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Permit CITY TIGARD MASTER PERMIT � DEVELOPMENT SERVICES PERMIT UED: 5/13/03 00141 DAT ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 13672 SW LEAH TERR PARCEL: 2S109BA -07900 SUBDIVISION: DAFFODIL HILL ZONING: R -7 BLOCK: LOT: 005 JURISDICTION: TIG REMARKS: New SF detached, Path 1. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 31 FIRST: 1,463 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,559 sf GARAGE: 627 sf FRONT: 15 PARKING SPACES : TYPE OF CONST: RETWL DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: '294,466.90 OCCUPANCY GRP: BDRM: 4 BATH: 4 TOTAL: 3,022 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 6 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: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F 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: $ 7,898.63 HEIGHTS CONSTRUCTION HEIGHTS CONSTRUCTION LLC This permit is subject to the regulations contained in the H Tigard Municipal Code, State of OR. Specialty Codes and PO BOX CONSTRUCTION PO BOX 91249 PORTLAND, OR 97291 PORTLAND, OR 97291 all other applicable laws. All work will be done i 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 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insj Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Roof Nailing Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Be. c ura ■ echanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Issu : d ■ By : ' - ! '� I _ �` � Lk � Permittee.Signature : )C r' ' .Jd Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day . . Building Permit Application : -., d , • Date/By: v Building A / 7 °3 Permit No.:I/5 T,100.5 -ao ii // City of Tigard zA p v , Datemy: Approval Other Permit No.: C= - 00/A0 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: AAAV 1 f - 9,g -o3 Permit No.: Phone: 503,6394171 Fax: 503-598-1960 ' 1it 7 A ‘,. Post 1 I cryt k.- Land Use Internet wwvv.ci.tigard.or.us I , at. t.W.,p1 , I- ,. Date/By: i 1 I b 3 . -,'... - Contact V q • c tjo's.. (0 See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: r 7L4k .i. --7 SuppleMental information ' E ::::" TY-ProrwoRw,: -:-:-.,:,::, .: ‘, REQUI ''.'''':''''' ''''' ' '''::; • ''' " . '.-- ' '' - ., :: l': ,'',',' • DATA:. S New construction 0 Demolition ,' ,- - . ---- • -4,v: :;•-).: 2,-7.:-.....= :.- , • ,- ... 0 Addition/alteration/replacement E] Other: RATEGORr OF CONSTRUCTION , .:::: - :1,.,-,T: A --: - - Note: Permit fees* are based on the total value of the work performed. Indicate lgj 1 & 2-Family dwelling 0 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. 0 Accessory Building P Multi-Family 0 Master Builder 0 Other: Valuation s 25o,o00 -:'• -::',. j0BISITIVINIFORMATIONiiiidiLOCATIONI, -, :LI; '', ::: . No of bedrooms _ ...4L No of baths:1 Job. site 15(012 i 1,6t0- "cP..420sc..4., Total number of floors 'S New dwelling area (sq. ft.) X) 0 Suite #. Bldg./Apt.#: Garage/carport area (sq. ft.) C•t? Project Name: P(4(-07 ‘1..... IA k L..1.-- Covered porch area (sq. ft.) 4' Cross street/Directions to job site: Deck area (sq. ft.) 0 Other structure area (sq. ft.) I - .,,,,,,,,,,: .,-....--1,::..-,--,m+.gi,4,,:bi,-.:, . :,---:-..,.,• /(-) 3 ,,, K,qp,,WDTA*Kik,;!.', i':.:' CALAff$:k:br#gb1WMIW Subdivision:DA PrODt (... 14 u-- Lot #: 6 Tax map/parcel #: .25Iogegl-o,)9c0 Note: Permit fees* are based on the total value of the work performed. Indicate : 'r DESCRIPTION OF WORK : ' ',..'',s. the value (rounded to the nearest dollar) of all equipment materials, labor, overhead and profit for the work indicated on this application. Valuation $ 7 Existing building area (sq. ft.) New building area (sq. ft.) Number of stories iTTI`Ft.00ERT:VOWNlEICW,M'fr, _ii';'` &ItEN Type of construction Name: \I ekNeseC5 c-c.)05 ( 0 13 Occupancy group(s): Existing: New: Addi s?..0. y: 4 1%2-4 11 1 City/State/Zip: ?..e..-ct,,p. , o ft, - Phone: 5 -7A1- 75 Fax: 5 -2-1 / - (At I NOTICE: All contractors and subcontractors are required to be ..., .„, licensed with the Oregon Construction Contractors Board under CONT CT. , _. N..5.,,,......,,.;:.,,.. provisions of ORS 701 and may be required to be licensed in the Business Name: 3u. . pe l■-) L. jurisdiction where work is being performed. If the applicant is exempt Contact Name: W.erRLui- ..5e.,44p,rrr from licensing, the following reason applies: Address: 512..c., tk..) t-A 51 r. City/State/Zip: foi..rbo, F'hone:G .7(4- 4.513 I Fax: 503 - ZAC e - 65`1 fi:17- 401 -WANOnR,MUREPEeIMMA ? E-mail: . . 'rRi'l '' e..J 14-141 : 5P JP e l s ? 1 . 557-4-94! '" n r' s ' C '""' F14* ' * ''''''' 444 ''' I 'l' e.:-el-il ' ::: ' 14- ' Business Name: Wsv., wrs c„,as oi.- Fees due upon application s Address: ?.c>. ,,,,c., y4° City/State/Zip: RAL.:1 c; ,7_. 9 VI( . Amount received $ Phone:5 .??.o . z9,,, f Fax: 2.a. - Z17 ( - e'll 7 Date received: CCB Lie. #: 1S 4.5 Authorized • — - Notice: This permit application expires If a permit is not obraiiii Signature: p Date: 180 days after it has been accepted as complete. IC , t4(/..v1 - rr *Fee methodology set by Tri-County Building Industry Service Board. _ (Please print name) ' i:\Dsts\Permit FOhns\BIdgPermitApp.doc 01/03 Building Fixtures Plumbing Permit Application OF ICE u ONLY Date received: 5/ 9 03 Permit no.: //D - - 00/7 • �t Ci of Ti and .� ) `, g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, T igard, 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: 5 x z r s.r r ,c A = ; ' TAPE O . ° «; I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑Tenant improvement New construction ❑ Addition /alteration/replacement ❑Food service ❑Other: '' ' ,' - JOB SITE INFORMATION = FEE "SCHEDULE (for;special'information use checklist) Job address: 3 Z sj 1, rµ. "(�{uvncfz 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: 5 Block: Subdivision: SFR (2) bath Mill__ Project name: 1 , p . U, SFR (3) bath City /county: , V-lickft4 ZIP: ¶'ZZ, 4- Each additional bath/kitchen NM Description and location of work on premises: FJtC 13 S f 2- Site utilities: ■ -. Catch basin/area drain Est date of completion/inspection: Drywells /leach line /trench drain t. . Footing drain (no. lin. ft.) _ iV.- i :� , : CONTRACTOR. x:= `. , Manufactured home utilities _ Business name: 1 ' , L{) 1. IPA Manholes ill Address: ' p $., . , Rain drain connector MI EnhIMSIIIIIMIIIIIIIII State:pft_ ZIP: "-/ , _ 7 Sanitary sewer (no. lin. ft.) - Phone: 6 .y - y b 4 IERIMIMI E -mail: ' Storm sewer (no. lin. ft.) _ CCB no.: V, , • Plumb. bus. reg. no: , - ‘6(.0 ' Water service (no. Ire. ft. City /metro lic. no.: 0 0 . tp 1 5 A immiMil Fixture or item: ■ -. Contractor's representative signature: `, Back _ t tionvalve Back flow preventer MI Print name: l e 1 0" h pN Date: Backwater valve NM ERIEMEAMIIIIIIIIIIIIIIIM CONTACT PERSON ,, ; Basins/lavatory _ al • Clothes washer MI Address: S SW pa i g' Dishwasher Drinking fountain(s) - City: p '( -�,p State:0(1, ZIP: '11.- Ejectors /sump - Phone: -R ' 573 Fax: 24, §59 r Expansion tank - § , - ' :. OWNER , :' . , :k' 'R '-'- ',w Fixture /sewer cap Name (print): A Pc0,c,1 \N,.4„,.. Floor drains /floor sinks /hub �� Garba_e diseosal NM -� Mailing address: p i p. I r Hose bibb IIIII City: r.. l-h EMI ZIP: - Ice maker Phone: ' ,',S5 2 IEWORIM E -mail: Interceptor /grease trap M Owner installation /residential maintenance only: The actual installation Primer(s) NM will be made by me or the maintenance and repair made by my regular Roof drain (commercial) 111111 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 ME Address: Water heater MI City: State: ZIP: Other: IIIII Phone: Fax: E -mail: Total MI Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ Plan rev (at _ %) $ O Visa 0 MasterCard expires if a permit is not obtained o Credit card number. w 1 80 d ays after i t has been Expires p State. surcharge -(8 %) $ Ex Name of cardholder as shown on credit card accepted as complete. TOTAL. S Cardholder signature Amount 440 -4616 (6/00/COM) 411,,, E lectrical Permit Application '4 :,. ,,�.� Date received: 9 9 a Permit no.: - - -ap7o , , , w s City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall 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: 3 t : s : 1 ' t N` "k«-a w -F P 3 w'n my} y 1 :, ry �-. r« s ``iF �.a.xa .T+ 4: ` = n U � 4 � .� TYPE O ERNIIT -� » � : �y„ fell & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement l New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial r - u - ..� . 1,�, ��d:. 1 ' 7F +7, 4,* ,t y w .., .., �r .._;s , ... , _. , zµ ` : . : P) 710 ev' 1 s 4,' e �� , A t ]0 `- : .. JOBi S ITE INFOItMAT10N l t t ,. t tx�C "�o-�z�rw. ...� i i.x�r.�_a�ex �a. r. ..c� � .... �'"..� .+ e,..�r:,_�r �. ,�, - tom _ >. .w+ :w�.,�s�c. r .:,a _ _....�i.:. � .s .x.�..,� -.�., �C .... i '` ^icy„_� t,.'rk�" ;,�'�r Job address: 4 r .. la � L Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: ,', t Block: Subdivision: •R. bt.4.. Project name: j, -F(p(I V ILA-- Description and location of work on premises: I . !i 5r Estimated date of completion/inspection: " .3 g y. � x . . ' `CONT1tA'CTOR' /A� „ , PLICATION'� .24ZILY - o- l iR. �g �'4j =r;�' Z i F I tts CHEDLLE;`. . * ZY :P ithi", C' `Y.k.; . '4. " ,, -, :F. , „ , ,, ,. �a^ u'. _ „ .k ti'rt . u1' i .- . „ r 43.: . Z r. , L. . i., , iit ;. .,,, �, .,.. . - 5 _. "i .. '.A - . e. . .V. rz S , 2_^3.,, —. L — „,?d .I . .,�.. , -.3..a..AL - .iE �. , � „ .. _ . Y Fee Job no: ?j Co 1 Z S .E µ r. 1 4 Vr TE Description Qty. (ea.) Total no. Max ax B t 1 e: '5 L New residential - single or mufti- family per Address: ' Q L _ Z \ dwellingattit. Includes attached garage. State:,fgt.., ZIP: ' ZIP: 11123 ” Service included: Phone: , y;. `-, -St 4'ci =Mal E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof _— CCB no.: $( Elec. bus. lic. no: ''S 1 —‘ ., C„ Limited energy, residential AZy_ ec MIMI 2 City /metro lic. no.: Limited energy, non- residential ___ 2 ► Each manufactured home or modular dwelling ■■. Signature of supervising electrician (required) Date Service and/or feeder 2 Sup elect name (print) la - se,+(1„� y License no7,et77S � Servtcesorfeeders installation, �.. 2 1r ' "` , d} ., , , '���PROPE 4, .^ „ s alteration or relocation: ; r ��" �', �w . Vi a„ � -.. t . r , 200 amps or less "� �,...d 'emu= .,u� _ ,.: h _ :..� - .��_ .: „� Name (print): Jr �,G S- '1A9.. , ' 201 amps to 400 amps ___ 2 401 amps to 600 amps MINN _ 2 Mailing address: "c3. 1i 9 4k 601 amps to 1000 amps ___ 2 City: A. , i t•.) State:o(l_ ZIP: '17&i Over 1000 amps or volts ___ 2 Phone: L°l I • i sc(? Fax: F91 - / 11 E -mail: Reconnect only _ L Owner installation: The installation is being made on property I own Temporary servicesorfeeders which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: 200 amps or less 17•11111 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps IIIMMIll 2 Owner's signature: Date: 401 to 600 amps 11=.1111 _ 2 1Z ` ''','''':C.-;.74"! '1. ` i ` n `�`°`'`£ Branch circuits - new alteration, h . : ( : ENGINEER ' b _ . r , , --"�' -- ---� or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: State: ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 111.11 2 Phone: Fax: E -mail: Each additional branch circuit: ___— t Jam' s+ r V e l i. `4 1! -.'7�1 'i r;. ■■ . x ���r�PLAN REVIEW (Pleas a chect tht _apply) � , ..