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Permit , t ;, CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00008 DEVELOPMENT SERVICES DATE ISSUED: 3/4/03 -`' - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11490 SW GALLO AVE PARCEL: 1 S134DC -11400 SUBDIVISION: CASCADIAN PLACE ZONING: R -4.5 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: Const. new SF detached residence. BUILDING REISSUE: STORIES. 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,317 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,433 sf GARAGE: 528 sf FRONT: 22 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5 VALUE' 269,946 00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,750 sf REAR: 57 PLUMBING SINKS: 1 WATER CLOSETS. 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 0 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES. 1 SF RAIN DRAINS: 1 CATCH BASINS. TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES' MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K• 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP' btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 • 200 amp: 0 - 200 amp' W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp. 201 - 400 amp: 1st W/O SVC /F DR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL /PANEL: IN PLANT' MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL. 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL• GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,497.48 This permit is subject to the regulations contained in the KEYSTONE DEVEOPMENT INC. KEYSTONE DEVELOPMENT Tigard Municipal Code, State of OR Specialty Codes and PO BOX 476 PO BOX 476 all other applicable laws. All work will be done in LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Phone: 503 635 - 4736 Phone: 503 635 - 4736 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080 You Reg #: LIC 71135 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain lnsp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Plumb Final Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Service Insp Building Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Appr /Sdwlk Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electrical Fina1 4-- Issued By : C /_I _i.__� p (__ Permittee Signature : i Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the b siness day = a • ).6 -r M Building Permit Ap li ' �n �v Date received: 7 -- Perrnit;no .I - r ©pe�Q� , .1 � City of Tigard R " Address: 13125 SW Hall Blvd, Ti d, Project/appl. no.: -Expire date:, City of Tigard �� � i , Phone: (503) 639 -4171 I JR Date issued: By t4 Receipt no.: 0 Fax: (503) 598-1 960 TIGARD Case file no.: Payment type:. z GITY OF Land use approval: BUILDING DIV ISIO N 1 &2 family: Simple Complex: , ;: , ' , .. ... TYPE OF PER1\'IIT , a : >. � :, .„ .. r • • LT 1•& 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family P ew construction ❑ Demolition 7 - -- 0 Addition/alteration / replacement ❑Tenant improvement ❑Fire sprinkler /alarm ❑ Other: ,.,.; . ., r.. • . JO RSITEINFORMATION{ ' " -- r t Job address: / 4i9 d 5 \J l• 1.1,0 � . Bldg. no.: Suite no.: Lot: ock: Subdivision: A • ti b . A 1 Tax map /tax lot/account no.: at /06 Project name: l _ Description and location of work on premises/special conditions: IJFW SV12- c � _ : - " OWNER, ' '. ' .. FOR SPECIAL INFORMATION, USE CHECKLIST Name: - b l - O ('. I (\t C , : ' (Floodplain,`septiccapaeity, solar, etc ) Mailing address: PO ('erf.. l lf, 1 & 2 family dwelling: City: K E GS,.,) l-&O State: O'-: ZIP: tip (�/� � � �'� g Valuation of work $ Phone: (o3 5 - 113(r . (Fax: bag -114 1 1E-mail: No. of bedrooms/baths 1 Owner's representative: JAMe-S. F(,1 -- Total number of floors Phone: SNOW.. . Fax:" ' • -. E- mail: New dwelling area (sq. ft.) O APPLICANT Garage/carport area (sq. ft.) 2 Name: 4A OE-- ." Covered porch area (sq. ft.) l' Mailing address: Deck area (sq. ft.) City: - I State: : • . ( ZIP: ; : -Other structure area (sq. ft.) • Phone: . Fax:,: E- mail:;' .. , . . a Commercial/industriallmulti- family: \ CONTRACTOR Valuation of work $ Business name: 'Existing bldg. area (sq. ft.) Address: New bldg. area (sq. ft.) ` City: I State: , : I ZIP: - - Number of stories" Phone: • I Fax: (E -mail: Type of construction Occupancy group(s): Existing: CCB no.: —1i15* .. . , —� New: City /metro lie. no.: Notice: All contractors and subcontractors are required to be ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Name: • OASGO 4, z provisions of ORS 701 and may be required to be licensed in the Address: 1( 0 OW (,Ei1 j' jurisdiction where work is being performed. If the applicant is City: Poi IState: of ZIP: " 4'')2-ae exempt from licensing, the following reason applies: Contact person: Plan no.: 2231 1.11 , Phone: 2.9 5 - q 16 l Fax: 225 -01$3 E -mail: ENGINEER Name: F--pW .1. Contact person: Fees due upon application $ Address: 4-5 9 - (624-4 Date received: City: 190 1 2 -11- , la't`er (State: p . (ZIP: 1,121,(, Amount received $ Phone: 9.0 14- - 6 - (Fax: 2 -- 6 , 7( 2 1I E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of w and ordinances governing this U Visa ❑ MasterCard work will be complied wi whethi, s I , ed herein or not. Credit card number. _ Expires . `' Authorized signature: /.� �1� ature: ; ,k, . . '; . Date: 1 l /1 tom' - � � Name of cardholder as shown on credit card Print name: - M@S tbhA - . , „ ., • - $ ( ;, . Cardholder signature Amount Notice: This permit application expi if a ^ permit is not obtained within 180 days after it has been accepted • as complete. _ ' 440- 4613 • 4 04/07/2003 11:59 5036254455 HILL ELECTRIC INC PAGE 03 ai, Electrical Permit Application Date received: Pamir noln$T 2403, OOdiO; : III. no.: it CiCity O >ignr *� 1 - Clry r•jTignrd Address: 13125 SW Hall Blvd Tigard, OR 97223 pate Issued; By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598•• 1960 Case file no.: Land use approval: f)'1'1: OP i i it�fl l' X I & 2 family dwelling or accessory L Commercial/industrial 0 Multi- family O Tenant improvement O New consuvction Cl Addition/alteration/replacement i Other: LI Partial J011 Sill I,N 1 ORM Job address: r i / i i►� ' Bid :- no .: Suite no.: Tax ma• tax lotlaceount no.: Lot: Block: Subdivision: / r Project name: Descri • ion and location of work on premises: ! Estimated date of completion/inspection: - (:UI\`IRA("bUR AI'1'1_ICAl ION 61•'!•: S('111;Dl ]ob no: MIR Tow i , Deec�ri • boa !►�' [ lFi7 w to id�dal - doge or molt -f mw per III Address: F.. "WIN ;r�i �� dwe111ngm1�lecMtd�alad■dg r+ege &mot included: E -mail. 1000 ft. or loss II Phone: / BBch addidorfal 500 • . ft or portion thereof 1111111_ - CCB no.: 1 '`, Elec. bus. lie. no: ilIMMIlli LimiuAl _ _ ,residential __ 2 ((retro lic. no.: Limited en- .y,non- residential =MEM 2 / t ∎ . . /„ _ 03 Each manufactured home or modular dwelling ■1 . � �u service and/or feeder e o su•� ,,,,���?'a -'fir • uircd Date raloce r �i &ant rtOU 9r edon deer l.tlon, •. 2 PROPEll;'1'1' OWNER 200 amps or leas �.. Ll1 1 201 am • s to 400 amps IIIIIIMMIIIEIIM 401 amps to 600 am • s __ES. 2 Mailing address: 601 • to 1000 amps 2 EMINIMIIIMMINEMII State: Over 1000 Imps or volts __=111 2 EXIIIIIIIIMM Phone: E -mail: Retonnectonl 111=M111111•11 I Owner installation: The installation is being made on property 1 own Temporary orfeeders �. . dlt� lea, alteration. or relocation: which is not intended for sale, lease, rent. or exchange according to or leas 2 200 amps ORS 447, 455, 479, 670. 701- 201 am, to 400 amps MOB Owner's si:nature: Date: 401 to 600 am • =111111... 2 - ........ .. a ( I NF -... mach cltculb new, alleratlbn, or exteahIoo per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 IllEglatZEMEEGI B. Sec for branch circuits without purchase of servitx or feeder fee, first branch circuit: � _ ■ __ III 2 Phone: E marl: E ach a branch arr i 1'LC\ It1.NIEIN (Ple:a.e check .ell that applyI M� • (S(Scrvlaralce eeorfeeder monotIncluded): 1.11.111 O Service over 225 empa•commetotai 0 Health -care facility Each • um • or ini • ation circle 2 O Service over 320 amps•ruing of 1 &2 O Hazardous location Each sign or outline li htin . =1r_ 2 family dwellings O Building over 10.000 square feet four or Signal circuit(e) or a limited energy panel. E■.IlIl O System over 600 volts nominal more residential uniu in one structure Alteration, or ax tension' O Building over three stories O Feeders, 400 amps or awns 'Desert • lion: O Occupant load over 99 persons O Manufactured structures or RY par1c O Egress/lightingplan O Other: 111•1111111111111= Submit sett of plane with any of the above, The above .re not applicable to temporary conatructtola seaMce. Other [rate call uriugction fa mo•e information• Notice: This it a lication Permit fee $ Not ell 1ur:d,edau accept credit canA■. c ) � P P Plan review (at _ 9b) $ O v115 O MasterCard expires if a permit is not obtained Credit cmd somber; _ [ / within 180 days after it has been State surcharge (8%) ..,, $ °a p" ° ' accepted as compacts. TOTAL $ - Name of esrdhoider as shon on credit turd Cardholder signature - Amount 440-4615 (6RWCOM) - ry ,, FOR.OF IC USE . �' ,, Mech a1 ical Permit Application Received Mechanical Date/By. Permit No.•? T .00j OO(7(d City of Tigard Planning Approval Building Date/By Permit No.: 13125 SW Hall Blvd. Plan Other Tigard, Oregon 97223 Date/By: t- A Permit No.. . � Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use �d�(M � I Contact Case No.. Internet: www.ci.tigard.or.us 0 ' '�I Contac Date/By t Juris Z See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 '4 ' Name/Method. Supplemental Information. "'< " ` PP OD✓IMERCI SCFIEDULE ';USE.CHECKLIS,T ,, },_; ;� �� �;"'` := � �'; TYI 'E�OFxWORIC`;.� °<:�'.:�.�.� <,�4 �., :,Q., ��:;_,- C I ew construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all k ",' ; ', ;, -I CATEGQRY it- ONS i 1; ;',i mechanical materials, equipment, labor, overhead and profit. & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family Z ' SIDENTIA VEQIIIPIVI ENT/SYSTEMSITEt;"SCAEDULEI Description I Qty I Fee(ea.) Total ❑ Master Builder ❑ Other: - - Heating/coolin " ` < = JOB: SI< TE =INFORT! ATtONarid I:OCATION; IL Furnace - add -on air conditioning ** f 14.00 tit-6/2.° tit-6/2.° Job site l l t+qo Svi 6(,1,D /'N Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work i 14.00 Pei" " Project Name: Hydronic hot water system 14.00 1 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 . 1 - \� Unit heaters (fuel, not electric) .�� v L 0 (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 1 10.00 /0.00 (1 L2 - Lot # : Repair units 12.15 Subdivision: C/�jClt N f" j� �J ' ' " ' " ''eOther Fuel:Appliances.' `'',; ",,.P:,, " Tax map /parcel #: i Water heater i 10.00 1.0 . . ��;r 4- `5' °'° 'MS CRIPTIOl!I ®F WORK �d; ,... ir:. 5 1-4 , Gas fireplace I 10.00 to N C,Lv S Flue vent (water heater /gas fireplace) L 10.00 2 „00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner /flue /vent 10.00 .#` lig 2 , ' OPERTY "OWNERS '4-`:.I K ' ` N"��.t Other: 10.00 :TENANT : :,.:. -;.F ';.�; "` Name: 'i S 17 e. \NIZ> `" :t.: , , -- "_'_. Enviironmeiiiif iwicsiwainkiioii __ � :',: Range hood/other kitchen equipment a 10.00 9,0, 00 Address: . i< 10 k9 Clothes dryer exhaust 1 10.00 to t po City /State /Zip: (P OS ele / Ol qi iji Single duct exhaust Phone: * bps- (-(i'? Fax: (bathrooms, toilet compartments, 5 " "." 'P..PLICANT: =$ : ',- =::_`� ° : :: ;` J3j CONTACTTPERSOi!T'�'i. li,$_ utility rooms) 6.80 ✓ Name: _ _Q- Attic /crawl space fans 10.00 Other: 10.00 Address: , __, •_ . FfuebPiping _ . _: r , , , City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. 1 ** Phone: Fax: Gas heat pump ** E -mail: Wall /suspended /unit_heater ** .: , ,, = : :e <. $ ;' fCONTRACTOR" :�.. . =r` g #.f, . , .3� = .� �r�r`..:. � ��`;: .4.�;.;•_ °,,:� - ":. F.�* Water heater / ** Business Name: "112 4'GddN ,A ,'.; ' C Fireplace ,1 ** c� ** Address: Range BBQ I ** City /State /Zip; , Clothes dryer (gas) ( ** Phone: Fax: Other: ** CCB Lic._ #: Total: 7 f3 `Me c hani calTe`imitTees* - Authorized ( Subtotal: $ /)('j , Q . Signature: /v ) 1 6 \--- Date: I I / b 3 Minimum Permit Fee $72.50 $ I i API f ( f 0 0 -ii, Plan Review Fee (25% of Permit Fee) $ 37 . D (Please print name) State Surcharge (8% of Permit Fee) $ 12 • 03 TOTAL PERMIT FEE $ ag ® e 03 Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it his been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 " 1\ Plumbing Permit Application FOR OFFICE USE ONLY R ece i ved Plumbing �/�,�, ' Date/By: Permit No.:Y r tsTTC)e3 -0000e Planning Approval Sewer City of 'Tigard Date/By Permit No.: 13125 SW Hall Blvd. Plan Review l Other Tigard, Oregon 97223 Date/By: f -9�/ > PermitNo.• i 4 , 4 , 114 Phone: 503- 639 -4171 Fax: 503 -598 -1960 f Post - Review [[[ Land Use g Internet: www.ci.tigard.or.us �' I :' Contact Juris.: Date/By Case No ® See Page 2 for � . p. � Contact 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. ;,,; t %7 ' T .. '. : :: FEE*; SCfiEDULE'( forispecial 'irifkiiiatioirue' scliOldist ` Ej N �,�; . , u E� .', , TXPE�, OF;:WORIC� � ' �' ' .; ~s' , .. � )y �' ew construction ❑ Demolition Description I Qty. I Fee(ea.) I Total Addi lacement El >_ ' .n,, New 1- 2 & =i_an1ily_ a wetlings' ❑ 1 -.T; ' "- Y= r ' (incliid for Tearutilit /;connectio n),;,, , ? -' RY. f OF CONSTRUCTION -'.•,;;: h' :,_ .-- �- . '" : 249.20 SFR (1) bath H & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350 00 ❑Accessory Building ❑ Multi- Family SFR (3) bath / 399.00 @O ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 s';';; r;' " "aJOB)SITE' INFO -�x " r `'` , ' Fire sprinkler - sq. ft.: Page 2 ��s = RMATIQ1V,an'i1I;OCATION" `��`�; -K: Job site address: 1144 6 Sty; G t--D :: �. :. i;x `' x.:' ".�� -.., A . - Sifei ititi A'::4" . - .. _, Bld /A t #: Catch basin/area drain 16.60 Suite #: g p Drywell /leach line /trench drain 16.60 Project Name: Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 -1.1 (A f' \C-P-- Manholes 16.60 'PJRO Dl..; 61) J Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 �C V11J 1V\ � Lot #: 2) Storm sewer (no. linear ft.) Page 2 Subdivision: U} Water service (no. linear ft.) Page 2 Tax map/parcel #: ., °" r£ ' s �.�� §" _, - -�'_� z,<..ttx a .�Fiz`ture�orIfem: � �� ;_ .� � ° �,. i<.:.,' '','1- tDESCRIPTION ° ' OF'WORK�a°;,�. , ;�, °1�' o 16.60 _ Absorption valve Nom%-' S Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ROPERTi OWNER' , i ii " ' ."'' - 3� - ; . Drinking fountain 16.60 ( - I TENANT'. ", ,:.: , s. _ Ejectors /sump 16.60 Name: KEii Si N e DeJ P. 1 NC_- Expansion tank 16.60 Address: f0 (' --Vi 6 Fixture /sewer cap 16.60 p t 1 Floor drain /floor sink/hub 16.60 City/State/Zip: �1.(j1•� OSW e t �"' ql 1 16.60 G arbage disposal Phone: (9 - S - 1-03 L Fax: Hose bib 16.60 AP =PLICANT` • �', lensT w CONTACT,:PERSON ` _ Ice maker 16.60 ^ Name: 5 Alm Q._ Interceptor /grease trap 16.60 Medical gas - value: $ Page 2 Address: Primer 16.60 City /State /Zip: • Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 `,, ?.. . s gli _ _ 7: ;4. Urinal 16.60 �';�CQN'I'RACTOR',' ..� � ��,.�.., .,, 16.60 Water closet Business Name: /\ SS 0 1� 1`^� \� Water heater 16.60 Address: . , ; , i , ' 1 rl p' , c Other: City /State /Zip: • ` .. ' ` -. ° , Y Other: Phone: ,. . Fax: , , ,.} ,. 4= ` Eluintiing�PermitiFees °„ , , ,, , . Subtotal $ 3 /ft," CCB Lie. #: . ' umb. Lie.j$: Minimum Permit Fee $72.50 $ Authorized . afe: .l )11 Residential Backflow Mtmmum Fee $36.25 Signature: % ' li °I) - Plan Review (25% of Permit Fee) $ f q, 7'S ( � l M, Pp - State Surcharge (8% of Permit Fee) $ 31 • q7 (Please print name) TOTAL PERMIT FEE $ 5 67 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. - *Fee methodology set by Tri- County Building Industry Service Board. is \Dsts\Permit Forms\P1mPermitApp.doc 01/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ASSOCIATED PLUMBING CO P O BOX 301362 PORTLAND, OR 97230 Plumbing Signature Form • Permit #: MST2003 -00008 Date Issued: 3/4/03 Parcel: 1 S134DC -11400 Site Address: 11490 SW GALLO AVE Subdivision: CASCADIAN PLACE Block: Lot: 003 Jurisdiction: TIG Zoning: R Remarks: Const. new SF detached residence. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: KEYSTONE DEVEOPMENT INC. ASSOCIATED PLUMBING CO PO BOX 476 P 0 BOX 301362 LAKE OSWEGO, OR 97034 PORTLAND, OR 97230 Phone #: 503 - 635 -4736 Phone #: 331 -0582 Reg #: MET 00001881 LIC 57890 PLM 26 -412PB AN INK SIGNATURE IS REQUIRED ON THIS FORM cam- k, /✓ .. Signature of Authorized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RANDALL HILL ELECTRIC INC 14819 SW BELL RD SHERWOOD, OR 97140 Electrical Signature Form Permit #: MST2003 -00008 Date Issued: 3/4/03 Parcel: 1 S134DC -11400 Site Address: 11490 SW GALLO AVE Subdivision: CASCADIAN PLACE Block: Lot: 003 Jurisdiction: TIG Zoning: R -4.5 Remarks: Const. new SF detached residence. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: KEYSTONE DEVEOPMENT INC. RANDALL HILL ELECTRIC INC PO BOX 476 14819 SW BELL RD LAKE OSWEGO, OR 97034 SHERWOOD, OR 97140 Phone #: 503 - 635 -4736 Phone #: 625 -5606 Reg #: LIC 56501 SUP 3051S ELE 3 -257C AN INK SIGNATURE IS REQUIRED ON THIS FORM X Cdt Signature of Supervi ing Electrician If you have any questions, please call 503.718.2433. �r 4/ TREE CE EET R ST R TIFICATION .. .. 1 I, .4 M E5 PO , Owner /Agent for ke.*STOrI e Off' P. G . 0. (PLEASE PRINT) (PERMIT HOLDER) f RECEIVED RE 0. .3 p 8 2003 Do hereby f y that, the f location AU G , l o meets City of T igard /Wash ngton M County G% OF TIGARD BUILDING DIVISION land use and development standards for street tree installation. I 0 W CAA LL O \I F ADDRESS: I I �� ,� LOT: SUBDIVISION: g5G Ate tA1-1 PLAC BY: �i ',��n, ✓ /` DATE: g I�� I RECEIV D BY: G ,_e.■ 4 ' I : 0 -4 1 4 /-I . DATE: O A. r - CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 3 : oo o.y' INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received ` q Date Requested F-E AM PM BUP Location Suite / MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing / 7Q Insulation A !' 4) � 4c Drywall Nailing �"� Firewall Fire Sprinkler Fire Alarm .1,-/)-',/,‘Ls' 1,-/) MCM Susp'd Ceiling Roof Other: Q� r.f/A ( CZA PART FAIL PLUMBING Post & Beam Wider Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL ° . Post & Beam Rough -In Gas Line Smo - Dampers PART FAIL ELECTRICAL - Service • Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection �:;s: (503) 639 -4175 O INSPECTION DIVISION Business Line: 5 03 639 -4171 MST > r l» d o BUP Received Date Requested - 7-a,3 AM PM BUP Location 1/ 7 M d e Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: 3 4 7 Ftg Drain L ` �2 n -77— � ELR Crawl Drain /c�(J Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation • Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL / PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL G ` / V ELECTRICAL /� ,I G L 3 Service Rough -In \ UG�I Fire Alarm mal El Reinspection fee of $ required before next inspection. -Pay at City Hall, 13125 SW Hall Blvd. ART FAIL SITE Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA -y Approach/Sidewalk Date 7 2 3- - �'.� Inspecto Ext Other: Final DO NOT REMOVE this inspection record rom the ob site. PASS PART FAIL l CITY OF TIGARD 24 -Hour BUILDING Inspection Liner (504639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested I � /�"� AM PM BUP Location ( 4t D 4 c r r a Suite MEC Contact Person Ph ( ) g6 3O PLM Contractor Ph ( ) a SWR ✓) BUILDING Tenant/ e k i Z T7 9 75 / Footing ELC Ft Foundaiation Access: 1404.174 04i<ei 4 /- - '! LR 9 Crawl Drain —�� Slab I•;- ,r,� ? T •.ection Notes: �-� t /� 7 o c 5/3 2 - Post & Beam /� / " Shear Anchors G / 7 7/" Ce Y r& Ext Sheath /Shear C� Int Sheath /Shear Framing Insulation i� /ez, zio + /I Drywall Nailing Firewall Fire Sprinkler Fire Alarm 0417-- J `' / i , ' A - TA - -2 Susp d Ceiling l j' ��/ `� Roof MIX Other: I 7 Final PASS PART FAIL _ PLUMBING 4 A'7f Pvs SSG © «tit �G Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS RT FAIL TR Service Rough -In UG/Slab Low Voltage Fire larm rhoi•It Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • S PART FAIL S _ 111 Please call for reinspection RE: ll E Unable to inspect — no access Fire Supply Line ADA lb / ' Approach /Sidewalk Date Inspecto s J � � Ext Other: r Final DO NOT REMOVE this inspection recor from he job site. PASS PART FAIL