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Permit
A 1, CITY OF TIGARD PERMIT PERMIT PERMIT #: MST2006 -00253 COMMUNITY DEVELOPMENT DATE ISSUED: 1/3/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134DB-07900 SITE ADDRESS: 11184 SW FOREST LN ZONING: R -4.5 SUBDIVISION: STONECHASE LOT: 003 JURISDICTION: TIG Project Description: SF BUILDING REISSUE: MAl231F STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 17 FIRST: 1,732 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 644 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: 4 BATH: 2 TOTAL: 1,732 at 178,508.00 REAR: PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 4 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 4 MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: 1 VENT FANS: CLOTHES DRYER: 1 NAT FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 4 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: 3 201 - 400 amp: 201 • 400 amp: 1st W/O SVC /FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: 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: 0TH: ALL ENCOM 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 applicable FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION laws. All work will be done in accordance with approved plans. This PO BOX 1577 PO BOX 1577 permit will expire if work is not started within 180 days of issuance, or BEAVERTON, OR 97075 BEAVERTON, OR 97075 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 of these rules or direct Phone: 503 - 590 - 0805 Contact #: PRI 503 - 590 - 0805 questions to OUNC by calling 503.246.6699 or 1.800.332.2344. FAX 503 -590 -1751 Reg #: LIC 71037 TOTAL FEES: $ 10,051.97 REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 A i ,. Issu d By : _ �� / _1� / Permittee Signature : /� /� 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. • ' `• ti , ;_9 t!:tr; t �� ^ t .,g Building Permit Application y" -- FOR OFFICE lJSE ON.LY ' Received ��, �.,/ City of Tigard C ;Ty U ". • , #116 l0 5 a Date /By `„Z f7� �,�f •� Perm No.: M � O'F �.e� _^ � 5 ' 13125 SW Hall Blvd., Tigard, OR 97 't g f J Plan Review C ''' Phone: 503.639.4171 Fax: 503.59$ 1 D /�Q -H Hr.I Date /By. \ • (9 - q Other Permit: C a • - TI G A • Inspection Line: 503.639 �+ Date Ready/By: , / ''J tics ® See Page 2 for Internet: www.tigard - or.gov • *Ai Notifie ethod r NV �,} �� Supplemental Information . , TYPE. OF WORK REQUIRED DATA: 1- AND 2= FAMILY DWELLING f'°'t 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 CATEGORY CONSTRUCTION :` work indicated on this application. (il, 1- and 2 -family dwelling ❑ Commercial /industrial Valuation: $ ❑ Accessory building CI Multi-family Number of bedrooms: 3 Master builder ❑ Other: Number of bathrooms: 9, • - • ;. "4018 SITE' INFORMATION AND LOCATION Total number of floors: / Job site address: /J�v S C,(J �P ,,.. 1 /;,(1-e-, New dwelling area: ' iq re feet City /State /ZIP: ' 7 ma _ 4.,,„_. 9 7:2 , 2 _, 3 Garage /carport area: 4,e/e/ square feet Suite/bldg. /apt. no.: 1 Project name: Covered porch area: - jr7 square feet ti 36 Cross street /directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST. . Subdivision: _ / 6 -L .CC /, 2-C- I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the - DESCRIPTION' OF WORK - ., work indicated on this application. • Valuation: $ 7 /1-6-1•74..A.-/ Existing building area: square feet New building area: square feet g ' fi PROPERTY OWNER ❑ TENANT Number of stories: • Name: � vt-t/- c O t S7', LC. ri ■ 0 Type of construction: Address: 7- P . (, ':& AS 7 7 Occupancy groups: . City /State /ZIP: •g „,, , `ice 9 ' 7 L) ],5 Existing: Phone` i3) S9o- a,3) Fax: (50) - 7S - 1 New: . Fii 'APPLICANT • • ❑ CONTACT, PERSON ' - . NOTICE Business name: S -ice- t gi C (:),_a- 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 apply: Phone:( ) Fax::( ) E -mail: . , ;CONTRACTOR, - - -, . Business name: S-'1,,. jM A"4 6 0-t./ BUILDING PERMIT FEES* ' Address: (Please: refer to fee schedule ' Structural plan review fee (or deposit): j City /State /ZIP: FLS plan review fee (if applicable): Phone: ( ) Fax:( ) Total fees due upon application: CCB Iic.: 7/ o 37 Amount received: Authorized signature: �� �'_. This permit application expires if a permit is not obtained n within 180 days after it has been accepted as complete. Print name: IV/Lc %-1 /2„ ,� 7 - Date: / v 2v - p (, * Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits\BUP -TI- PermitApp.doc 03/23/06 440.4613T(1I/02 /COM/WEB) a Building Division Plan Submittal Requirement Matrix T I G A R D Commercial & Multi - Family - New, Additions or Alterations 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: \Building \Permits \BUP- TI- PermitApp.doc 03/23/06 F ! ` Electrical Permit Application Qr' = _- __ ___ FOR - OFFICE- U:SE- ON LA' - - - : - . : - -- City of Tigard i ,, O1 T Y j� ZUUb Date/By. �� U -� Permit No.: v 13125 SW Hall Blvd., Tigard, O bN r ) ( af� H Plan Review ® ' " Phone: 503.639.4171 Fax: 503.598 a 2 � l Date/B Other Permit: Ti GA R D Inspection Line: 503.639.4175 �,�� 1 ®� Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW . Er New construction El Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION.' ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ® Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or J SITE IN FORMATION AND LOCATION: ❑Emergency system. larger separately derived system. , ., _ _ . ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ", D OOHP or more. occupancy. Job no.: Job site address: //7t7 Sr: ) 2eS7 L,y v i✓ ❑ Six or more residential units. ❑ Recreational vehicle parks. ❑ Health -care facilities. ❑ Supply voltage for more than City / State/ZIP: `��� /Ilt aZ DA-- ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. . FEE SCHEDULE R Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: 4 - (? Lot no.: 3 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential / 75.00 2 ' DESCRIPTION OF WORK - (with above sq. ft.) • �p Limited energy, multi - family 75.00 2 ALP t,./ Wr"yr k. residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 pit' ' OWNER . , ❑ TENANT 201 amps to 400 amps 106.85 2 Name: OU fe, C� "� S -. 401 amps to 600 amps 160.60 2 – 601 amps to 1,000 amps 240.60 2 c- Address: 0 . ,,,-- ) i7 '7 Over 1,000 amps or volts 454.65 2 City / State/ZIP:` U �,, /L , 7 2-23 Temporary services or feeders installation, alteration, and /or relocation Phone: (5213) v— Q �06-- Fax: (95:3) „:5 70 _ / 2 5-/ 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 599 amps 133.75 _ 2 Branch circuits - new, alteration, or extension, per panel . Owner signature: Date: A. Fee for branch circuits with p' APPLICANT ❑ CONTACT PERSON • above service or feeder fee, 6.65 2 / each branch circuit Business name: , ._- ,o: gp0 a .. B. Fee for branch circuits without service or feeder fee, 46.85 2 Contact name: first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular t dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E - mail: Pump or irrigation circle 53.40 2 . , C Sign or outline lighting 53.40 • 2 Business name: t J � . Signal circuit(s) or limited - P �•/J l energy panel, alteration, or Address: 7,5 S' kJ zits"' ` ' , s extension. Describe: Page 2 2 City/ State/ZIP• � i 7' . - /9Na OR- '27 ( Each additional inspection over allowable in any of the above �, '7 Per inspection 62.50 ��- Phone: ( p3 }42_ 44 7 .73` 4 Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lie.: 93 t ?> Electrical Lic.:`, j� C Suprv. Lic.:3 :23 c Industrial plant per hour 73.75 r ELECTRICAL PERMIT FEES, . . Suprv. Electrician signature, required: ( �.- C'rrnc. (& Subtotal: Print name: a � �r A Q ctoz1 J Date/ U-- /3 —3 Plan review (25% ofpermit fee): �j� �f State surcharge (8% of permit fee): Authorized signature: ///1��� TOTAL PERMIT FEE: t This permit application expires if a permit is not obtained within 180 Print name: �� ���� D .� Date: f O f 3�Q t j days after it, has been accepted as complete. Number of inspections allowed per permit. I:\ Building \Permits\ELC- PennitApp.doc 05/23/06 440-4615T(11/05/COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: 1 RESIDENTIAL WOR . ONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (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- PermitApp.doc 03/23/06 I Mechanical Permit Application __L__ _. - _ - _ ___ .._._. OFrICE OSa- O l X- - -,- - .- _: _ E I VE Received City of Tigard e t� Date/By Permit No.: 5 . a -p - o pals` li a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit: �. Phone: 503.639.4171 Fax: 503.59 I Date/By. TI G A D Inspection Line: 503.639 2111.6 Date Ready /By: Jurist lb See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information t9 /Tj'Y.,�O�iF_ TIGAR tD TYPxE `O °`tYbTAKlinft. 'I . ' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST New construction El 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. Value: $ CATEGORY OF. CONSTRUCTION :., _ ' RESIDENTIAL EQUIPMENT SYSTEMS'FEES* KI 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. ❑ Multi family D. Master builder ❑ Other: Description I Qty. Ea. I Total • • ' ., - ' JOB SITE' INFORMATION AND LOCATION - .' Heating /cooling • / Air conditioning or heat pump Job site address: 1 / �( e/ S_ C' l� Fo :� L , (requires site plan showing placement) 14.00 City /State/ZIP: -779 Z 3 Furnace 100,000 BTU (ducts/vents) 14.00 Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17 Gas heat pump 14.00 Cross street /directions to job site: Duct work 14.00 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: S - c- , f e. Lot no.: 3 for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK . Water heater 10.00 Gas fireplace 10.00 q t....c.f...4 1 N�.4,,, 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 lja PROPERTY OWNER I ' ' ❑ TENANT Chimney /liner /flue/vent 10.00 Other: 10.00 Name: r(,t.44( 1 awyi_ S ,,� Environmental exhaust and ventilation Address: ` Range hood/other kitchen C'. `,j '� equipment 10.00 City /State /ZIP: Eyo�4 ,- O/L Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ) l J-- ©P 6 s Fax: (Sf`3) 3-20-- 1 6 / toilet compartments, utility rooms) 6.80 - R. APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Business name: SA-1...1 - As 4� 01.) Fuel 10.00 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 - Business name: S Barbecue �-Q� Clothes dryer (gas) � /�(,p rkIliq Other: Address: 75-6 0 S (,j J / _-_c./ \ 1 ' - MECHANICAL PERMNITFEES* City /State /ZIP: / C R 0,4,2_- 722-. Subtotal Phone: (,S ) (2 __ S6 U3 Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: 6, 6, 5 7,? State surcharge (8% of permit fee) �j TOTAL PERMIT FEE Authorized signature: SJL� -y t/ /„...,tv,,. days after permit application expires if a permit is not obtained within I80 / fter it has been accepted as complete. . Print name: N , / A i, �(j( /;. s Date: 1 Q--- 12 0.� * Fee methodology set by Tri- County Building Industry Service Board L\ Building\Permits\MEC- PermitApp.doc 04 /06/06 440-4617T (I 1 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: `Total" Valuation;.° >r ; PerinitxFee:. , $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 12/30/05 2 Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY • Received City of Tigard Permit No.: 1 1111 1 3125 SW Hall Blvd., Tigard, OR 9 7223 Dale/By: /►1S'ji �(o -00,+) c�3 ® Plan Review Phone: 503.639.4171 f l : y Other Petmit No.: T LG A N D Inspection Line: 503 • 1 Date Ready/By: I ° "g RI See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE u iBiO�k.F ?1111f FEES! SCHEDULE ' New construction cm/ yp For special information use checklist r eTift Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement BU1 _R i :r f4.'VISION New 1- 2- family dwellings (includes 100 ft. for each utility connection) , . CATEGORY OF CONSTRUCTION' , - - `. . -- SFR(1)bath 249.20 N 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 gr Master builder ❑ Other: Each additional bath/kitchen 45.00 Fire sprinkler ( sq. ft.) Page 2 ' - JOB` SITE' INFORMATION AND LOCATION Site utilities Job site address:./ /4194 S t _) 1 ? L /�,.f.� Catch basin or area drain 16.60 City/State/ZIP: Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: S f 1 Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK - Backflow preventer Page 2 12 c/ A.J�-w /...-/e - yh..e- Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 PROPERTY. OWNER - ❑ TENANT . Ejectors/sump 16.60 Name: aC. Expansion tank 16.60 Address: rp U i 1 / 7 Fixture /sewer cap 16.60 City /State /ZIP: 267-p. - 0 4, 97 p 7 Floor drain/floor sink /hub 16.60 Phone: (SO) S d d cPpS Fax: (,s S `�d -, '7 / Garbage disposal 1 6.60 Hose bib 16.60 'APPLI , , ❑ CONTACT PERSON Ice maker 16.60 Business name: S, !` " "" /-,4 S J 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: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: 6 ' C 4L U ,b / Water heater 16.60 Address: )5 jz .3' z ---/ ,0 v-e, Other: Subtotal City /State /ZIP: /// L c- f �, o x e t,_-_ 9 2 -__.? Minimum permit fee: $72.50 Phone:6 ) 42 c 23 /7 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: l 5 9 @ 7 Plumbing Lic. no_4/ '5 Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: /yy ` TOTAL PERMIT FEE Print name: Ati�C� 7.- (i.Ji_scr Date: /O --l3 -d 6 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\PLMF- PermitApp doc 04 /06/06 440 -4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: 'Site; Utilities • Qty. ...Fee(ea) Total . Square Footage: Permit ; • Footing drain - 1 ' 100' 55.00 0 to 2,000 $1 15.00 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 - Storm & Rain Drain - 1st 100' 55.00 Valuation: PermitwFee: .. $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 Fixture or Item ' Qty. : Fee (ea) `Total' 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 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 each additional $100.00 or fraction thereof to Inspection of existing plumbing or 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: Plan Review for Complex Structures • . • 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. Quantity by (Fixture) ,WorlePerformed ID Any new commercial building. Fixture Replace ❑ Any new exterior plumbing site utilities. Previous 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 Isometric or 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 permit results in an Water Extractor 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:\ Building \Permits\PLM- PennitApp.doc 07/06/05 2) 4 , - FOUR D CONSTRUCTION CO 13/F POST OFFICE BOX 1577 • BEAVERTON, OREGON, 97075 • PHONE (503) 641-0935 1 • * 1 : .;•, . 4.- , y • ,... 2 ' . ;;-t t .-.S MUST DEVEBLEOI;EMREANi. T "a• ' 1 - P PROVE6 '- • 7 'OW; ' 04-e_ _9_2,2,2,3 7 i . " - • 1 ,. 4 , - ••• 1(11 ,r, V !,.. •„ .., .. z - .., ,... Pr , , t C.. " Li .,.,*;,.,.. :,.Z:.(.70 ,.. ,,, . . • ,. . ,, .. ,.: - . . r ;" .‘fl Tr, i „•••-c-..,.,, -/ 0 n , .* ,-;-;-' , 7 . ,,,,,. t . • : 1:: r ,,, . , .. , .;;;: / ..... ,( .. ,h ,, v, :ii i, ; h'_; ! .,•: ', /: (:::: :,,, . ,,, ,ii - *..... <-..,•-s ) ,... , • .... ...,-. I 7 / „,-,' Fo vcll , .. .--* '1 k ..,....% . o . i ,-,-..-e--• ._. ...- ,-- .., i . • l hi \ \ I 111111111,. n11601111) / ei'6"R . -.., 0 , - 1 -- ) - G t• g IN 5 . • I ' 0,611 577. ''( V . QIIIIMIIIPler , A '* s /1/94 .ci 6, re. ST I Aiyie, • CITY OF'TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.:VUNT[-- o vG PLANNING DIVISION: Required Setba <.s: ❑ Approved ❑ 'N,ot . Approved . Side: 5 Street Side: Front. Gage: Rear: " Visual Clearance: Approved.. ❑ Not Approved Maximum Building Height feet CWS Service Provider Letter Required: ❑ Yes ❑ No di-Le • 0 R ceived B, - -Date: rOl� l-6 ENGINEER! DEPARTMENT: Actual Iope: S 9'a El Approved ❑ Not Approved Site.P Approved ❑ t A proved B Date: . ib b Notes: 7),(A_ • City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • IN T I GARD RESIDENTIAL PERMIT APPLICATION REVIEW 1', r, i u t N unt l r MST2006 -00253 l.ttt At, 3 S uh0i\ i.t„n Stonechase 1 J r& 11184 SW Forest Lane (:,tnt.trt N uu Dale DeHarrport liu .inc<- Four D Construction Co. t i ( r P.O. Box 1577 I t Beaverton I State I I Zip 197075 As required by the 1999 Legislative action (Senate Bill 587), your residential permit application and plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or "complex" as defined in ORS 455.467 and 455.469. x The application is complete. The application is incomplete for the following reason: I I The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and /or approved. I I The submitted plans cannot be reviewed until the above information has been submitted and /or approved. I I The plans are deemed "simple ". I x I The plans are deemed "complex ". 4 k) V).dS• D6 Name of Plans Reviewer Date Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 STREET TREE CERTIFICATION I, 174J,B13 s Owner/Agent for D nth/ lieti (PLEASE PRINT) (PERMIT HOLDER) - - Do hereby certify that the following location meets City of Tigard and Wa County land use and development standard street tree installation. ADDRESS: SUBDIVISION: 7 G7144-e LOT: SIGNATURE: DATE: 2 -g4167, r • resV /AGENT) RECEIVED BY: DATE: 8 (CITY OF TIGARD) I: \ Building\ Forms\ StreetTrecCertificate 01/19/07 CITY OF TIGARD , BUILDING DIVISION PERMIT #: MST2006-00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 / A pp Inspection Requests (24 Hrs.): (503) 639 -4175 �'� V II I INSPECTION WORKSHEET FOR DATE: 8/8/2007 TIME: 7:00AM PAGE: 37 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF. 8/6/07 ADD a/c unit. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503590 -0805 Inspection Request Scheduled For: Date: 8/8/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 053589 -04 503 - 720.0012 Y Corrections /Comments /Instructions: • PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS n FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: c \--11.4.1i I Nit-- Date: ?I Ti 0 7 _ Phone #: (503) 718- CITY OF TIGARD , A BUILDING DIVISION PE 13125 SW Hall Blvd., Tigard, OR 97223 , ' . DATEIS ISSUED: #: M ED U Phone: (503) 639-4171 , *!Notpu l . :+\. Inspection Requests (24 Hrs.): (503) 639-4175 _JAIL IL INSPECTION WORKSHEET FOR DATE: 8/312007 TIME: 7:03A1v1 PAGE: 21 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-690.0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 Inspection Request Scheduled For: Date: 8/3/2007 Pour Ti 7: Code # Inspection Description Confirm # Contact # M z . sage 399 Plumbing final 053389.01 503-720-7445 1° ri 01, - 1 - Cf Corrections/Comments/Instructions: ' r: PIJLI i/k-eli, _cr( ,\,etic,e _ , , ( g: VIA,A1 C .0-4 -- dak__ ( 1 X Vikai0x- /1.4A -\ — "7 u * Fr t , 4--vt4/ sik_ _ 0 ( ) C ZOL--2t. ________ke_____________I;LL- I 4 s 1/, 4 " / ••A. ‘ L1T/1 \AA* 'Prrk----. 4irjr1 lb.-IL* VIASke- ( (-- qA,A- 5 ( 1-- 3 c •I'c 1 e..s.-,,A tder 62 • ' ' \xtoogrt-a- T 7 \ a L I" d i PAS., I I PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS 1 , FAIL i v 0 I I CALL FOR INSPECTION I 1 ADDITIONAL FEES ASSESSED Inspector: /4/0(/ Date: ) Phone #: (503) 718- 2- - yz-cf , . CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2006 -00263 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/26/2007 TIME: 7:00AM PAGE: 7 SITE ADDRESS: 11 SW FOREST LW CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 -590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 59(1.0805 Inspection Request Scheduled For: Date: 4/26/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 047202 -01 503 - 720.7445 N Corrections /Comments/ Instructions: g PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: �'t'� Date: U I h Phone #: (503) 718- . .} CITY OF TIGARD BUILDING DIVISION , N4p i pt i i PERMIT #: MST2006 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 ,-,11Ir -11. INSPECTION WORKSHEET FOR DATE: 1/29/2007 TIME: 7:05AM PAGE: 2 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 083 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-590-0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590-0805 Inspection Request Scheduled For: Date: 1/2912007 Pour Time: Code # Inspection Description Confirm # Contact # Message 315 Rog/beam plumbing 042656-03 603-720-7446 N Corrections/Comments/Instructions: \AO_ I T id i al • :,. PASS El PARTIAL APPROVAL El CANCEL I I NO ACCESS r FAIL I I CALL FOR I SPECTION fl ADDITI ()NAL F: ES ASSESSED --\ , twow-il ...■ A 8 A - 577 Inspector: AIMAL Date: I I P Phone #: (503) 71- CITY OF TIGARD BUILDING DIVISION PERMIT #: p,IST2006.00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1f3/2007 Phone: (503) 639 -4171 / iv jmlPi Inspection Requests (24 Hrs.): (503) 639 -4175 W %I INSPECTION WORKSHEET FOR DATE: 1/23/2007 TIME: 7 :02AM PAGE: 37 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 580 - 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503580.0805 Inspection Request Scheduled For: Date: //2312007 Pour Time: Code # Inspection Description Confirm # Contact # Message , 310 Crawl drain 042400 -01 603- 969-4631 Y Corrections /Comments /Instructions: • .4 PASS ❑ PARTIAL APPROVAL n CANCEL I NO ACCESS ❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Al , \L- Date: I )-31 6 Phone #: (503) 718- PA r-c li CITY OF TIGARD • BUILDING DIVISION • PERMIT #: MST200S -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 0 ii 0 Inspection Requests (24 Hrs.): (503) 639-4175 � � � I. INSPECTION WORKSHEET FOR DATE: 3 - TIME: PAGE: 11a.1..I30 r 7 ; 02AM 33 SITE ADDRESS: 11104 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 - 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 0805 Inspection Request Scheduled For: Date: 1/2312007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 042400 -05 503-989-41631 N Corrections /Comments /Instructions: • 4 P, \ ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: P \)-{ Date: f l :7. 6 � Phone #: (503) 718- . . CITY OF TIGARD . . . A I , BUILDING DIVISION ' PERMIT #: ivIST2006-00253 I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/7007 l Phone: (503) 639-4171 1440 Inspection Requests (24 Hrs.): (503) 639-4175 AA '.. q..... INSPECTION WORKSHEET FOR DATE: 1/23/2007 TIME: 7:02AM PAGE: 34 SITE ADDRESS: 1114 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503..590.0305 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590-0805 Inspection Request Scheduled For: Date: 1/23/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 042400-04 503969-4631 N Corrections/Comments/Instructions: PASS 0 PARTIAL APPROVAL 0 CANCEL n NO ACCESS 1 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: 1 M" Date: ' 71 Phone #: (503) 718- CITY OF TIGARD .. , I BUILDING DIVISION PERMIT #: MaT2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/312007 Phone: (503) 639 -4171 I,91,l� 1 Inspection Requests (24 Hrs.): (503) 639 -4175 112. INSPECTION WORKSHEET FOR DATE: 1/23/2007 TIME: 7:02AM PAGE: 35 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 5Q3- 530-0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590-0805 1 Inspection Request Scheduled For: Date: 1/2312007 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rain drain 042400 -03 503-969-4631 N Corrections /Comments /Instructions: PASS PARTIAL APPROVAL n CANCEL NO ACCESS FAIL 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: v k , A • D )-3 J6 Phone #: (503) 718- CITY OF TIGARD ._ . • A BUILDING DIVISION PERMIT #: MST200 &00353 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 113/2007 Phone: (503) 639 -4171 /�ii y Inspection Requests (24 Hrs.): (503) 639 -4175 ' I� . ' � INSPECTION WORKSHEET FOR DATE: 1123/2007 TIME: 7 :02AM PAGE: 36 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-590 -OB05 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503. 590.0005 Inspection Request Scheduled For: Date: 1123/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 042400 -02 503 -869 -4631 N Corrections /Comments /Instructions: 1)..,e_ASS n PARTIAL APPROVAL I I CANCEL _ NO ACCESS FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector'." \Y f/ Date: I .J) t9 Phone #: (503) 718 - CITY OF TIGARD r BUILDING DIVISION PERMIT #: MST200&00263 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/312007 Phone: (503) 639 -4171 r ���u�ii�@I j�� Inspection Requests (24 Hrs.): (503) 639 -4175 `:_.. 1 INSPECTION WORKSHEET FOR DATE: 8/8/2007 TIME: 7:00AM PAGE: 36 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: _ SUBDIVISION: STONECHASE LOT #: 003 - TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF. 8/6/07 ADD a/c unit. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 603-5900805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503- 590 -0805 Inspection Request Scheduled For: Date: 8/8/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 053589.05 503 - 7200012 N Corrections/Comments/Instructions: J )1/ �!� ' ^ S pi PARTIAL APPROVAL Li CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 14 / 4 W--.-- - - - - -- Date: / Phone #: (503) 718- Z)12--(/ f CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200&00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 =� INSPECTION WORKSHEET FOR DATE: 8/8/2007 TIME: 7:00AM PAGE: 39 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF. 8/6/07 ADD a/c unit. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590-0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-690.0805 Inspection Request Scheduled For: Date: 8/8/2007 Pour Tim Code # Inspection Description Confirm # Contact # M -ss.ge 699 Mechanical final 053589 -03 503- 7200012 Y Corrections/Comments/Instructions: • ►; -ASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: Date: O Phone #: (503) 718- CITY OF TIGARD r BUILDING DIVISION PERMIT #: MST2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2001 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/3/2007 TIME: 7:03AM PAGE: 18 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503.5840805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 500 - 0805 Inspection Request Scheduled For: Date: 8/3 /2007 . Pour Time: Code # I nspection Description Confirm # Contact # Message 299 Final inspection 053389.03 503- 7247445 N Corrections /Comments /Instructions: •! t[► W\,e cam, , ` it 7 1 Q L_v--if I I PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ,FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ` 70 Date: V3 (0 Phone #: (503) 718- '�� I CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200000253 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 x� ii Inspection Requests (24 Hrs.): (503) 639 -4175 ���!I� INSPECTION WORKSHEET FOR DATE: 8/3/2007 TIME: 7:03A1v1 PAGE: 20 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 603-590-0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 590-0805 Inspection Request Scheduled For: Date: 8/3/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 063389-02 503. 7207445 N Corrections /Comments /Instructions: i N ' + ‘ ,e \ 9 Nra Ci 4/ CL-L-S , %,■..c___ 7 . 4 q ' KC V_ . v .I ! �J v • • (:)\.) \r-' 4 PASS I 1 PARTIAL APPROVAL n CANCEL NO ACCESS ,FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED f� Inspector:" Vi/ Date: g-7/� 7 Phone #: (503) 718 -' ` 2'1 i CITY OF TIGARD i . , 1 BUILDING DIVISION PERMIT #: MST2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 113/2007 Phone: (503) 639 -4171 �+ Inspection Requests (24 Hrs.): (503) 639 -4175 iii• 'I I.. INSPECTION WORKSHEET FOR DATE: 7/18/2007 TIME: 7 :01AM PAGE: 47 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: � SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 -590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 -590 -0805 Inspection Request Scheduled For: Date: 7/18/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 052227 -01 503 - 357 -2350 Y Corrections /Comments /Instructions: SS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS _ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED - )rle Inspector: -. Date Phone #: (503) 718- r- CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 1 P t Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/24/2007 TIME: 7:01AM PAGE: 51 SITE ADDRESS: 11184 SW FOREST LW CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF I OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503.690 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590-0805 Inspection Request Scheduled For: Date: 4/24/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 046996-01 503. 720 -0012 N Corrections/Comments/Instructions: Mg 1j ? 0 al-e "- ' . PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL OR INSPECTION I 1 ADDITIONAL FEES ASSESSED Inspector: Date: C ; 1 ( hone #: (503) 718 -2 r Yip CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2005 0025 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/312007 Phone: (503) 639 -4171 /A A Inspection Requests (24 Hrs.): (503) 639 -4175 '� '' I INSPECTION WORKSHEET FOR DATE: 4120/2007 TIME: 7:00AM PAGE: 84 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503.590 -0005 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503. 590-0005 Inspection Request Sc p Req Scheduled For: Date: 4/20/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 046841 -03 503-720-0012 N Corrections /Comments /Instructions: 0 10 \IN tea F6_7; r �� Z) 4 I P.,(21K1/6ip s,./4, 0/ &eit -a 4 6 1 6 ( //z- 1 U / .1- - a - g Z Ati,,i / / / / , A fr /.4, /el — 6 .2 © f 7 z-71/9 1 I PASS n PARTIAL APPROVAL CANCEL ❑ NO ACCESS FAIL CALL FOR SPECTION n ADDITIONAL FEES ASSESSED ' I i • Inspector: / Date: o ? Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006 -00253 , 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 � o. , °a��„� tiI Inspection Requests (24 Hrs.): (503) 639 -4175 — IL INSPECTION WORKSHEET FOR DATE: 4/20/2007 TIME: 7 :00AM PAGE: 85 SITE ADDRESS: 11 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE . DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-590-0806 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 590 -0805 Inspection Request Scheduled For: Date: 4/20/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 116 Electrical service 046841 -02 503- 720 -0012 N Corrections /Comments/ Instructions: J PASS III PARTIAL APPROVAL ❑ CANCEL NO ACCESS , I \ I FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED , , V/Z4y D Inspector: , • Date: Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200&00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639- 4171w'�ulli�l � , Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/11/2007 TIME: 7:01AM PAGE: 97 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, • PHONE #: 503.590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503.580 - 0805 Inspection Request Scheduled For: Date: 5/11/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 280 Insulation 048098-01 503-720-7445 N Corrections/Comments/Instructions: PASS PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: g j ' Phone #: (503) 718- 7- 4'4.°r • ' CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006-00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 Jalt _.. INSPECTION WORKSHEET FOR DATE: 4/26/2007 TIME: 7:00AM PAGE: 5 • SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503.930.0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503- 590 -080 Inspection Request Scheduled For: Date: 4/26/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 0472.02 -03 503 -720 -7445 N Corrections /Comments/ Instructions: / PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ` Date: zr —v 7 Phone #: (503) 718- f1,¢,Co'Ti4- v- / /5 7 " ° ` CITY OF TIGARD ' BUILDING DIVISION PERMIT #: M ST200&00253 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: /1312007 Phone: (503) 639 -4171 Np li Inspection Requests (24 Hrs.): (503) 639 -4175 ��'. 1 INSPECTION WORKSHEET FOR DATE: 412612007 TIME: 7 :00AM PAGE: 6 SITE ADDRESS: 11184 SW FOREST LW CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 -590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 530.0805 Inspection Request Scheduled For: Date: 4/26/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 615 Mechanical rough -in 047202 -02 . 501- 720 -7445 N Corrections /Comments /Instructions: 4 4 PASS I 1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: if Date:! Z7 ^ Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: M ST20000253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 J„„7,411111( .. • INSPECTION WORKSHEET FOR DATE: 4/24/2007 TIME: 7:01AM PAGE: 52 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF • OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 -590- 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 590 -10805 • Inspection Request Scheduled For: Date: 4/24/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 046995.02 503-720-0012 N Corrections /Comments /Instructions: • `I4PASS n PARTIAL APPROVAL n CANCEL U NO ACCESS FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: Date: 2-0 Phone #: (503) 718- CITY OF TIGARD , BUILDING DIVISION PERMIT #: MST2004002663 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 1 44 Inspection Requests (24 Hrs.): (503) 639 -4175 A IL INSPECTION WORKSHEET FOR DATE: 4/24/2007 TIME: 7:01AM PAGE: 53 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF . OWNER: FOUR D CONSTRUCTION CO, PHONE #: 603.590- 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503.590 -0805 Inspection Request Scheduled For: Date: 4/24/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 235 Shear walls/anchors 046995-01 503 - 720-0012 N Corrections /Comments /Instructions: l PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS %' AIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED r .",_ ...._. ../ . Inspector: Date: / 2 V 7 Phone #: (503) 718 2 Z3 CITY OF TIGARD ' BUILDING DIVISION PERMIT #: MST2006-00263 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 tu Phone: (503) 639 -4171 Ain\ � 1p�11 1 i l Inspection Requests (24 Hrs.): (503) 639 -4175 „_.14I■ INSPECTION WORKSHEET FOR DATE: 4/20/2007 TIME: 7:00AM PAGE: 86 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR 0 CONSTRUCTION CO, PHONE #: 503 -590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503. 590 - 0805 Inspection Request Scheduled For: Date: 4/2012007 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 046841 -01 503 - 720 -0012 N Corrections/Comments/Instructions: . 6(U15 [PASS U PARTIAL APPROVAL ❑ CANCEL Li NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: t • p / Date: ( ` P h one #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MS1'2006.00253 13125 SW Hail Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639- 4171 u� �lm �ii�l�hl Inspection Requests (24 Hrs.): (503) 639 -4175 ..:'W _,.. INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 72 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-590.0005 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 , Inspection Request Scheduled For: Date: 4/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 242 Interior shear walls 046712 -06 503- 720 -0012 N Corrections /Comments/ Instructions: • Z ---- PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 4- -/ 9 -- Q? Phone #: (503) 718 - '2..51--4-'c— CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200600253 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/3/2007 I Phone: (503) 639 -4171 0 27 , yp,0041 ii Inspection Requests (24 Hrs.): (503) 639 - 4175 , ' ' I_.. INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 73 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-590-0005 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503.590 -0605 Inspection Request Scheduled For: Date: 4/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 046712 -05 503-720-0012 N Corrections /Comments /Instructions: J //45:77 " 05 KO , -�i r4 ' .5 - ®.✓ � i C 441. e<'" PASS I • PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 4 Date: g-- / 9--07 Phone #: (503) 718- 21-1-4-t!- t t CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006-00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 / �iurrr �1 /1 ' I �h Inspection Requests (24 Hrs.): (503) 639 -4175 J __ . INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 74 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503- 590 - 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590 -0805 • Inspection Request Scheduled For: Date: 4/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 235 Shear walls/anthers 046712-04 503-720-0012 N Corrections /Comments / Instructions: Dui -ie. rev614- 1 /j - v / /Gd 6.) /MSO /LJ/; - /e.- - 5-6 / 1 -a • ❑ PASS ❑ PARTIAL APPROVAL n CANCEL I I NO ACCESS AIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED • Inspector: Date: ¢ L9 --a7 Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 4µ4„r j 1 I � Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/10/2007 TIME: 7:00AM PAGE: 29 SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 590 - 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503.590 -0805 Inspection Request Scheduled For: Date: 4/10/2007 Pour Time: 11:00 Code # Inspection Description Confirm # Contact # Message 210 Foundation walls 046260-02 503-720 -0012 N Corrections /Comments/ Instructions: -44 -5 L c /96-G/za -c t wrti Coo. -Pr 1 — — 07 l 'L • SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: #' - -7 Phone #: (503) 718 - ? -4�4'- CITY OF TIGARD BUILDING DIVISION PERMIT #: Pr9S`I2006- 002ri3 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/3/2007 Phone: (503) 639 -4171 /! v'+ "NPR i lil Inspection Requests (24 Hrs.): (503) 639 -4175 _.: INSPECTION WORKSHEET FOR DATE: 4/10/2007 TIME: 7:00AM PAGE: 31 SITE ADDRESS: 11104 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR 0 CONSTRUCTION CO, PHONE #: 503- 590 -0805 CONTRACTOR: FOUR 0 CONSTRUCTION PHONE #: 503. 590.0805 Inspection Request Scheduled For: Date: 4/10/2007 Pour Time: 11:00 Code # Inspection Description Confirm # Contact # Message 205 Fooling 046260-01 503 - 7200012 N Corrections/Comments/Instructions: /� 1 / E «u SO.: G?7vti 6, ,3 C 1i C;71,-) ' - 1 - 10 a 7 C ,sr3 AA / 173 PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ` — /O— 0 7 Phone #: (503) 718- 2:9-45— CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2007 , Phone: (503) 639 -4171 Id� Inspection Requests (24 Hrs.): (503) 639 -4175 a. `, INSPECTION WORKSHEET FOR DATE: 1/29/2007 TIME: 7 :05AM PAGE: 4 SITE ADDRESS: 1 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0605 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 -590 -0805 • Inspection Request Scheduled For: Date: 1/29/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 225 Post/beam structural 042656-01 503-720-7445 N Corrections /Comments/ Instructions: AI111 111 , r ,... PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS n FAIL ❑ CALL FOR IN •PECTION n ADDITI NA FEES ASSESSED Inspector: diffif Date: ( 6 Phone #: (503) 71 z CITY OF TIGARD BUILDING DIVISION - PERMIT #: IViST2006 -00253 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /13/2007 Phone: (503) 639 -4171 kn �.. � Inspection Requests (24 Hrs.): (503) 639 -4175 ' 1_.. INSPECTION WORKSHEET FOR DATE: 1/29/2007 TIME: 7 :05AM PAGE: 3 SITE ADDRESS: 11114 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: SF • OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503 - 590.0805 Inspection Request Scheduled For: Date: 1/29f2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 605 Post/beam mechanical 042656 -02 503- 720 -7445 N Corrections /Comments /Instructions: r .. . , ..: , .//111111 I I All \ laWifillir=111Ki `-- , .../ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL CALL FOR IN ECTION ❑ ADDITI • AL FEES ASSESSED 1 Inspector: allo Date: C A Phone #: (503) 718 - ticl. CITY OF TIGARD m { BUILDING DIVISION PERMIT #: 00 _ d 4 ,2 . 53 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 � i A Inspection Requests (24 Hrs.): (503) 639 -4175 =__� INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / / 1 8 Y CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: . CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: /- E*- O 7 Pour Time: / , 0 0 Code # Inspection Description Confirm # Contact # es e N d a id tb- 7 Corrections/Comments! Instructions: ©% 9(001 O C iI 007- C r r " ,s, -- W. . 1. 7 s -4. - / , . gal _'w i . U : [ - - : (6 .r c.... s PASS n PARTIAL APPROVAL ❑ CANCEL fI NO ACCESS ❑ FAIL II CALL FOR INSPECTION ❑ ADDIT,I•N' FEES ASSESSED Inspector: , // Date: �r Ph #: 503 718 - p )