Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00213
/l DEVELOPMENT SERVICES DATE ISSUED: 9/3/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12950 SW OXALIS TERR PARCEL: 2S104BC -08500
SUBDIVISION: HILLSHIRE CREST ZONING: R -
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: New SF detached
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: 806 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: 1,517 sf GARAGE: 560 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: NONE DWELLING UNITS: THRD: 1,592 sf RIGHT: 5
VALUE: 381,645.40
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 3.915 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: BOILJCMP < 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: 6
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: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFER: 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:
> RES UNITS: SVC /FDR> =225 A: > 600 V NOMINAL: CLS ARENSPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 9,034.43
This permit is subject to the regulations contained in the
RIDGECREST CONSTRUCTION CO RIDGECREST HOMES
Tigard other ica l State of w k wil b o ne i n
6600 SW 92ND AVE SUITE 210 6600 SW 92ND AVE SUITE 210 and all other applicable laws. All work will be done in
PORTLAND, OR 97223 TIGARD, OR 97223
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.
Phone: 503 246 - 8808 Phone: 503 246 - 8808 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 59228 rules are set forth in OAR 952- 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ins Rain drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Storm drain Insp Plumb Final
Foundation Insp Footing /Foundation Dn Electrical Rough In Gas Line Insp Water Service Insp Building Final
Issued By : ,/2 a .."-7 2 Permittee Signature : .
Call (503) 639 -4175 by 7:00 p.m. for an inspection nee • ed he next business day
Building Permit Application FOR OFFICE USE ONLY
City of Tigard � � Received ��/ Permit No.:H1 � dD �
O � 3
13125 SW Hall Blvd., Tigard, OR 9jC Plan Revie tv O
Phone: 503.639.4171 Fax: 503.5 .60 41 /em,I � � Date/By: Other Permitpy�e(i
Inspection Line: 503.639.4175 . ` 71 I Date Ready/By: lur • ��E3 See Attached Checklist for
Internet: www.ci.tigard.or.us OV \ C �\ Notified/Method: 7/0 Supplemental Information
a
. TYPE• •O1; FI.ORK _ REQUIRED DATA.: - -; AND 2- FAMILY DWELLING
%New construction \P'' ❑ 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 OF CONSTRUCTION, - .. work indicated on this application.
0 .1- and 2- family dwelling El Commercial/industrial Valuation: $
Accessory building Multi-family Number of bedrooms:
❑ rY g ❑ Y '''*i
❑ Master builder • ❑ Other: Number of bathrooms: 3 j
- JOB SITE INFORMATION' AND, LOCATION : .N , .: -' .. Total number of floors:
3
Job site address: ,//29d -7, Sa) 7y(,.9..2/s ��,�w f New dwelling area: 3 . square feet
City/State/ZIP: 7 /bi 0 g/,' 92 d Garage/carport area: , tj -(6 square feet
Suite/bldg. /apt. no.: Project name: /. _.5 j .i se (7,,E> 7L. Covered porch area: square feet •
Cross street/directions to job site: 5 e S /61/ d d)C,1L) 5 Deck area: (7. 9,..c7,2 „ square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: J 5 /-ejf (lQiS71- Lot no.: 7 Permit fees* are based on the value of the work performed. l'
Tax map /parcel no.: 5 /O S/ 2 5 c F s-a 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: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER - .. ❑ TENANT . Number of stories:
Name: ,]/L -ee(1 7 • 4),57 Type of construction:
/,�b)
Address: 4 ) f / ) '/ ,, Occupancy groups:
City/State/ZIP: ,v141-( 4;, � 92 ? 3 / �j Existing:
Phone: (x-0) 9 7 W . , ' 7 r e F / Fax: ��3 e,9 y 2 O e New:
• .. ❑ APPLICANT = . ('CONTACT PERSON
• NOTICE •
Business name: All contractors and subcontractors are required to be
Contact name: Al/ 421 C4��2G4 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
/ T apply:
Phone: ( ) Fax:: ( )
E -mail:
'CONTRACTOR ; .
Business name: /f BUILDING PERMIT FEES* - ` 1
Address: /� �, // Please refer to fee schedule.
/
City/State/ZIP: C ! � / L - /r/ C• Fees due upon application
Phone: ( ) Fax: ( )
CCB lic.: a - 9_ Amount received
Date received:
Authorized signature: r: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �� C i / aia ,,4 Date: 7 /z„.4),, • Fee methodology set by Tri-County Building Industry
Service Board.
i:\ Building \Permits\BUP- PemiitApp.doc 12/03 440- 4613T(11 /07JCOM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City Of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By:
Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 A ,
24- Hour Inspection Line: 503.639.4175 a {,�. .,'
0 Electrical 0 Plumbing 0 Mechanical
Internet: www.ci.tigard.or.us "" 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control. ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable Local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore • on and shall be shown to be applicable to the .ro under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will ° not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03
. t
Electrigal Permit ApplicatiQtO FOR OFFICE USE ONLY
City of Tigard��� ® ®� Day °a PermitNo.:Msr� /V ,9-113
13125 SW Hall Blvd., Tigard, OR 94 Plan Review
Phone: 503.639.4171 Fax: 503.598. 960 ' ���� +I� Date/13 : Other Permit:
��� Inspection Line: 503.639.4175 \ �# i Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us "c \CI \I Notified/Method: Supplemental Information
. , • TYPE :Q. VOA Pi AN. REVIEW
,New construction ❑ Additic "aeration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location
. ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
,CATEGORY 'OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
lA 1- and 2 - famil y dwelling ['System over 600 volts nominal units in one structure
g ❑ CommerciaUindustrial 0 building ['Building over three stories ['Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATIbN- AND LOCATION • . r ' - `' . . ❑ RV park
['Egress/lighting
Job no.: Job site address:l j ` C�� >�fe �� ❑Health -care facility ❑Other:
Z��� {� Submit 2 sets of plans with any of the above.
City/State /ZIP: 7-/e /r A /96 9 7Z2_.3 The above are not applicable to temporary construction service. '
) _ FEE* SCHEDULE .� :-.`•.:' .
Suite/bldg. /apt. no.: Project name:
Description I Qty. I Fee. I Total
Cross street/directions to job site: E,41.570•74 d- 40 ' �b New residential single or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: / /f , �i Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Subdivision: / 47/5 (q� "� I ft Limited energy, residential 1 75.00 2
Tax map /parcel no.: a .5/0 V ( r
/� 6' Limited energy, non - residential 75.00 • 2
' DESCRIPTION• OF WORK . Each manufactured or modular
- dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
=PROPERTY OWNER .I • ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /9 ! D / /� (; 2 $ 7 e (.(.1 601 amps to 1,000 amps 240.60 2
Address: bhtP � 5 C 9„2,0 � �, a
,0 0 ,/0 Over 1,000 amps or volts 454.65 2
only � ,, y� f )f ,' 4 ii7 6 3 Te se 66.85 2
City/State /ZIP: z/ Temporary services or feeders installation, alteration, and/or
Phone: (5- ' /6 _7-7v 7 I� Fax: (5 a V6 - ,3 t� Z 2 00 am ion
!O 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 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
' APPLICANT . ;I KCONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: I branch circuit
� ®lj G' /J� � B. Fee ou service circuits f
Contact name: 1//
`C ` without service or feeder fee, 46.85 2
Address: �� Each eacadd branch h 'l branch circuit circuit 6.65 2
City/State/ZIP: 6, - it-' . - IP Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:
) I Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
.
' CONTRACTOR ` energy panel, alteration, or
/ / � � C , extension. Describe: Page 2 2
Business name: [� G
Address: 2 7 O / 5 t 9' -5 Jo? ....5 / 5g Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: te/i, 64--)., t./j7/1 � , P� 97,20 Investigation per hour (1 hr min) 62.50
�s"o -
Phone: 96'190 Fax:
(5 6" 7
L y v Industrial plant per hour 73.75
- ELECTRICAL PERMIT FEES*
CCB Lic.: As - c(y 9 7 I Electrical Lic.: ,3 6 C 1 Suprv. Lic.:
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: re4.. f / fil `L L I Date: �f� .1- State surcharge (8% of permit fee)
�� / TOTAL PERMIT FEE
Authorized signature: &� ' r i T hTis permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
���/ Print name: Date: 01/ • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Bui lding\Permits\ELC- PormitApp.doc 12/03 440.4615T(IO /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: ' -- -1
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:
COMAIRCIAL WORk ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
•
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pertnits\ELC- PmnitApp.doc 04/03
' Buil'digg Fixtures N
Plumbing Permit Appl, FOR OFFICE USE ONLY
City of Tigard �S " p 0 Received
Date/By: Permit No.:N92 �y - a/ 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 \�� \�N., bir o * `k'I i ' Other Permit No.:
24- Hour Inspection Line: 503.639.4175 �1 . =•I �� D ate/By:
' Date Ready/By: / ® See Page 2 for
Internet: www.ci.tigard.or.us , \ G \ Notified/Method: ha. Supplemental Information 1. TYPE Oh:% R K . .. FEE`', SCHEDULE �; , . '
Iew construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION .. SFR (1) bath 249.20
•
)24- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ ` Accessory building ❑ Multi-family SFR (3) bath 399.00
Each additional bath/Idtchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• JOB SITE INFORMATION AND LOCATION' Site utilities
Job site address: l029s'/7 3--(,e) Q�,9 ; S /,.2".�14 Catch basin or area drain 16.60
City/ State/ZIP: '7/ f G 10 ,/,.. 7,, -3 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: (,1
5 � '-)Ai'/ s Manholes 16.60
Rain drain connector i 16.60
Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: /,. j <,7 1�� ( ���5-t 1 Lot no.: Water service (no. linear fl.: ) Page 2
T / ` / c Fixture or item
Tax map /parcel no.: .72_5/0 Y roc D s-dn Absorption valve 16.60
. - DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
. 10 . , PROPERTY. OWNER '1 ❑ TENANT
Ejectors /sump 16.60
Name: e f U (t'L. l/C /®, �O�,s4e,/,t-�� - J9 CO Expansion tank 16.60
iL
Address: b o / ,/ ) ,�� O `` 44,-)2e 2/ 0 Fixture/sewer cap 16.60
City/ State/ZIP: ! / Ate 2, 7 2 3 Floor drain/floor sink/hub 16.60
Phone: (5'03) I V,- 7 70 7 ' Fax: ( ?`6 _ 34, 701._ _ Crarbage disposal 16.60
❑ APPLICANT' .kCONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: 'v// /( CZaeed j }� Medical gas (value: $ ) Page 2
Address: /40 ()I 16.60
City/ State/ZIP: ��� V ` IS Roof drain (commercial) 16.60
`-� Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60 °
Business name: C ��i k 613 4 p � f I, ;V 6 Water heater 16.60
Address: 77 (4 �UJ / � s ‘2,0-e h Other:
iq % ��1 i I 9 f7aO(� Subtotal
City/State/ZIP:
/5/0:1(.1 / Minimum permit fee: $72.50
Phone: (5 6/I' 7-- 97 Fax: (5,3)4 _ 6-979 Residential backflow minimum permit fee: $36.25
CCB Lic.: 7 yz.,, Plumbing Lic. no.:X -./(.)T "LT Plan review (25% of permit fee)
( "� / State surcharge (8% of permit fee)
Authorized si lure: TOTAL PERMIT FEE
Print name: 6 1---„„)}1 0 / /, b Date:7 /_,, 07 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 \Pertnits\PLMF- PennitApp.doc 12/03 440- 4616T(l0/02/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 Fee: ' • : .
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
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 Valuation: Permit Fee
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
•
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
•
Fixture Type: • Replace
New Moved. Existing Capped Comments regarding fixture work:
•
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru •
Cuspidor/Water Aspirator •
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach.Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
is Building\Pemtiw\PLM- PumitApp.doc 3/03
Mechanical Permit Application U FOR OFFICE USE ONLY
City of Tigard �� ��� DateBy Permit No.: )_11.-,,Q,0 v,,664 `,
13125 SW Hall Blvd., Tigard, OR 97223\ -\\ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ® ® a / %is®gr , t ;\ Date/By: Other Permit:
Inspection Line: 503.639.4175 Ap p� � - r I I Date ed /Met Ready/By: Ju Supplemental See Page 2 for
Internet: www.ci.tigard.or.us �U Notified/Method: - Supplemental Information
r 1IG('�� .t
T YPE'f�P��U(� "� COMMERCIAL FEE *.SCHEDULE, -_DSE CHECKLIST -
- Nit New construction ❑ Addit 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.
CATEGORY OF CONSTRUCTION Value: $
', RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
K1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
!. ,��� J �/ �/ ''�'�� Air conditioning or heat pump
Job site address:
9J� c.J't 1 k HG /.s / 4441 (requires site plan showing placement) 14.00
City/State/ZIP: ?—/ /I C [) 909 Fumace 100,000 BTU (ducts/vents) 14.00
? Furnace 100,000+ BTU (ducts/vents) / 17.90 / 7' y0
Suite/bldg. /apt. no.: rii
ect name:
Gas heat pump 14.00
Cross street/directions to job site: O� S/Bzj Y Dl` �`/ 5 Duct work 14.00
C 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: /. /e , , ( 01 -Lot no .7 Flue/vent for any of above 10.00
v/ �(/ (J / Other: 10.00
Tax map /parcel no.: tp 5/a r c. )re.c9 O Other fuel appliances
• DESCRIPTION OF WORK Water heater / 10.00 _/
Gas fireplace 2 10.00 L-0
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
PROPERTY OWNER _ I El TENANT Chimney/liner /flue /vent 10.00
� t5iL / /�i / Ether: 10.00
Name: f.,/z) �J � 57 , /� N (if Environmental exhaust and ventilation
Address: b� J !' / /� / 7� � j Range hood other kitchen
bb t , 0 /. 7 _ ,- /[ D equipment t 10.00 J
Cit State/ZIP: C�V 1'air> , ,(_f � , 3 Clothes dryer exhaust 1 10.00 / )
!!!! ���v l / Single -duct exhaust (bathrooms,
Phone: 45'03) (l _ F 7 Fax: (rD -) a) (/6 — 3 Y/ toilet compartments, utility rooms) 6.80 ..?ti, G 6
APPLICANT It CONTACT 'PERSON - ' Attic /crawlspace fans 10.00
Other: 10.00 _
Business name: Fuel piping
Contact name: I
�� P P �f ' � � $5.40 for first four; $1.00 for each additional
Address: n Furnace, etc. /
(J Gas heat pump
City/ State/ZIP: .- ' Q Wall/suspended/unit heater
Phone: ( ) v Fax:: ( ) Water heater /
Fireplace ,
E -mail: Range i
CONTRACTOR Barbecue
5()/ P
Business name: ' ,, �� y� l J ./v C Clothes dryer (gas) t10
L Other: 6.
Address: 9 (41 7 e/' (� /6 MECHANICAL PERMIT FEES* _!
City/State/ZIP: GCJ // / / � t,7//J gji 9, /970 Subtotal /(5
/ / //" 6 I Minimum permit fee ($72.50)
Phone: 6-03) 6 _ /7,.\ Fax: (6-03) /- qq
(o �if /O.- Plan review (25% of permit fee)
CCB lic.: c /7 . ( _2 .. _ . 2,/ State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: / / \ This permit application expires if,a permit is not obtained within 180
�� t, / days after It has been accepted as complete.
Print name: a l /�� I l I I I I Date: // • Fee methodology set by Tri- County Building Industry Service Board
i:l Building \Pemdts\MEC- PemtitApp.doe 12/03 440.4617T(11/02/ OM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
, Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including •
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or •
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
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• Do hereby certify tha4 the fo11owing location ■
• meets ,City��;of;T-igard /Washington ` County ■ ■
• land use and development standards for street tree installation. ■
• ■
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• ADDRESS: I 2._ 9 SG S -w . c� Ka ; its 1 c �.R. ■
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CITY OFTIGARD 4 , -
1 BUILDING DIVISION PERMIT #: MST2004 -00213
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/3/2004
Phone: (503) 639 - 4171 U �'xm0,4 1I
Inspection Requests (24 Hrs.): (503) 639 -4175 : -_ ' ` 'IL.
INSPECTION WORKSHEET FOR DATE: 5/3/2005 TIME: 7:14AM PAGE: 43
SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK:
SUBDIVISION: HILLSHIRE CR LOT #: 00 7 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: New SF detached. 12/9/04: Added NC.
OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503-246 -8808
CONTRACTOR: RIDGECREST HOMES PHONE #: 503-246-8808
Inspection Request Scheduled For: Date: 5/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 005957 -01 503209 -7859 N
Corrections /Comments/ Instructions:
( __j itl -) !AI SQL L ;/7 ca_ - f7 r T1 l.L�
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: S ---- 3 -0S Phone #: (503) 718-
_CITY OF TIGARD 4 -
BUILDING DIVISION P ERMIT #: M ST2004 -00213
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9 /3/2004
Phone: (503) 639 -4171 : � ` i .
Inspection Requests (24 Hrs.): (503) 639 -4175 ...
INSPECTION WORKSHEET FOR DATE: 5/3/2005 TIME: 7 :14AM PAGE: 41
SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK:
SUBDIVISION: HILLSHIRE CREST LOT #: 007 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: New SF detached. 12/9/04: Added NC.
OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503.246 -8808
CONTRACTOR: RIDGECREST HOMES PHONE #: 503 - 246.8808
Inspection Request Scheduled For: Date: 513/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 005957 -02 503- 209-7859 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4
Inspector: ., Date: 5 7-
Phone #: (503) 718-
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST o2OU 13
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested —�� AM PM BUP
Location )5 x 714 Suite MEC
Contact Person Ph ( )D0 — 7 _F-9 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
Insulation
Drywall Nailing
Firewall
/
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final ' % ii/
PASS PART FAIL . —
PLUMBING i �� / / / r
Post & Beam
Under Slab /�ll0 ` ` 4•0"- �
ot■:::119 r
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS CT FAIL
MECHA' AL
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 ID Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Gl
Approach/Sidewalk Date l ! /� Inspector v Ext
Other:
Final DO NOT REMOVE thls inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD , _ 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST . / •�� 4
3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Reque ted AM PM BUP
Location • / :odp Suite MEC
Contact Person A Ph ( ) 2-09 - 7 FS 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
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 -T"
Other: JO-e. , r tc.E'/
F'
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 El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line Cr7-32
ADA Approach/Sidewalk Date V lU &5 I nspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OFTIGARD
BUILDING DIVISION ill PERMIT #: MST2004 -00213 ,
1 13125 SW Hall Blvd., Tigard, OR _23 DATE ISSUED: 9/3/2004
Phone: (503) 639 -4171 fiat � Al,,.
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __..
INSPECTION WORKSHEET FOR DATE: 4/29/2005 TIME: 7:11AM PAGE: 10
SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK:
SUBDIVISION: HILLSHIRE CREST LOT #: 007 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: New SF detached. 12/9/04: Added NC.
OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503. 246 -8808
CONTRACTOR: RIDGECREST HOMES PHONE #: 503 - 246 -8808
Inspection Request Scheduled For: Date: 4/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 005696 -01 503 - 209-7859 N
Corrections /Comments/ Instructions:
41 ■MAll r—f 4. _,..01111r ' -a.'
h 6'
/ 7
111 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
N4 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 2 Date: v , 1 Phone #: (503) 718-
r
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2004 -00213
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/3/2004
Phone: (503) 639 -4171 aa,N. d 'N i,llll , i�
Inspection Requests (24 Hrs.): (503) 639 -4175 ` :_ I
INSPECTION WORKSHEET FOR DATE: 3/31/2005 TIME: 7 :06AM PAGE: 10
SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK:
SUBDIVISION: HILLSHIRE CREST LOT #: 007 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: New SF detached. 12/9/04: Added A/C.
OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503246 -8808
CONTRACTOR: RIDGECREST HOMES PHONE #: 503.246 -880B
Inspection Request Scheduled For: Date: 3/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 003382 -01 603-209.7859 Y
Corrections/Comments/Instructions:
. /
c:__:e:: r
' PASS El PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
' �❑ \ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / v Date: Phone #: (503) 718-
CITY OFTIGARDr }
I BUILDING DIVISION PERMIT #: MST2004 -00213
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/3/2004
Phone: (503) 639 -4171 a ? /1 09 , , , ,`lii
Ins Requests (24 Hrs.): (503) 639 -4175 .. __..
INSPECTION WORKSHEET FOR DATE: 5/2/2005 TIME: 7 :10AM PAGE: 7
SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK:
SUBDIVISION: HILLSHIRE CREST LOT #: 007 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: New SF detached. 12/9/04: Added NC.
OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503 - 246-8808
CONTRACTOR: RIDGECREST HOMES PHONE #: 503 - 246-8808
Inspection Request Scheduled For: Date: 5/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 005820 -01 503- 209 -7859 N •
Corrections /Comments/ Instructions:
II -
6 — yy
(d
1
NIX PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/iri/1
Inspector: Date j if Phone #: (503) 718 -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST pep y O 13
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested " AM PM BUP
Location 1 9,s7) S7) 0 pJLA _7A/( - Suite MEC
Contact Person R "?-f Ph ( ) �d 7 — 7 ES 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
Insulation
Drywall Nailing
Firewall ���
Fire Sprinkler
Fire Alarm
Susp'd Ceiling i L /�■
Other: � -m / r ��/
/ `
Final
PASS PART FAIL
PLUMBING
Post
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FA
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 call for reinspection RE: E] Unable to inspect — no access
Fire Supply Line
ADA
2� 6
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 Line: (50 i •-417
INSPECTION DIVISION Business Line: (` • 171 M S DO r °o a�3
BUP
Received Date Requested 9 c 7 AM PM BUP
Location c )(2 -&e ms — rceyvu Suite MEC
Contact Person 4.4 -2Y Ph ( ) 6({- q — 8i ( 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 j
Framing UV
Insulation '-jl ,, D ,lee
Drywall Nailing �� `"' !�
Firewall
Fire Sprinkler Levt-Ne Fire Alarm —V/ ��� — crer
Susp'd Ceiling
Roof
Other:
Final
11= FAIL 5-'4 7€44../t ` ` J/ C yr
• :eam
Under Slab
Rough -In
4 gz - f16iii =1I' e ,
Catch Basin / Manhole L
'S`to D
an
Other:
Fi
PAS ART FAIL `
MECHAN L L/l �� �'� — ��✓� l y rll-‘—‘N
Post & Beam •
Rough -In -. �
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final fl 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: El Unable to inspect - no access
Fire Supply Line
ADA •� /d
\ �1
Approach/Sidewalk Date / Inspector v ct
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 MST 04 y 06 3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ( 3 AM PM BUP
Location dZ I a - 77"./14-) Suite MEC
Contact Person Ph ( ) — 7 R5-? 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
• er Slab
oug - n
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi aI
S PART FAIL
HANICAL
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 call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA 1,
Approach/Sidewalk Date 1311 6 v/ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD .
BUILDING DIVISION - PERMIT #: MST2004 -00213
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/3/2004
PYiine: (503) 639 -4171 va hFll
Inspection Requests (24 Hrs.): (503) 639 -4175 '1J—
INSPECTION WORKSHEET FOR DATE: 4/18/2005 TIME: 7:14AM PAGE: 14
SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK:
SUBDIVISION: HILLSHIRE CREST LOT #: 007 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: New SF detached. 12/9/04: Added A/C.
OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503-246-8808
CONTRACTOR: RIDGECREST HOMES PHONE #: 503 - 246-8808
Inspection Request Scheduled For: Date: 4/18 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004761 -01 503- 209 -7859 N
Corrections /Comments/ Instructions:
,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `Date: /�' Phone #: (503) 718 -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST , o Oo A■ 3
INSPEPTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested) \a) AM PM BUP
Location 1 D-- S ;rJ r Suite MEC
Contact Person �� YN Ph (7_) QS" o 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
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 n
Rough -In t � 1 I �� 4h ( n ? R
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
ZE3 alb
UG/Slab
_ Cage
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date i 0 Inspector Ext
Other:
Final DO NOT REMOVE thls Inspection record f om t b site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST Od / -`O o 2-13
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested / AM PM BUP
Location `O rj D (9)( -' v) Suite MEC
Contact Person i4,c e ) Ph ( ) O q - 7 8"S 9 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 A rt' , 2 ��c s—
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceilin%
Roof /
Other:
Final
PART FAIL
I 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
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 call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line
ADA _
Approach/Sidewalk Dat 1 —J � 0 5 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING 11111 Inspection Line: (503) 6 75 66-2(3
INSPECTION DIVISION Business Line: (50 1 MSTa �"
BUP
Received Date Requested / — 4 7 1 AM PM BUP
Location / 2-9 5 44 Suite MEC
Contact Person Ph ( ) e — 7 8 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 w J ,`
Framin• T "Y�' , G�—��
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other
Fin
S PART FAIL
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
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE D Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA L L Q \`
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 Line: (503) 39 -4175 MST '0 60)- (3
INSPECTION DIVISION Business Line: (503 39 - 4171
j �/ BUP
Received G Date equested� / )- — 2 -a PM BUP
Location / (- Uxo_ac.� l Suite MEC
Contact Person Ph ( ) 'd 9 7PC7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear t--
a /,
u ation /q'i O 777
Drywall Nailing !
I Fire Sprinkler �✓
Fire Alarm
Susp'd Ceiling
Roof
Other:
Fi
PART FAIL
ING
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
Gas Line
Smoke Dampers
Fi
PART FAIL
EL TRICAL
Service
Rough -In
UG/Slab
�•w volt • -
Fire arm
) PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector — Ext
Other:
Final DO NOT REMOVE this Inspection record fro a Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour , `
BUILDING Inspection Line: (5 ) 639 -4175
MST 1`f v ,, , &3
INSPECTION DIVISION Business Line: - 639 -4171
�/ BUP
Received I ° � V Date Re uested a�' AM PM BUP
Location / d '6e-) — Suite MEC
Contact Person P ( -5773 )ae I 7 5 ? PLM
Contractor h ( ) 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
Framing
Insulation
Drywall Nailing
Firewall _ / v 1
Fire Sprinkler v /
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
�
as Line
o ampers
Fir -
PART FAIL
E J RICAL
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
ADA
Approach/Sidewalk Date Z- 0 Inspector = _ Ext
Other:
Final DO NOT REM VE this Inspection record fr v the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING . Inspection Line: (503) 639 -4175 MSaDY) 4-/- Do a L3
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received Date Requested /a 4 AM PM BUP
Location ) 0 C)iC cc p 77,A4 Suite MEC
Contact Person R, i• J Ph ( ) 20 T -" 78S'7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab n I Inspection Notes: SIT
Post & Beam
S ear Anchors
Sheath/r�
Framing th/ r ,�+"'/ �ilL /_ ' Ty,e J,1/� -�E -. ... - 5,-/-41z_
Insulation � S // �
Drywall Nailing G - �- � �� 4 1.- fi•
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceili g
Roof
Other:
• ART FAIL
P � BIN
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
ELECTRICAL
Service
Rough -In
UG/Siab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next ins ection. 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 J 2 6 _ a nspector Ext
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 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
` 0/4 O BUP
Received / Date ted S ,A�� PM BUP
Location /cc - ?SZ) � aPS 7 "t -vv Suite MEC
•
Contact Person C� Ph (S�j - ,% 1 PLM
Contractor �� Ph ( ) SWR
�UILDIN Tenant/Owner C__,64 edAf..ce ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
�C�wlDrain
Slab) Inspection Notes: /� SIT
Post & Beam 1.. -rte
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear SZA-4 e",
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
A 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
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: 0 Unable to inspect – no access
Fire Supply Line
ADA /
Approach/Sidewalk Date !e — 0 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 39 -4175 MSTc &0 4- 0 0 a 13
INSPECTION DIVISION Business Line: 03) 639 -4171
BUP
Received Date Requ sted ` AM PM BUP
1 - 9o a �) ,
Location /aA4 Suite MEC
Contact Person <4:6-4.) Ph ( ) D J 7 (?5-7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
dad'unapon> Access: ELR
9
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing �S w? S'Zt7 N t'
Firewall JJJJ J PRA `/Z - 1; E 13 41 tJo
Fire Sprinkler
Fire Alarm I � p: 7 G� (S)
Susp'd Ceiling
Roof
Other: , i j 5 A10707> OE A 4 . S P,
PART FAIL PK_o �/Z 1_ e?" �r� (�Q v ►A v eN v4
BING 4 1 ? y ( 3 / Fo' Co NC37e-__ o
Post Beam
Under r Slab / / SO (1 Lig ) '7 3 tt4
Rough-In y) 4 1 1 " Ce/l/G��C.� s L��L� o&/
Sanitary Sewer �� Pa �� ` ( o AST
Rain Drains `�
Catch Basin / Manhole s) G� . �/ —��.. S & 0/e ,,rf0 /pd312._
Storm Drain
Shower Pan F - 1 4 5/ Z j E / ro 4c -erg c...,
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 Please call for reinspection RE: / _ Unable to inspect – no access
Fire Supply Line
ADA D ate / �- a� Inspector Ext
p
Other:
Final DO NOT REMOVE this inspection recor m the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour _-
BUILDING Inspection Line: (503) 639 -4175 MST °� 6)46 °° - 3
INSPECTION DIVISION " Business Line: (503) 639 -4171
BUP
Received Date Re uested 9 ? AM 1/ : od PM BUP
Location f — � 7 S) ' (7 Z, i4 / ( -Q4/1. Suite MEC
Contact Person f Ph ( ),e)- 13-s? PLM
Contractor Ph ( ) SWR
4 t 3tftL-7G Tenant/Owner ELC
ootin
oundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: r SIT
Post & Beam . D D P,2_(4.1\
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing ' 9 (J r6/L - "Z l - r1/ 4 ,%
Insulation
Drywall Nailing i2.nI: 7 > crt' L> C i re
Firewall
Fire Sprinkler � r •s' AA' I4.
Fire Alarm 1i�
Susp'd Ceiling
Roof
Other:
Final
PART FAIL
• MBING
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
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: D Unable to inspect - no access .
Fire Supply Line
ADA
Approach/Sidewalk Date g Inspector _' Ext
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
MST �0v D Q �� 3
INSPECTION DIVISION Business Line: (503) 639 -4171
c, �J BUP
Received Date Requested ' ?f AM PM BUP
Location —9,S Suite MEC
Contact Person Ph ( ) Y) ' 7 8'S PLM
Contractor Ph ( ) SWR
WANG Tenant/Owner ELC
o tin ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear ti � j J � S TI Z-e.
Framing (`L'
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART
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
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 �? O
Approach/Sidewalk Date SL Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour .
BUILDING Inspection Line: (50 • . 6 ti ) 3
4175
4 (Po -- 0 (..1
INSPECTION DIVISION Business Line: ;03 z-4171_, ._ 6)
BUP
Received Date Requested 9 t / AM PM i./- BUP
...
Location _, It / Suite MEC
Contact Person ------ Aj-C--- , ---- 1-- Ph ( ) l) — 7 2 PLM
Contractor Ph ( ) &n/ ; 00,0id-
BUILDING Tenant/Owner ELC
Footing
oundation frA Access: ELC
' g a rai red ELR
Cra a rain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear yr e_ --g d-a_1.2,1 d.,,,,c-...,- _ c...,. 1
Framing
Insulation
rel.t_ .f" ,......._-- S
Drywall Nailing
Firewall i
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ot h A a " r S I S PART FAIL
MBING
Post & Beam
(
1 .
F
Under Slab
Rough-In
ervice
n ewe
Catch Ba . Manhole
-- orm Dr.',
Shower Pan
Other:
Final
PASS PART
MECHANICAL
Post & Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Y \e"_________
Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL