BASEMENT' sf LEFT. SMOKE DETECTORS TYPE OF USE. SF FLOOR LOAD SECOND sf GARAGE sf FRONT. PARKING SPACES TYPE OF CONST. RETWL DWELLING UNITS: THIRD sf RIGHT. VALUE 2 000 00 OCCUPANCY GRP• BORM BATH TOTAL: 0 sf REAR. PLUMBING SINKS WATER CLOSETS WASHING MACH. LAUNDRY TRAYS. RAIN DRAIN TRAPS LAVATORIES DISHWASHERS: FLOOR DRAINS SEWER LINES SF RAIN DRAINS CATCH BASINS• TUB /SHOWERS. 1 GARBAGE DISP: WATER HEATERS WATER LINES BCKFLW PREVNTR GREASE TRAPS: OTHER FIXTURES 1 MECHANICAL FUEL TYPES FURN < 100K BOIUCMP < 3HP VENT FANS' CLOTHES DRYER FURN > =100K UNIT HEATERS HOODS' OTHER UNITS MAX INP: btu FLOOR FURNANCES' VENTS' WOODSTOVES GAS OUTLETS 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS 0 - 200 amp' 1 0 - 200 amp. W /SVC OR FDR. 8 PUMP /IRRIGATION: PER INSPECTION EA ADD'L 500SF 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: EA ADDL BR CIR. SIGNAL/PANEL IN PLANT MANU HM /SVC /FDR. 601 - 1000 amp 601 +amps -1000• 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' This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other MICLAU, ION + MARIA OWNER applicable laws All work will be done In accordance with approved 13814 SW FERNRIDGE TERR plans. This permit will expire If work is not started within 180 days TIGARD, OR 97223 of issuance, or if the work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952- 001 -0010 through 952- 001 -0080 You may obtain copies Phone: 503 - 524 - 9347 Contact #: of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1-800-332-2344 Reg #: TOTAL FEES: REQUIRED ITEMS AND REPORTS Issued By : A. .., _ __`/ Permittee Signature : c'7. P` �'J " Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. '�1Buil P ermit Appr � l t � a ) 8 ' � ` E r, ! t OR OFFICE. USE NLY . r . Received Permit No City of Tigard o Date/By S D� S aol, b - coo 13125 SW Hall Blvd., Tigard, OR 97223 APR 5 2006 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / / "'"/� y'.?' I't' Date/B . Other Permit Line: 503.639.4175 " '' Date Ready /By See Attach Checklist for Internet: www.tigard- or.gov CITY OF TIGARD Noh ' fied/Method Supplemental Info • BUILDING DIVISION TYPE OF WORK REQUIRED DATA: 1- AND1- FAMILY DWELLING ❑ 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: }.L� ' equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ❑ 1- and 2- family dwelling ❑ Commercial /industrial °'t f •� Ac cessory building ❑ Multi- family Number of bedrooms: / / ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION , Total number of floors: / Job site address. / 3 ,, /4L r I A c. e/ 6-c- 7//c( New dwelling area. square feet City /State /ZIP 176 6/ c7 7 Z2-3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street /directions to job site: te a,,./ Ffezo frAio aeoc/A16•9 k_ Deck area: square feet Other structure area: square feet /3 t?CJ REQUIRED DATA : - COMMERCIAL- USE Subdivision: M04/../ /h/GS7/ Lot no.: 7 Permit fees* are based on the value of the work performed. Tax map /parcel no. • 5'/ 9 � c , 0 0 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overheaad, , and and the profit for the DESCRIPTION OF WORK . work indicated on this application. &&_-_ 0 C � /� S J Z-417 o Ai /91 L,� �it,� ✓�L� Valuation: $ / Existing building area: square feet New building area: square feet PROPERTY OWNER . ❑ TENANT Number of stories Name: /0/..) /7/(/.4j `f /...9fi- ,I /f1- Miaiiid Type of construction: Address: /3 4 /4 s. W . F-6-2,00e/0 G Ce' `�� Occupancy groups City /State /ZIP. 77 .6 d & ne . 12.3 Existing: Phone ( ) 5 _,Z 11--- 47 Fax: ( ) New: ❑ APPLICANT . ' ❑ CO NTACT PERSON NOTICE„ Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: / applicant is exempt from licensing, the following reasons aPP 7� (r » S Phone: ( ) Fax.: ( ) I ti G► 404 3 E -mail 5 -00 CONTRACTOR. • � l DS -13 Business name A w t\I C-12- BUILDING PERMIT FEES* Address: Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone. ( ) Fax:( ) Amount received CCB lic.: Date received. 5 /� Authorized signature: This permit ap icatidn expires if a permit is not obtained h n within 180 days after it has been accepted as complete. � Print name: ! _ !/ /4_ /f f cZn-u Date: /7 /6 v / 6 * Fee methodology set by Tri- County Building Industry Service Board. P \Building \Permits \BUP -T1- PermitApp doc 12/30/05 440 -4613T(I 1 /02/COM /WEB) _ • Building Division Plan Submittal Requirement Matrix - Commercial & Multi- Family - New, Additions or Alterations City of Tigard Type of Submittal # of Plans (Includes new, additions and alterations.) Required at Submittal Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* Fire Protection System 2 ** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. I \Bu Idols \Permits \BUP -TI- PermitApp doc 12/30/05 440 -4613T(I 1 /02/COM/WEB) Eiett cal,Permit App, .:.icatiio�ir� ' FO'2 ?OFFlCE`l"1SL,ON`LY City of Tigard 2006 Date�Bed Permit No D .�, 13125 SW Hall Blvd., Tigard, OR 9722'fiPR 2006 Plan Review Dl° Phone: 503.639.4171 Fax: 503.598. 960 4�rl' Pilitusi l l Date/I3 Other Permit. Inspection Line: 503.639.4175 el,11„ Date Ready/By. Jons See Page 2 for Internet www.ci.tigard.or.us CITY OF TIGARD Notified/Method Supplemental Information OU LDtNO DITTO. NI TYPE OF WORK • _ PLAN REVIEW • ❑ New construction X Addition /alteration /replacement Please check all that apply over 225 amps, comm'I ❑Hazardous location . ❑ Demolition ❑ Other: ['Service over 320 amps — rating ❑Bulldog over 10,000 sq. ft -, CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential 1- and,2-faffrilrchretttrig ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi - family ID Master builder 0 Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: / �,�✓� > r � Iiealth -care facility ❑Other: / � / . W' t" 1 � S`ubmit 2 sets of plans with any of the above. City /State /ZIP: ' 7 7 4 j ok 9'`7 2z5 The above are not applicable to temporary construction service. • Suite/bldg. /apt. no.: l Project name: FEE* SCHEDULE q.,,� Description I Qty. I Fee. I Total I Cross street/directions to job site: Gee °�� '�LD / r AI Q2, G' SR New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft or less 145.15 4 Subdivision: ''lc/(,u///G crihe Lot no.: 7 Ea. add'I 500 sq. ft or portion 33.40 1 map/parcel no.: 2 S Limited energy, residential 75.00 2 Tax map/parcel 7 �u Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular 6 6C7--/ C �� C dwelling, service and/or feeder 90 90 • 2 / Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 201 amps to 400 amps 4 106.85 J04„5115' 0(�,. $ 2 s PROPERTY OWNER ❑ 'TENANT l 401 amps to 600 amps 160.60 2 Name: /OK) .6 lq A, 1,) A M I C L .zr 601 amps to 1,000 amps 240.60 2 Address: /3 re / L s „ F C4:. ki t , G= j L -i^j -, Over 1,000 amps or volts 454.65 2 - Reconnect only 66.85 2 City /State /ZIP: `T( t t o 1L ce -- / �y 72 -3 Temporary services or feeders installation, alteration, and /or Phone: (511 ) ,��/ C 3 " Fax: ( ) relocation 00 amps 3 / 200 amps or less 66.85 I 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, lea4e, rent, r excha ge, according to ORS 447, 449, 670, and 701. / ! ! C 401 amps to 600 amps 133.75 2 Owner signature: < °�( ( L e ` ` Date: 7 ( G Branch circuits — new, alteration, or extension, per panel • 0 APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each �/ 6 65 p Business name: S P n'l G branch circuit ( , (p O 2 Contact name: B Fee for branch circuits without service or feeder fee, first branch circuit 46:85 2 Address: Each add'I branch circuit 6.65 2 f. City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- - CONTRACTOR energy panel, alteration, or EL Describe: Page 2 2 Business name: Z1/11-A( i.4- GL i Address: 1 5E (C/ f j Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: p D / -FL /M/ D/Z 4 ) 7 2 g 6 Investigation per hour (1 hr min) 62.50 Phone: (c031 35 — 'Q / ' ,/' C.• Fax: (' j a31 77/ S3 0 Industrial plant per hour 73 75 - �l ELECTRICAL PERMIT FEES* CCB Lie.: /C7/ 1 Electrical Lic.:2 4 (Og& Suprv. Lie.: i 0 s' Subtotal /33 / / — —v-1 Suprv. Electrician signatur , required.111111 9 z. 4 ( —1 • Plan review (25% of permit fee) E State surcharge (8% of permit fee) jo.( 7 Print name: J�/LvI u 73 v ()MA Date: 03 --3f - 0 TOTAL PERMIT FEE / Lig. / Authorized signature: , This permit application expires if a permit is not obtained within 180 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 penult allowed i\ Building \Permits\ELC- PermitApp doc 12/03 440- 4615T(10 /o2/COM/WEB Electrical Permit Application - City of Tigard �, 1 Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Building \Permits \ELC- PermuApp doc 04/03 ,.J Plumbing Permit Application r ,i - .0 vn 'W � t�l r '1 �y r} 3d i §'`S � ki . 7,:,:i.,,,, a ',� .r F 414' k � -1 `' p i ti .4 , m , ; ;FO R iJ'F, 1 &� � L U .,, } o i 4 2 , � � .. . . � - c '. '+ ) ��, y �'"' - .. ,:.; 9 M1 , s + L` a �� rte, -.. ax zr City EeW E C E I V �� Permit No 6 13125 SW Hall Blvd., Tigard, OR 97223 Phone 503.639 4171 Fax 503 598.1960 .,/4: �r 3 �i ,,, Date/By Permit y Other Peit No. 24- Hour Inspection Line: 503.639.4175 APR a s' Internet: www.tigard -or gov • -- .- v r . , . u' Date Ready/By ° y- See Page for Notified/Method. / ® Supplemental Information ���'� =�1'd yr. .(�l IV *T' - _� rmahon �'�.� : 4 = - :; >' .r rTYP,E \VORK '''' . :Y:7. ''':'i.. : .aw � , : �,� e , * ^" . � ' i ...: .., r ' ,���`�3„ � r !CARD *� �. ' .. w'�; � FEE �EDULE : _ « =a�.' x�.; a� � p s ,. rs;, ❑ New construction BUILD to For special information use checklist. �t I Description I Qty I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: /.9S-'7s"/ New 1- 2- family dwellings (includes 100 ft. for each utility connection) .".'' - . „• :t,. Ft „ , kfi ='' "? `_ ;v.''" SFR (1) bath 249.20 ❑ 1 -land 2 -family dwellmg 0 Commercial/industrial SFR (2) bath 350.00 Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master budder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 n 7 ° .'JOB `SITEYIN FORMATION ; AN D LO CATION ; ;"� r '7 - ° .:' . , Site utilities ::-.";!,."•-'..;-.."7.-• ,.��� " ".' � „ . _ ` , ��� � "'s' *�'��' Job site address: /3 f //7t _c_ce. `°.A✓ 2 /Q G */e44.<_- Catch basin or area drain 16.60 City /State/ZIP: g7 6 4-,e9 02, 77'Z Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.. I Project name: Footing drain (no. linear ft.. ) Page 2 Cross street/directions to job site. gt = "G"�D pI ..c 4-71.4.,0 Manholes 16.60 Manufactured home utilities 110.00 / ` �' a'c /�-+ 1 °o ( (7 4 - Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision. 1,7 Q .ei, /,v c .5-7,7ip [ Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: 6 p Absorption valve 16.60 s r, • ', - :D , f� v RIPT O1V OF WORK ,i:, • .. - _ ' S� Backflow preventer Page 2 ( (- Mai C `N Sc/Z4 4-' -a �y w,4. Backwater valve 16.60 / Clothes washer 16.60 Dishwasher 16.60 .J 1 (PROPERTY-OWNER - },� .R , : ,;:, _TENANT ` x ,„ Drinking fountain 16.60 Ejectors/sump 16.60 Name: / OAQ / C[14 O / e-21 C Expansion tank 16.60 Address. /3 4 S CV . F c Q OU £ %D G E f / �/` � � Fixture /sewer cap 16.60 City /State/ZIP: / ' 6 fl - D ( . q 7 2 Z 3 Floor drain/floor sink/hub 16.60 5 2) / , Phone. ( 5ZLi - q'3 47 Fax. ( ) Garbage disposal 16.60 ._ , - : ❑ APPLICANT,- -' / ❑ CONTACT. PERSON I' Hose bib 16.60 Business name Ice maker 16 60 Interceptor /grease trap 16 60 Contact name: Medical gas (value: $ ) Page 2 Address Primer 16.60 City /State/ZIP. Roof drain (commercial) 16.60 Phone: Sink/basin/lavatory 16 60 • ( ) Fax::( ) Tub /shower /shower pan Y 16.60 E -mail: 'Urinal 16 60 ' ' , - CONTRACTOR - .. Water closet 16 60 Business name. (fl j \ 0).'t.,, Water heater 16 60 Address • Other: City /State/ZIP: _ Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax ( ) Residential backflow minimum permit fee: $36.25 • /A•561 CCB Lie : Plu bing Lic. no : Plan review (25% of permit fee) � �- State surcharge (8% of permit fee) .�. Authorized signature: '' ((//(t�� /� TOTAL PERMIT FEE 7�,� / ' ! Print name: �� `� /?'/ C7../R1 Date: /5/2/4 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\PLM- PermitApp doc 12/30/05 440 -46 16T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: %]}p> •K 7Y .:�, .' ^.`rp3,.oY ° ca itl - _ `Y :19".'tn ^F �...5`: ' `n 'ayS ..F..g it"x�4. 'r : �' -.d -� s.`�;:� �. �: t 'Fee. . ' » , rMr Perm>< , �, � ����- : Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $16000 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 _ ` Valuhtion:, . t' irermitiF .. _ .....> , N... . Storm & Rain Drain - 1st 100' 55.00 $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 F1txtlAi'C O1' ItCil1 f fit£ Qty ". =Fee (ea), ; >Totel additional $100.00 or fraction thereof to and 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 Back flow 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof Fixture Work: Y ¢ P1n Itevae� %:ffor:Co ° >mple'Striactures >< Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria accurately report fixtures could result in increased sewer fees *. Please check all that apply. med ❑ Any new commercial building. . . u j ;Quantity by (Friture) WorkP erfor -, , s:r • , ❑ Any new exterior plumbing site utilities. ,Fiitu�e " , -� ° ; . _ � 'a� a m., -. ` : �Re Y P g rt, . - `' f ;g X 'rc ° °; :' . `Pievious, 'Capped ;Added` , Existing -. ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service -Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area Dishwasher -Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain/sink 2" Submit 2 sets of plans with any of the above. -3" Car Wash Drain } . °t`''IS®aimetriC Oi .Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this ermit results in an Water Extractor p Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures plumbing permit can be issued. i \Buildmg\Permus\PLM- Perm,Wpp doc 07106/05 Mechanical Permit Application , , FOitoFI lcl'usc oiNw. " pity of Tigard Received Date/By- Permit No : • &--- 0, • _� 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review Phone 503.639.4171 Fax: 503.598.1960 6 4,00, 1 0; f ig Date /By Other Permit: Line: 503.639.4175 _ ■ y 1 , � 1 Date Ready/By: 3uris. Internet: www.ci.tigard �� -' Supplemental See Page l Information g Notified/Method Supplemental nformation TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Er Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value $ 1:1 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS'FEES * - For special information use checklist Multi -famil ❑ Multi-family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SIT INFORMATION AND LOCATION Heating /cooling Job site address: / // j j / S ( -!/Q� £(96-e: /om � /!C Air conditioning or heat pump �" (re gwres site plan showing placement) 14.00 City /State /ZIP' '77C/ - -D ./e.. 677 2-2-3 Furnace 100,000 BTU (ducts/vents) 14.00 / / Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg /apt no.: Project name: Gas heat pump 14.00 Cross street /directions to job site: Q p�= b , Aereo, v , w ,,- Duct work 14.00 LHydronic 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: Qi/C/I/V itg_ Lot no : Flue /vent for any of above 10.00 572./ .. C , � Other: 10.00 Tax map /parcel no.- � 6 O (/J Other fuel appliances DESCRIPTION OF WORK • Water heater 10.00 /� p Gas fireplace i 10.00 .11- E / � 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 ❑ PROPERTY OWNER ❑TENANT Chimney /liner /flue/vent 10.00 Other 10.00 Name: {0 1:7 ei �- [ C�-C) Environmental exhaust and ventilation (/`�}� /24- f ,� pp I� }'/ !� /�/ /�� p q C� Range hood/other kitchen Address: ( ✓ v S_W _Q/`' ��JV (� " equipment 10 00 City /State /ZIP: C j--? Q( _ '77 22 3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( 3 ) if:7 Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT , ❑..CONTACT PERSON Attic/crawispace fans 10.00 Business name: Other 10.00 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 CONTRACTOR Barbecue r u id e _ Clothes dryer (gas) Business name. ' Other: Address' M ECHANICAL PERMIT FEES* City /State /ZIP Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7 ... Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) S. $ 0 TOTAL PERMIT FEE Authorized signature. `.° This p ermit a expires if a permit is not obtained within 180 l days after it has been accepted as complete. Print name: /Wit— 151 4 C Date. /� Q * Fee methodology set by Tn- County Building Industry Service Board i \ Building \Permits\MEC- PermitApp.doc 12/03 44 -4617T (11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total. Valuation: Permit Fee: $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•\ Buildin \Permits\MEC- PermitApp.doc 12/03 2 :_ -. _ � __ CITY ������N�������� ._ ��m m w ��n� u mn�w�mnm�� ' BUILDING ��U��U��U���� � ~~~,"~~~�,,~~, ~~.°.~~"~~.~ PERMIT #: &4s 13125SVV Hall B|vd.. Tigard, OH97223 DATE ISSUED: 4/5/7006 Phone: (503) 639-4171 Inspection Requests (24Hryl:(503)630'4175 ,-.A4 ^ 1 I � INSPECTION WORKSHEET FOR DATE: 1/8/2007 TIME: 7:00AM PAGE: 3 akftvrsD6 /�1 ' /^"�"'°u / SITE ADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: m(}RN\NG8TAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: {)rig. plans show as finished basement. Adding sheetrock, insulation and w|ect/inm|, plumbing, and nmmchmniva|(fhep}mnwine*t.) 6/15/06 :Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: hAlCLAU. ION +MARIA, PHONE #: 503'624'9347 . CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1/8/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 041889-01 603-624'9247 N Corrections/Comments/Instructions: 0 TA PASS ri PARTIAL APPROVAL I CANCEL ILI NO ACCESS | | FAIL | I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED ^ � � ���� Inspector: r�x' �� 1/64 � Date: � Phone #: (503) 718- �-- ^/ . ' • . CITY W�^��������&���� ' , � ` �*mm m OF wn��m^�n��� BUILDING DIVISION ' ' ~°~,,~,~=,,°,= ~�,,"~°"~~.~ PERMIT #: M 13125SVV Hall 8lvd, Tigard, ORg7223 DATE ISSUED: 415/2006 Phone: (503) 639-4171 Inspection Requo�a(24Hraj:(503)G3S-4175 ~��W� F INSPECTION WORKSHEET FOR DATE: 1011/20O0 TIME: 7:02AM PAGE: 9 ' 1 SITEADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: op TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement. Adding mhee1,och, insulation and electrical, plumbing, and ' mnenhmnins8(f}replmue insert) 6/15/D0:Addmd(1)4DO amp feeder, (4) branch circuits, (1) Low Voltage ' OWNER: MICLAU, ION + MARIA, PHONE #: 503-524-9347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/11/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 038030-01 603'524'9347 N . Corrections/Comments/Instructions: �� �^/ ^,--;^�0.z+;0-.5:- - I 1 . 1 1 1 -- / PASS PARTIAL APPROVAL �� CANCEL NO ACCESS _ _ I | FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: ' Date: p—/7---, Phone #: /503\ 718- !cL4-4,--S ou CITY OF ' ��un n ��m� TIGARD BUILDING DIVISION • PERMIT #: kAST2006-00075 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/5/2006 Phone: (5O8)O3S'4171 pi �\ Inspection Raqueata(24Hroj:(583)83Q'4175 ~i�-' INSPECTION WORKSHEET FOR DATE: 10/5/2000 TIME: 7:00AM PAGE: 16 SITE ADDRESS: 13814 EWFERNR|DGETERR CLASS OF WORK: SUBDIVISION: k4DRM|NGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: k4}CLAU DESCRIPTION: Orig. plans show as finished basement. Adding sheetrock, insulation and electrical, plumbing, omd mechanical(fireplace insert.) 6415/06:Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503-524'9347 / CONTRACTOR: OWNER PHONE #: : Inspection Request Scheduled For: Date: 10/6/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 037762'01 603-624-9347 N Corrections/Comments/Instructions: � �� y � ,... _ /A A,&r . 40 4-248.3 . I PARTIAL APPROVAL ri CANCEL 0 NO ACCESS FAIL fl CALL FOR INSPECT I ADDITIONAL FEES ASSESSED � �' Inspector: /IA | ~L~/~ y Date: � '� Phone #: (503) 718- ��4� --^ - ` ^ _ CITY OF TIGARD . . BUILDING DIVISION . PERMIT #: 1ST2006-00075 13125 SW Hall Blvd., Tigard, OR 97223 A DATE ISSUED: 41512006 Phone: (503) 639-4171 4 4901# Inspection Requests (24 Hrs.): (503) 639-4175 ..-1 ■ f 411 — --... INSPECTION WORKSHEET FOR DATE: 9/29/2006 TIME: 7 06Aivi PAGE: 4 SITE ADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: moRNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement. Adding sheetrock, insulation and electrical, plumbing, and mechanical(Fireplace insert) 6/15/06:Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503-524-9347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9129/2006 Pour Time: Code # lilappntinn escription Confirm # Contact # Message 199 Electrical final 037421-01 503-524-9347 N Corrections/Comments/Instructions: ( e it 10/ /0■3())kii‘j• Ikr_VAS S 7 PARTIAL APPROVAL 7 CANCEL NO ACCESS FAIL CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED Inspector: (3 e k) cie) L.1 Date: 9 ZA 6 (4) Phone #: (503) 718- 2,4410 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006-00075 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 402005 Phone: (503) 639-4171 140/4 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 9/2812006 TIME: 7:02AM PAGE: 10 SITE ADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement. Adding sheetroc:k, insulation and electrical, plumbing, and rnechanical(fireplace insert.) 15/05: Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503-249347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/28/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 037327-01 503-524-9347 Corrections/Comments/Instructions: Pzo cCS 11 t 01 Abt k (5 % Oka/ 2 PASS LII PARTIAL APPROVAL El CANCEL NO ACCESS AFAIL J CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: GI Date: 91 2 01, Phone #: (503) 718- 11411 1 CITY OF TIGARD " • , BUILDING DIVISION PERMIT #: MST2€ 06 00075 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: A15/2006 Phone: (503) 639 -4171 � * 8t a � � ' �N9111ti Inspection Requests (24 Hrs.): (503) 639 -4175 •:_.. INSPECTION WORKSHEET FOR DATE: 9/27f2005 TIME: 7 : 07AM PAGE: 34 SITE ADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement. Adding sheetrock, insulation and electrical, plumbing, and mechanical(fireplace insert,) 8/15/06:Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503 -524 -9347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9f27f2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 037222 -01 503 - 524 -9347 N SAS as'I m 'Too . Corrections/Comments/Instructions: l Nt'l A(I- cfaA AN • j a if. Ngii• wYSOti .. N. W© ►3 Q V N Go \ ).(1 . I1i2iN J Ni WALL To gk LiS le r" 3i".1 , k (tsboyiN, iQ ` l . 44 1 t •'3 tZ-Ak-A. i 6 k).i z\-c\ IA ea A 4U em1/400_) 1 ALL >t� tR6- A00 QZ ` r� 1.4_f a n) 620 fWe m,6 s7 & Pa5.`C - aO e3 kgc,44Aoq CL.ft -. to 60:4 ( 6-ito(b itoNika 1?)obswi "t) , Tta. vi44) ilac IN 5 -PQ pec, . C� R,- eAkot)6 Boot c � alwEsw cL Nev ` RAL- sifie KNO �4u tZ t1(4p . I I PASS I I PARTIAL APPROVAL CANCEL n NO ACCESS .FAIL ACALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED Inspector: 6'- ' - Nbe Date: 9 21 06 Phone #: (503) 7181, -!_ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006-00075 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/5/2006 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 8/8/2006 TIME: 7:06AM PAGE: 89 SITE ADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement. Adding sheetrock, insulation and electrical, plumbing, and mechanical(fireplace insert.) 6/15/06: Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503-524-9347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 8/8/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 115 Electrical service 034499-01 503-524-9347 Corrections /Comments/ Instructions: itA q i e l" 44/1/6pe/Mbe iOn --1 /12 , -Z , t , f-te-j1 at if;\ 4t,e' 1 vc 6,- _ ASS 7 PARTIAL APPROVAL LII CANCEL 7 NO ACCESS FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: r4 41P • Date: s3 Phone #: (503) 71E- Wo L. CITY OF TIGARD Ai . , . BUILDING DIVISION PERMIT #: MST2006-00075 13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 4/5/2006 Phone: (503) 639-4171 AdiA Inspection Requests (24 Hrs.): (503) 639-4175 1 INSPECTION WORKSHEET FOR DATE: 6/21/2006 TIME: 7:07AM PAGE: 14 SITE ADDRESS: 13814 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement, Adding sheetrock, insulation and electrical, plumbing, and mechanical(fireplace insert.) 6116106:Added (1) 400 amp feeder, (4) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503-524-9347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/21/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message '120 Electrical rough-in 032070-01 503-5249347 N • Corrections /Comments/ Instructions: PASS El PARTIAL APPROVAL El CANCEL NO ACCESS I FAIL 0 CALL FOR INSPECTION pi ADDITIONAL FEES ASSESSED Inspector: E (1\1Q? ( ...C":- Date: 6( N, Phone #: (503) 718- 2- ‘ CITY OF TIGARD m sr BUILDING DIVISION PERMIT #: Q > e:706 7S 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 J „,/kiiiiit ii + In spection Requests (24 Hrs.): (503) 639 -4175 _ INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 1 3 / % 2-���4`-' ' " ' - CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: /9'y6.2-1 6 ?"7 3 9 7 PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 4.--O" /2A4 _ �. Corrections /Comments /Instructions: sz T (g= 1 vN 13 F?R-W\:C17 foIL 54 1∎ Wi(C:, 0 ty U Li INA -a 1 "- % 0 b Rytcs\i'4, f)Krz- ti; RI , Irk • 1 \b0 1 AA6f 11 60Al. C:i(it_v►`tS lk AD I 1- Mkn _ vi Z- LPN '64 C1'T L\ : P 1_Sf\ s' apt i 0 1 ki 5 p w,,,`p 1 oJo,yD i q v 1,1 (o i=' r( Y, •4\ a_Qt\i L` c t lt<1. 1 5 N� S'a(Lv c5 1 ) 2- ‘• t( A.ftYp- Fes.b• smv I , PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL ,CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C pV 66 LE Date: 6i I 5 6 Phone #: (503) 718- 2i-1L44)' CITY OF ��mu n ��w� mm��mwunn�� . • - BUILDING DIVISION PERMIT #: ���2OO�OD�}�� 13125 SW Hall Blvd., Tigard, OR 97223 D/TE ISSUED: 4/5/2806 Phone: (503) 630'4171 ialtb ://4 lit Inspection Requests (24 Hrs.): ( G3S'417S .�L��� INSPECTION WORKSHEET FOR DATE: 3/3/2006 TIME: 7 :O 3 AK 4 PAGE: 27 . SITE ADDRESS: 13614 SW FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: K4|GLAU DESCRIPTION: Orig. plans show as finished basement. Adding nhemb*uk, insulation and electrical, plumbing, and mmnhmnixa|(firmmaceinowrt.)G/16/U6:Addod/1\4DO amp feeder, (4) branch circuits, /1\ Low Voltage ' OWNER: MICLAU, ION + MARIA, PHONE #: 503-524-9317 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: []ate: 773 Pour Time: Code # Inspection Description Confirm # Contact # Message 260 Insulation 032591'01 503-524'9M7 N Corrections/Comments/Instructions: ' i ^ PAS8 | I PARTIAL APPROVAL n CANCEL n NO ACCESS | | FAIL El CALL FORiNSPECT0N fl ADDITIONAL FEES ASSESSED � Inspector: �2� °°- �� � Dmt -�-� � �--��/-� Phona #� /GO3\ 718- , ' ' CITY OF TIGARD . . . BUILDING DIVISION 1 PERMIT #: 114,91'2006-000M 4/5/2006 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 /0 4llit 1fi Il Inspection Requests (24 Hrs.): (503) 639-4175 Jr ,,_...... INSPECTION WORKSHEET FOR DATE: 7/3/2006 TIME: 7 : 03 AIV 1 PAGE: 46 SITE ADDRESS: 13014 sw FERNRIDGE TERR CLASS OF WORK: SUBDIVISION: MORNINGSTAR LOT #: 007 TYPE OF USE: PROJECT NAME: MICLAU DESCRIPTION: Orig. plans show as finished basement. Adding sheetrock, insulation and electrical, plumbing, and mechanical(fireplace insert.) 6/15106:Added (1) 400 amp feeder, 0) branch circuits, (1) Low Voltage - OWNER: MICLAU, ION + MARIA, PHONE #: 503-524-9347 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/3/2006 Pour Time: Code # Inspection Description Confirm # Contact .# Message 275 Framing 032515.01 503-524-9347 N Corrections/Comments/Instructions: • . . • I ' PASS I I PARTIAL APPROVAL I I CANCEL n NO ACCESS El FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED /A Inspector: / - • Date: 7- 3---a 0 Phone #: (503) 718- –25i-47–C— CITY OF TIGARD r� s BUILDING DIVISION PERMIT #:0j0(0 ODD 75 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 . ■■ NI ll Inspection Requests (24 Hrs.): (503) 639 -4175 • INSPECTION WORKSHEET FOR DATE: TIME: PAGE: ADDRESS• / 3 87 1 / J/Uf /T/VL) CLASS OF WORK: SUBDIVI ION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message • i 13 n 'Leci% • L51R L dAtet__, te ••rrections /Comments /Instructions: oe-e-As S (PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS I I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 6- �� Phone #: (503) 718- 2� CITY OF TIGARD BUILDING DIVISION - PERMIT #: M 6T ion -- x075" 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: lik/ Phone: (503) 639- 4171nI�n�iI�f�l l Inspection Requests (24 Hrs.): (503) 639 -4175 J.. __.. INSPECTION WORKSHEET FOR DATE: ,� f / 44 TIME: PAGE: SITE ADDRESS: 1 5g I q 5 -�% F t Lt*D6 `C_ ?t CLASS OF WORK: AL' SUBDIVISION: LOT #: TYPE OF USE: c� PROJECT NAME: DESCRIPTION: OWNER: M l C i.,F} L l l� PHONE #: SG'5- ?/35/ 7 CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 1 7 /4 Pour Time: Code # Inspection Description Confirm # Contact # Message • bgotof-L Pit Corrections /Comments /Instructions: IN l / V I - PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ill Date:../ i� Phone #: (503) 718 -