� , ,� Misc .(Seniceor feederaotincluded): 0 Service over 225 amps commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps -rating of 1 &2 O Hazardous location Each sign or outline lighting MI= 2 family dwellings 17 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2 Cl Building over three stories ❑ Feeders, 400 amps or more •Descri r Lion: 0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: CI Egress/lightingplan O 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 $ - D Visa MasterCard — expires -if -a- permit -is -not- obtained Plan review (at _ %) $ Credit card number: I / 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 (6/00 /COM) x .. . . Mec calPermit Application _ . , - f x . , r ► ate received: / 9 D g Permit no.: )/ r , , , v i' ,i!' City of Tigard _ _ •ject/appl.no.: Expire date: Ciry o'Tigard Address: 13125 SW Hall 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.: -4' TYPE: OF PERMIT ' A I & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement jig New construction Cl Addition/alteration /replacement 0 Other: , JOB SITE I1 Ii'OR IA1ION . `: COMMERCIAL VALUATION SCHEDULE r. - Job address: v3 . L SIJ \,. L,� -rte 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 $ 6,5 oc . Lot: G Block: 'Subdivision: *See checklist for important application information and Project name: iX, 4 p‘1,, \k,,V jurisdiction's fee schedule for residential permit fee. City /county: e∎ . o • ZIP: '` n, ' ' ; , l' S 2 FAMILY' DWEI LING PERMIT FEE =SCHEDULE Description and location of work on remises: AND COMMER CAL/INDLSTRIAL EQUIPMENT SCHEDULE L) ST" Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res. only Res. only Tenant improvement or change of use: H ha d ■ -- Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM Air conditioning (site plan required) — Is existing space insulated? 0 Yes 0 No Alteration o existing HVAC system -': 'k {^ MFCIIANICAL..:CONTRACTOR' F ' Boiler /compressors Business name: g i _ 1 , _ r _ t. State boiler permit no.: H�1G HP Tons BTU /H Address: i I r ' TF1' Fire/smoke dampers/duct smoke detectors - City: fop_ y0,p.J10 1EMM ZIP: 9 1Z 3 Heat pump (site plan required) — Phone: , , 0 , i Fax:644 -43 4 I E - mail: , Install/rep ace furnace/burner BTU H ■ -- CCB no.: 35" C, Including ductwork/vent liner O Yes 0 No Install/replace/relocate rflo hea[ers- suspended, ■ -- City/metro lic. no.: ' wall, or floor mounted Name (please print): I pa,. A , r E� Vent for appliance other than furnace Mill *'' , 3, _ .t: :.; CONTACT PERSON 4, , - r Refrigeration: 4 s '' - - - Absorption units , BTU/H Name: 'ivr IT Chillers HP M Comr ressors HP Address: ) su 420...k4, T Environmental exhaust and ventilation: Ill Em, -6-A..010 State:d fl,, ZIP: 7 - Appliance vent Phone: / `' Dryer exhaust 0 CO' WNER„ , ' ' . ' : Hoots, Type I res. kitchen/hazmat , . , - , , ', , _ hood fire suppression system © == Name: iQ a , t-'14: (11 \GC.. Exhaust fan with single duct (bath fans) Mailing address: P %. p " T. 01 rl. Aru'ti1aaeta ,taallatagula y ' 0 1 State:0 ZIP: Z6, � Fuel piping and bution (up to 4 outlets) ■ -- City: Type: LPG ?c• NG Oil Phone: 0 ) 4- 0 FERTME1111 E - mail: Fuel piping each additional over 4 outlets all `' : r 'ENGINEER n ' Process piptng (schematic required) - Number of outlets Name: ri , • ■ appl i a or egtnpment: Address: Decorativefireplace © City: State: ZIP: Insert- pe Phone: MEM= E -mail: Woodstove/pellet stove Applicant's signature: 1 . irfi4f. Date: Outer: Name (print): . tit 2 I Not all jurisdictions accept credit cards, please call jurisdction for more information. Permit fee $ O Visa t1 MasterCard Notice: This permit application Minimum fee $ expires_ if a. permit. is-not. obtained — crediecars nomticr: Ex pi within 180 days after it has been Plan review (at %) $ State surcharge (8%) .... $ Name of cardholder as shown on credit card accepted as complete. . $ TOTAL $ Cardholder signature Amount 440-4617 (6100 /COM) CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RECEIVED DAVID JEROME ELECTRIC MAY 15 2003 PO BOX 751 CITY OF TIGARD HILLSBORO, OR 97123 BUILDING DIVISION Electrical Signature Form Permit #: MST2003 -00141 Date Issued: 5/13/03 Parcel: 2S109BA -07900 Site Address: 13672 SW LEAH TERR Subdivision: DAFFODIL HILL Block: Lot: 005 Jurisdiction: TIG Zoning: R - 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 #: LIC 36051 SUP 2877S ELE 34 -119C AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Supe icing lectrician • If you have any questions, please call 503.718.2433. _ i ►®®®®AAAAAA® AAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAA I Pr ■ I ► S T RE ET T CERTIFICATION ► 7' ► ,z ' 7 ► If i/ 1 7) ��/ �l� , Rt *, weer %gent for ��0�/7 "� C I. ERMIT HOLDER (PLEASE RINT) (PERMIT HOLDER) ; i, ► p < /zY¢ ► a ,{a,= Via b.:.�. � Do hereb r 'Ffl x t "i! � ' ':t �`"' t g location ■ meets , i t,,:.T: of.: a <rdl a.4 ton ounty C .2, n C xY.Uewmh:litp4'A'ae 0 . ■ land use and development standards for street tree installation. ► ■ ■ ■ ■ ADDRESS: /3.7 Z _Si 6), L_ E • �-- .c ► LOT: SUBDIVISION: l i 4 TO ID < <. (-----//' • DATE: 2C ► BY: dr y / . RECEIVED BY: . . Or - d DATE: —=- d';L • VVV VVVVVV VVVV VV VVVVVVVVVVV VVV VYYYYYYYYYYVYYYYVYYY!fVYYVVVYs1 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST _CO /z/ INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Reque ted 7 AM PM BUP Location / 3 4 (-e Suite MEC Contact Person Ph ( ) c94. 7 " 17 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING • Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O er: AS 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 ❑ Please all for rei spection RE: ❑ Unable to inspect - no access - Fire Supply Line — ADA , Approach/Sidewalk Date 2 PP Inspector A 1 Ext Other: IP Final DO OT REMOVE this inspection rec rd from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: 1503) 639 -4175 MST 3 -b®% d r INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received t�-, Date Requested -30 Oi AM PM BUP Location s � C L 'A "7" Suite MEC Contact Person % Ph ( )Loot . 4 \ q L PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: 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 T FAIL ECTRICAJ ) Service Rough -In UG /Slab Low Voltage Fire arm PAS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 111 Please call for reinspection RE: in i na•le to inspect — no access -- Fire Supply Line -- -- — — -- -- ADA Approach /Sidewalk Date Inspector 0 Ext Other: Final DO NOT REMOVE this inspection ecord from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour Inspection Line: 1 T;� � _c / BUILDING P ( 50 � 6'39-4175 MS INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received - ' ) P Date Request- I J AM PM BUP Location /3(10' 7 Suite MEC Contact Person s Ph ( ) .20 /— / 7 �� PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear `) Framing L 6cT/Zer�/��1 ��,� �� C Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof • • • !' ._ PART FAIL - 0 BING 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 Dampers TAW RT FAIL • TRICAL 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: L Unable to inspect — no access Fire Supply Line ADA ' Approach/Sidewalk Dat �� � � 7 Inspector / \ Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL