Permit 4 4 .t
IT' .
4 11/1 CITY ®F TIGARD MASTER PERMIT
PERMIT #: MST2003 -00004
,L a DEVELOPMENT SERVICES DATE ISSUED: 3/5/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 13691 SW LEAH TERR PARCEL: 2S109BA -09200
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 018 JURISDICTION: TIG
REMARKS: New SF detached, PAth 1.
BUILDING
REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 33 FIRST: 1,518 sf BASEMENT: sf LEFT: 20 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,655 sf GARAGE: 612 sf FRONT: 17 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: 908 sf RIGHT: 5
VALUE: 394,080.80
OCCUPANCY GRP: R3 BORM: 4 BATH: 3 TOTAL: 4,081 sf REAR: 12
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: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5
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: 8 201 - 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: $ 8,479.14
This permit is subject to the regulations contained in the
HEIGHTS CONSTRUCTION HEIGHTS CONSTRUCTION LLC Tigard Muhicipal Code, State of OR. Specialty Codes and
PO BOX 91249 PO BOX 91249 all other applicable laws. All work will be done in
PORTLAND, OR 97291 PORTLAND, OR 97291 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: 503 291 - 2550 Phone: 503 291 - 2550 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 133745 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Post/Beam Mechanical Electrical Rough In Gas Line Insp Water Service Insp Building Final
Sewer Inspection Crawl Drain /Backwater Framing Insp Gas Fireplace Appr /Sdwlk Insp
Footing Insp Mechanical Insp Shear Wall lnsp • Insulation lnsp Electrical Final
Foundation Insp Plumb Top Out Exterior Sheathing Insr Rain drain Insp Mechanical Final
Post/Beam Structural \ectrical Service Low Voltage Water Line Insp Plumb Final Ar_
Iss �4 1 �' u Permittee Signature : ,� .�L .
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
old. I - 3 - ez9 e S d r.
%Q -dig -03 rfal r • a. _ c°
Building Permit Application j ` ' Y - _
A Date received: I 'f (p Permit no ,s�3 -,yetro L
City of Tigard . Project/appl.no.: Expire date: W
Ciry Address: 13125 SW Hall Blvd, Tigard, OR 972
Phone: (503) 639 - 4171 \ Date issued: By: 1 Receipt no.:
Fax: (503) 598 - 1960 ` Case file no.: Payment type:
Land use approval: VA R a ✓ J,100 t -•.5 l &2 family: Simple Complex:
rti ' r '. , 3 r d y } }x rt " z -hl, ` 7 - 4: !- - 4 i ,
�.� -� . , �, z ' S � � � TYPE .�: ' � r
�',` r �: Y"�. _ . . .T � �" .� - '4 •,.t! ,'�-, ... r �,% ,. � } at
lia(1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement, ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
?{ D y t k, -, a .; p :e,, a�" : • < ;. ,.fi JOB SITE INFORMATIOI't .! `fifg - ry .? -,-,'-'.....7.., . -, EU r ,{ ti ' " , : ::
Job address: \ 7 7 (A% S90 1,04>+I -4- - tl %( .- Bldg. no.: Suite no.:
Lot: \ eb i Block: ,Subdivision: p1,, oaV }S\u,.. I Tax map /tax lot/account no.:
Project name: 134.91 k.%,„„‘,.., '
Description and location of work on premises/special conditions: Nom.. 'S1 1•14X.5.- d L>( g:54.4 l'lJ(�
-----\
<<` . l 1 . '3} 4 u K« OWNER,,tii Y , f ' .' ry f : ". ;: * FOR1SPEC1AVINFORMATION, LSETCIIECh1ISTT ,.
Name: -, -,;= . -:, (., ( I`loodplatn Sept ccapacity solar,ete :)
Mailing address: 'F,p, tom. 0' i 2.41 1 & 2 family dwelling: ��y -,,r
City: ?p�.�∎,s�'1-3O I State:6 g, I ZIP: °111. 1 . Valuation of work $ `"' �v
Phone: 3 - 2`1 \ 'Fax: 011 - /ll I IE -mail: No. of bedrooms/baths Z
Owner's representative: -(e,�v � w5c,+ Cj j Total number of floors fr
Phone: 50'y ?Rog - AS 73 Fax: 46 E -mail: SuirIKT o'(t - fe. ' We dwelling area (sq. ft.) 2 4 1 4r2.
F'h i APPLICANT ff ` s_ ; ..'„.,'-''-::-- -- -'2'4-' ` Garage/carport area (sq: ft.)
(A I--
(
Name: >?As'(¢1CJL *&.„kkrell'C( Covered porch area (sq. ft.) 4 ,
Mailing address: St 2 P `,4 ( MR4-ts yc +Q 5T. Deck area (sq. ft.)
City: eoV(t •ti4- V, I Stateo g,, I ZIP: � a1 Other structure area (sq. ft.) d
Phone :1(./ ; 4573 Fax: 2 4(_3 - E-mail: r Commercial/ , . i rial/multi- family:
� � a '1.q....... �� CONTRA , �• '� � u 4
;; Valuation of work $
' ` , ,.. ., .. CONTRACTOR Existing bldg. area (sq. ft.) .
_ Business name: {A• ,W'(S col Csu0t'71®iJ New bldg. area (sq. ft.)
Address: 'gyp qp Gj1 Ll Number of stories
City: ?opfki=o19 I State:pQ. I ZIP: q?2M I . T of construction.
Phone: LD I - ''l,5$p I FA:�2�11 %1 l il
' E-ma: Occupancy grow �° ,
� ' �` Existing:
CCB no.: 1 -s ?G j pd, 01Q .D ► - 0 '� New:
City/metro 1ic. no.: ;, , Notice: All contractors and subcontractors are required to be g
~ARCIIITECT/DFSIGNER ' , T „ � , ; licensed with the Oregon Construction Contractors Board under
Name: ,(•t.:
,p LV(V,tG �( ±V^ t' : . a provisions of ORS 701 and may be required to be licensed in the
.
jurisdiction where work is being performed. If the applicant is
Address: 5 1 Z(/ 5%,(.1 MP�f1 -t 4E, t. 1 exempt from licensing, the following reason applies:
City 1 I t"Cl.3p !State 1 :p�. I ZIP: q7 Lla .
Contact person ''ip,a Plan no
Phone: s, , 7 5 Fax:/A( E-mail :
r
ENGINEER'
Name: ,,, , Etta Contact person: ,,, , 't, Fees due upon application $
Address: 5pp VI tie-Ala61v 3 Date received:
City: VAl5 l oo h -d-- I State:1 4 p ZIP: GI/5( Amount received $
Phone: 3i p ...VI I 46 3 !Y>t Fax: 144 - 4') 1 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 provision • of laws and ordinances governing this ❑ visa • ❑ MasterCard
work-will- be-complied -w) , r ified- herein - or-not._ wit card number. / /
Expires
,Authorized signature: ' / i Date: 1 t 7 (oS Name of cardholder as shown on credit card
Print name: tf s
C ardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 (6/00/COM)
. ,.a. • Building Fixtures
'� Plumbing Permit Application r 4 i (FF1CL _ 1.1S O Y
Date received: Permit 'i.e.( , a) -am
City of Tigard
t,,.lij {' `'J b Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
' # '� r k 'FMS 3
. _,. , � _� T�.TE QF PERAZIT � . , -. - ...
X I I & 2 family dwelling or accessory 0 Commerciallindustrial 0 Multi- family 0 Tenant improvement
fil New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
Y t t .QBSITEINFORMAflON . =t, -4 FEE SCHEDULE(forspec>- mformah onusec ec kl><st)
_ \ \�i.t
Job address: s FEZ. Description Qty. Fee(ea.) Total
Bldg. no.: ' Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: viz, 'Block: I Subdivision: SFR (2) bath
Project name: 'u 19 0\1_, %v.,, SFR (3) bath / •
City /county: 6,4 -(--/ 6 . - (tAA,Fi t.f I ZIP: 9 1 ?27- er Each additional bath/kitchen
Description and location of work on premises: 1JV_ 1J Sl•(2— Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain •
_, _ ` - �PI.UMBING, .cisitRACTOR Footing drain (no. lin. ft.) —I
" ` " Manufactured home utilities
Business name: 5t M3 . ?1,-0 k _ Manholes
Address: ?p e, '$ 1ltp State Rain drain connector
City: �t :0(L ZIP: ' p 1 Sanitary sewer (no. lin. ft.)
Phone: (p 4 - 401 4 I Fax :MZ. qp; L I E -mail: Storm sewer (no. lin. ft.)
CCB no.: 71 S( I Plumb. bus. reg. no: 3Q _ `s ore Water service (no. lin. ft.) _--.I
City /metro lie. no.: ("coo 1 t p R S Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer .
•
Print name: , ' Date: Backwater valve
-'- CONTACT p -E . 4 `,.x ; Basins /lavatory
Name: I A AC -- "*.A.\-1...111"1 Clothes washer
Address: Dishwasher
�{ LC1 SW �PdZ tO�.e� S l Drinking fountain(s)
City: ?'0(1,'(1,1z,A 0 I State:Oit. I ZIP: 9-11-‘1 �� ‘ Ejectorslsump
Phone: 1(e8 ' 57. Fax :a4L - � ) E -mail: " ,ir
4 c -. _. Expansion tank
3 f Y `. ,,, OWNER _ s & L i , Y r Fixture /sewer cap
Name tint . �.jl l tl ; „m' Floor drains /floor sinks/hub
(print) ��`�`�'�''
Garbage 'disposal
Mailing address: ft, 6 p 9) IA Hose bibb
City: 1 . I- Staie:pfl_ I ZIP: 977°1 I Ice maker
Phone: 7,611 • /S50 I Fax:7M 1- '111 I E -mail: Interceptor /grease trap
Owner installation/residential, maintenance only''Tli'e actual installation Primer(s)
will be made b me or The m and repair made by my 'regular Roof drain (commercial)
employee'on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name:
Water closet
Address: Water heater
City: I State: ZIP: Other:
Phone: Fax: ' E -mail: Total I
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit appli cation o $
❑Visa ❑ MastczCard __ expires_ if_a_permiLis_not_obtained_Plan review (at c /o)
Credit card number. / / within 180 days after it has been State surchar (8 /o) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount 440 -4616 (6/00/COM)
CI
ElectricalPermitApplication ._.._.__ - _-
Date received: Permit no •. , , 3 Uri
a::. 1 , A ,,, ..
! i . J - � City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW IIall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
,t if: i ,< t TYPEOF PERMIT , ; : x =
•
jek 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
Di( New construction 0 Addition/alteration /replacement 0 Other. 0 Partial
-- '1 . :7 s , _ ,.' ::: -: , ' ft JOB SITEIN -'� :,1 - : - ..... -,-, :Z . s 7
Job address: ,, • - Vc >.L...r. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ; . Block: Subdivision: .:.IL, I,t.t .
Project name: tp. it. \- i V- Description and location of work on premises: 1 - J3 5F17._
Estimated date of completion/inspection:
z. CONTRACTOR�APPLI'CATION ^ 0.1 w, _� " .. x FEE SCHEDULE 4 - w
Job no: Fee Max
Business name: "D.A.. 'S_ Description Qty. (ea.) Total no. insp
;-� �'' �' New residential -single or multi- family per
Address: t'Q L.; 7 \ dwelling unit. lncludes attached garage.
latga State ZIP: 11173 . Serviceincluded
Phone: • i -6 t 4'4' =MEM E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof __
CCB no.: Z (' QcJ\ Elec. bus. lic. no: 'sa - \ G Limited energy, residential ___ 2
City /metro lic. no.: Limited energy, non-residentilsi __ 2
IX • _ Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 111111 2
Sup. elect. name (print): cly.hittr0 A , gf�(Lo . License no:1,S7/ ° Services or feeders— installation,
alteration or relocation:
PROPERTY OWNER <; z , reif'n'46 ° . 200 amps or less 2
Name (print): _, _ , 1"1 • 201 amps to 400 amps ___ 2
401 amps to 600 amps __ 2
Mailing address: '.0. 1 ,,, 9 - A - 601 amps to 1000 amps MEN 2
City: ,,,' -11,..Z:.0.0 State oft. ZIP: 477 " , Over 1000 amps or volts ___ 2
Phone: L°I I - ZS a Fax: Z,°j ) - 01) 7 E -mail: Reconnect only ___ 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according, to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. • f ; b � v , � ,` ` '- 200 amps or Tess 2
'' . 201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps _IIIIIIIIIIIIII 2
,, , , ti ; r�r Branch circuits - new alteration,
_ EN .... :
a� - or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: s , s d, s ;, ,. ' o q* service or feeder fee, each branch circuit 2
City: i- State: ' ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ■■ 2
Phone: Fax: E -mail: Each additional branch circuit: __
• _- . " PLAN;'REVIEW (Please check all`Iliat apply) - Misc. (Service or feeder not included):
❑ Service Service 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle ■■ 2
O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each signor outline lighting ___ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* ■ 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa 0 MasterCard expires if a permiris norobtained —Plan- review -(at _ %)_$_____
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6i00/COM)
s. .
MechanicaalPermitApplication . ,
f ;
Date received: Permit n9 an 3 i r
City of Tigard
.,1. - 1 - .. i !. ty Project/appl. no.: Expire date:
C Tigard Address 13125 SW H Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
t, z ': -s ; , a TI PE OF M
PERIT
� Eta , . : .:�r� � s ; ;;. s . 4� .0
A 1 & 2 family dwelling or accessory D Commercial/industrial 0, Multi- family 0 Tenant, improvement
0 New construction D Addition/alteration /replacement D Other.
` s =- e? 5 =JOB` SITE;INFORMAl ION = F' to �* , , g E -.; _ COMMERCIA VAL
� ATION SCIIEDULE ; ,
Job address: 4 ( �c TOttivb.eg. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: Block: Subdivision: *See checklist for important application information and
Project name: DIN to . • L kl.ti jurisdiction's fee schedule for residential permit fee.
City /county: „� - • , ZIP: 10 ,7, • ;:` I & 2 FAMILY DWELLING PERMIT FEE;SCHEDULE .c '
Description and location of work on remises: AND COMMERICALIINDUSTRIAL EQUIPMENTSCIEDULE
1.) 5f--V— MI Fee(ea.) Total
Est. date of completion/inspection: M1 Description Res. only Res. only
Tenant improvement or change of use: VAC: ■--
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
Is existing space insulated? 0 Yes ❑ No F A t .
Alteration of existing HVAC system R
IYIFCIIANICAI: CONTRACTOR , : ,-,, Boiler /compressors
Business name: AI �' IJr_" 4 i State boiler permit no.: , _______ ■
HP Tons BTU /H
Address: 2, r .71k Fire/smoke dampers/ductsmoke detectors -
City: fon, i„p}.J10 ECM' r ZIP: 9/Z3o Heatpump(siteplanrequired) 11111
Phone: `, I , i Fax: -4134 E - mail: Install/replace furnac •urner BT ■ --
3 S . ; Including ductwork/vent liner D Yes CI No
CCB no.: InstalUreplace/relocate heaters - suspended, ■ --
City/metro lie. no.: wall, or floor mounted
Name (please print): p AS it 64 Vent for al , liance other than furnace — _—
Absriger u ts BTU1H ■ --
x , ;' .;, - ,', CONTACT' PERSON �:: `` Absorption units
Name: ' Ar'(( ,, j ( Chillers HP
Address: 1 SL) fjo.(LA ?' Com•ressors HP —
viromnental exhaust and ventilation: ■ --
immirri� t �• State:6n,. ZIP: ' • Appliance vent
ent
Phone: , r . , '' • 3 A`lM' ; � *M Dryer exhaust —
", "OWNER., Hoods, Type 1/res.kitch- azmat ■ __
dfiresuppression - __
Name: � q ; r /*�i�4(1fjN�Lt�)p }� ° '..' ' ry ; Exhaust with aust fan with singngle e duct duct (bath fans)
Mailing address: P S. om, - "41 . - gust . stem a' art from heatin : or AC M.
' i _� State: of. ,ZIP: •-' 1411 e piping and .but on (up to 4 outlets ■ --
Type: LPG NG Oil
Phone: I -V E - mail: Fuel .t. Ong each additiona over 4outlets I
• °<ENGINIh LR room ' roc , p . : (schematic required) MN Name: , V ' _ t . ,... Number of outlets
in _ I., - ap r . ce or eq = = pleat: ■ -
Address: Decorative fireplace
City: State: ZIP: Insert -t i IIIII --
Phone: E�i� E -mail: 'jo toy pellet
signature: a,��ii- Date: f Wi� th ,. MN
Name (print): . 6/ ► I A 1M
Not all jurisdictions accept credit cards, please can Jurisdiction for more information. Permit fee $
0 Visa ❑ MasterCard Notice: This permit application Minimum fee $
ex a permit notobtained
Credit card number: / / Plan review (at r %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shave on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount
4404617 (M)WCOM)
CITY OF TIGARD
13125 S.W. HALL BLVD. T l �J33
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE e p
DAVID JEROME ELECTRIC RECEIVED
PO BOX 751
HILLSBORO, OR 97123 MAR 0 7 2003
CITY OF TIGARD
BUILDING DIVISION
Electrical Signature Form
Permit #: MST2003 -00004
Date Issued: 3/5/03
Parcel: 2S109BA -09200
Site Address: 13691 SW LEAH TERR
Subdivision: DAFFODIL HILL
Block: Lot: 018
Jurisdiction: TIG
Zoning: R -7
Remarks: New SF detached, PAth 1.
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:
HEIGHTS CONSTRUCTION DAVID JEROME ELECTRIC
PO BOX 91249 PO BOX 751
PORTLAND, OR 97291 HILLSBORO, OR 97123
Phone #: 503 - 291 - 2550 Phone #: 648 -5144
Reg #: iIC 36051
SUP 2877S
ELE 34 -119C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising Electrician
f__ y_ ou _hav_e_an_y_questions,please call 503.718.2433.
•
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A .. Do hereb r * qi e cfollowing location
® meets C� of"1Ti�a /Tash on ^ County 0.
® land use and development standards for street tree installation. •
_
ADDRESS: (3 97 3- G✓. _ E!i-/ 7e(/2-eoic<_ _ - _ _ _
oi.
__
/6 0:-
• LOT: SUBDIVISION: / ) ( c , /90
A - � / DA`C'E: _�":v
I .- ,, --
41 RECEIVED BY: .� e----7 0-
�, DATE: 3 1 ..
— Y f i
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CITY OF TIGARD 24 -Hour
BUILDING Inspection/Line: (503) 639 -4175 �� 3 , Opo 6
INSPECTION DIVISION Business'tne: (503) 639 -4171 s
�i BUP
Received Date Requested 7//1 g AM PM BUP
Location Suite MEC
•
Contact Person Ph ( ) 7,G 9 / 7 55 PLM
Contractor Ph ( ) SWR
B DI Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain [acs - � p vag.w ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear `PL UM p i F L _
Framing �J-4 DAL i4
Drywall on
Drywall Nailing r -F-
Firewall ST1Z --'" G- C� l� ��o
Fire Sprinkler
Fire Alarm 2AJSLJ D IM 0
Susp'd Ceiling 4 �'
Roof
Oth-r:
*ASS PART a `� ,., p
PLUMBING `� Y` t O 'K. - e - An� OF' t � -{ 7 - t
Post &
Under Slabm JL �R/ Q� — — 11. - 6_r• f►
Rough -In !/
Water Service
1 S 72-�
Sanitary Sewer
•
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS P RT FAIL
CHAN AL
• :eam •
Rough -In
Gas Line
•
Sms, e Dampers
ItO PART FAIL
ELECTRIC AL
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 fl Please call for reinspection RE: / Q Unable to inspect - no access
- Fire - Supply Line
Date r ate �`� I nspector _ Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 006 C�
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
. Received 5 1 ( Date Requested / ' AM PM BUP
.Location / 2 (r7 ) 4- / . 11/t— Suite ' / MEC
Contact Person Ph ( ),V a l 17.9 Y PLM
Co tractor Ph ( ) SWR
= UILDING - Tenant/Owner ELC
-•oting ELC
-. undation" Access:
-, g Drain ELR
i Drain
Sal) Inspection Notes: SIT
Pn'st & Be
S i ear An ors
E • Shea /Shear
Int', hea Shear
Fra in
Ins at' n
• D I Nailing
Fire ',,:II
Fire m•rinkler
Fir- Al rm
Su
Roof
ither:
, ' na
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
4`►i> T
j P FAIL
'7 AN ' AL
Po-, & B=: m
Rou.`.
Gas
SI • e Dam'•.-
'ASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
• Volta: -
UM arm
Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ' Z
Approach /Sidewalk Date 4 Inspector N C fExt
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY. OF TIGARD 24 -Hour
BUILDING 1p Inspection Line: (503) 639 -4175 MST 3 - "� °ooW
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location 9 3 Cc, .9/ T.PJVt- Suite MEC
Contact. Person Ph ( ) 4; 9- / 7 4' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
•
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear it .� !!+
Framing t
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Ceiling
Roof •
`
AS PART FAIL
MBING �� � �
Post & Beam r Nor
- 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
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 El Please call for reinspection RE: Unable to inspect – no access
— Fire Supply Line - I
ADA
Date
Approach /Sidewalk O Inspecto _
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL