Permit '.
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00373
v� DEVELOPMENT SERVICES DATE ISSUED: 7/31/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10630 SW PARK ST . PARCEL: 2S103DA -04400
SUBDIVISION: FANTASY HILL ZONING: R - 3.5
BLOCK: LOT: 003 JURISDICTION: TIG
REMARKS: add 111 sf storage, kitchen re -do.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 111 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: at RIGHT: 5
VALUE: 2
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: 1 SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FOR: 00 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 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+ ampNolt :
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: LANDSCAPERRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 465.52
NOLES, DAVID R AND OWNER This permit is subject to the regulations contained in the
MARGARET L Tigard Municipal Code, State of OR. Specialty Codes and
MAR
MAR all other applicable laws. All work will be done in
10630 A S W PARK , OR K S ST T 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: Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Rep #: may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
■
REQUIRED INSPECTIONS
Footing Insp Electrical Rough In Electrical Final
Foundation Insp Framing lnsp Mechanical Final
Mechanical Insp Shear Wall lnsp Plumb Final
Plumb Top Out Exterior Sheathing Ins Final inspection
Electrical Service Rain drain Insp
Issued By .v ,(44',/e.--0-4.-- ,W (/) Permittee Signature b i / /]O /;j2t I)
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next ness day
(4
To 71- 7 -Dap -03
Building P :) 1 ; , 1 ' 1 ) 1 � . - on 011 l 5 I I. 0 \ I . \
Date received: 7 Z/ -03 Permit no.: �/ . , 9/ 00 3 , 3
y ' „ • j; C of Tigard' � l J
1i ga d 2� P no.: Expire date:
City of Tigard Address: 13125 S W Hall B t R 3
Phone: (503) 639_4171 CITY OF,TIGARD Date issued: f� Receipt no.: qi
(50�5 11 ° i Vii, :' ( Case file no.: Payment type:
Land use approval: 1842 family: Simple Complex: LP
Il • OF I'Elt :AMii
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
;i( Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
.I O It Sill .: I NI VI I O N
Job address: / , / r (/ aid or ' 'I .. Bld no.: Suite no.:
Lot: Block: Subdivision: fl' Tax map /tax lot/account no.: �, j I D, -Dµ rlll
Project name: A �.e .;,, ` , u • i - , / — —
Description and location of work on p - mises/special condi 'ons: _ i- f e " / � i _,/ i , ,_ # 5L s `roust
/./ ♦ / _ii '. I . . 7 / L1 IF
O „!NI :11 I (11? Sl'l (I \I. INFORAIA IION. t Sl. (111A 1:1,1S"I
Name: 1Oi)I, i al-, , reF 0 es (I I idpi: iin .;epticc :ipacitt.ail :lr.(lc.)
Mailing address: / , , ' k 1 & 2 family dwelling � .
� Q i i r q 3 g
State:O( ZIP: Valuation of work $ / 00 f \
Phone: , y a ' 4 4 . Fax: i i . • • fl0 ;, t r , _ P j / No. of bedrooms/baths t
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.).... ` re elip..)
:u' 1' I.1( a Nl Garage/carport area (sq. ft.) ( ///
Name: / v id V Lai i ref 11/4p (p$ Covered porch area (sq. ft.)
Mailing address: • , 30 51.c gllnIIIIIII Deck area (sq. ft.)
City: 1 . Are State:O r ZIP: • 1, 3 other structure area (sq. ft.)
Phone: a __ a Fax: E -mail: Commerciallindust iaUmtilti- fandly:
( O.NI-IR :,(`1011 Valuation of work $
Business name: Existing bldg. area (sq. ft.) 1
/ New bldg. area (sq. ft.)
Address:
City: State: ZIP: Number of stories
Phone: Fax: E -mail: Type of construction
CCB no.: Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
,l 11 C 1 I 1 l I ( I / I )1 S I (. \' I :Il licensed with the Oregon Construction Contractors Board under
Name: 120 ber+ Leh 'DeSt ' provisions of ORS 701 and may be required to be licensed in the
Address: dig l jurisdiction where work is being performed. If the applicant is
_M` , : ZIP: • 1_ I 1 exempt from licensing, the following reason applies:
Contact person: Ro bte+ 1-t bir ly Plan no.: ire . - ' - L , ,
Phone: : y 1Mi. j -mail:
1.NGIN1.111 QLFI('I: tsl (.) \L,
Name: °. tiler+ L be Contact person• ber4 r, , , Fees due upon application $
Address: - N , r n Date received:
State: (9r ZIP: • 7 , _ 3 Amount received $
Phone: , I, 3 , ' . L.T -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa CI MasterCard
work will be complied with, whether specified herein or not. Credit card number: / / •
Expires
Authorized signature: Date: Name of cardholder as shown on credit card
$
Print name:
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00/COM)
•
Plumbing Permit Application I
Date received: Permit no. j3-003 7
1 �!� City of Tigard O �l Sewer t no.: Buildin
-�` Address: 13125 SW Hall Bl 97223 f i g permit no.:
City of Ti Phone: (503) 639 -417 Project/appl. no.: Expire date:
Fax: 503 598 -19 0�
Fax: ( 503) 1 ^ LO Date issued: By: Receipt no.:
Land use approval: �u• .� Case file no.: Payment type:
0 1 & 2 family dwelling or accessory ial/industrial Cl Multi- family 13 Tenant improvement '
O New construction Addition/alteration /replacement Cl Food service 0 Other:
.1011 SII f: I!NFC)12! \I:\ I 1 l:E St Ili. )l 1.1. (for .pccin! information ti.c clicclaist)
Job address: ► , I 510 P • 'k Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and -'S'l • dwe ! , • only:
Tax map /tax lot/account no.: 3 PA - 04+00
(Includes 100 th for each utility connection)
Block: Subdivision: ( ) SFR ��jf S( f �•� �� SFR (2) bath
Project name: �J SFR (3) bath
City/county: T rd Wa hI IP: .343 Each additional bath/kitchen
ri lion anl'u?cati n of work_ a' premtises: kj./'� ri,iwwdeJ Site utilities:
('.a;t 1/1A 4 - 1: Catch basin/area drain
Est. date of completiotUinspection: Drywells/leach line/trench drain
Fo oting drain (no. lin. ft.)
Manufactured home utilities
Business name: 0 bOI)er Manholes '
Address: Rain drain connector /
City: I State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Print Back flow preventer
rint name: Date:
Backwater valve
Basins/lavatory
Name: Clothes washer
Dishwasher
City: dress: I State: I ZIP: Drinking fountain(s) '
Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): D Id a• M a( ref ?JDles . Floor drains/floor sinks/hub
k Garbage disposal l
Mailing address:- /ago 5 Hose bibb
City: - gard State:Cr I ZIP: q 70,93 Ice maker
Phone: 7 o,4D765 Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as ORS apter 447. Sink(s), basin(s), lays(s)
Owner's signature Date: Sump
Tubs/shower /shower pan
Name: Urinal
Address: Water closet •
Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee u $
13 visa O MasterC expires
ard if a permit is not obtained Plan review (at _ /o) $ Credit card number. / / within 180 days after it has been State surcharge ( 8a /o ) "" $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount
440-4616 (6/00/COM)
MechanicalPermit ' 1 ; tion �(_ � I: r
Date received: Permit no.: ' r 3 -003
City of Tigar
- x:61 ?fr `J b � ��(�`� Project/appl. no.: Expire date:
City of regard Address: 13125 SW Ha vd, Tigart�O�t �'$$`L'3 Date issued: By: Receipt no.:
Fax: (503) 5983971 , �� ,Nt '' SOO Case file no.: Payment type:
Land use approval: C+� ��C1 Building permit no.:
111'1: OF I'1 12 111'1
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family . 0 Tenant improvement
0 New construction gAddition /alteration/replacement ❑ Other:
JOB SI I I INI 0101: \l ION (O; \1 )II:R('INI. \: \L1: IION SCI11 :1)1 1.1
Job address: /)j 2{) Su) /ark 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.: ,, 5 A l - d A / profit. Value $ .
Lot: III Block: Subdivision: 1 ,�! , m- *See checklist for important application information and
Project name: 1 9 e ' ' • d' jurisdiction's fee schedule for residential permit fee.
City/county' h / 15 /N ;! LI ZIP: .i• � ,;t "1 1 „,„, 18 21 :\ NI11.1 I) ■% 11.1.I \( 1'1:12111 f III S( III•)(.I.I
Description and locati of or. •n premises: i /I /L !_ . : \.\I ) (:O\I)II-ItIt\HINDI SI1U.ti. L(2t1I')11:: M 11111)t.I.I-
/Y1,01/'6 ' rii. i D fit, of 7 7.1,5 rte ' Fee(ea.) Total
Est. date of completion inspection: Description Qty. • only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? Ill! Yes 0 No Air handling CFM
Air conditioning
(site plan required)
Is existing space insulated? CV Yes 0 No Alteration of existing HVAC system
All:(IIANICAI (O \f12: \( f012 Boiler /compressors
State boiler permit no.:
Business name:
OW 1V E HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: r11i ►rep ace 177177.7 ' ■ • er B l ' -
CCB no.: Including ductwork/vent liner 1=1 Yes ❑ No
Mr ocate .eaters – suspen
City/metro lic. no.: wall, or floor mounted
Name (please print): . . Vent for appliance other than furnace
C( \' I:\(`1 1'I:Its(\ Re– ig'r
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
•
Environmental exhaust and vendladom
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
O\, \'I:12 Hoods, Type 1/ 11/res. kitchen/hazmat III__
hood fire suppression system
. - Name: Da.1) k( I - LLE J . L ! I t Exhaust - fan with single duct (bath fans) -__
Mailing address: IOI030 , D !aft Exhaust em apart from heating or AC =
City: mil, / rd_ I Sttate:OTt„ I ZIP97at Fuel piping and distribution (up to 4 outlets) .
cm, Type: LPG NG Oil
Phone: •' ,. • _ Fax: E AO ley i , P L . ' - Fuel .i . in : each additional over 4 outlets = --
I= \•(.INI::I:12 ' , p , (schematic required) M
Name: Number of outlets -
11 , r 1, ap , t or eq ' , relent:
Address: Decorative fireplace
City: I State: I ZIP: Insert – type
Phone: Fax: I E - mail: Woodstove/pellet stove
Applicant's signature i 1 ; I / / . Date:
Other:
A
PP � � _ �. - ! , i _ � Other. MI
Name (print): l ! r �`a -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number. / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
$ Cardholder signature Amount 440 -4617 (6 /00/COM)
( > l( .� . 1\ I
Permit no.: (y 03 T) 37 3
"' Electrical Permit Application
'' Cl of Tigard Date received
Pro ecda I no.: Expire date:
4� ••I i City b 1 PP • P
City of Tigard Address: 13125 SW Hall 1 ie4 223 Date issued: By: Receipt no.:
Phone: (503) 639 �J
Fax: (503) 598 -1960 ^003 Case file no.: Payment type:
Land use approval: 0\'' 1 ` 6 G PQi0
❑ 1 & 2 family dwelling or accessory rcial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction Addition/alteration/replacement ❑ Other: ❑ Partial
Job address: I Din 3o 50 ar Bld4. no.: Suite no.: Tax map /tax lot/account no.:05 it 3( — bU
Lot: 3 Block: y�� Subdivision: # Mil
Project name: &D s K n k-i I Description and Acation of work on premises: Seis/let! Maido/kilhefi Mudd
Estimated date of completion/inspection:
('ON lit : \CIOlt Al'I'I.I( \ FI:F: ti( :IIE1)1 : 1.11
Job no: (91 J, N 612.... Fee Max
Business name: Desatpdon Qty. (ea.) Total no. imp
Address: •
New r al �earmdtl- family per
ftweningtmitindadesattat 6edgarege.
City: 'State: I ZIP: Serriceboeoded:
Phone: 1 Fax: E -mail: loop sq. ft. or less 4
CCB no.: I Elec. bus. lic. no: Each additional 500 sq. ft or portion thereof
Limited energy, residential 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): License no: Servlcesor feeders — Installation,
alteration or relocations
l 200 amps or less l 2
Name (print): T)A�id 4 MQrre�' /10/ 5 201 amps to 400 amps 2
Mailing 401 amps to 600 amps 2
g address: !D(030 C'.� J f424.-k, 601 amps to 1000 amps 2
City: -'1 d Stateer ZIP: q 1aa3 Over 1000 amps or volts 2
Phone: � ( pao7%.3 (Fax: (E -mail: Reconnect only
Owner installation: The installation is being made on property I own Temporary servicesor feeders -
which is not intended for sale, lease, rent, or exchange according to hon,aiteradon,or'Macadam
ORS 447, 455, 47 , 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signa Date: ( 401 to 600 amps 2
Branch circuits - new, alteration,
Name: or extension per panel: A. Fee for branch circuits with purchase of �
Address: service or feeder fee, each branch circuit (/ 2
City: `State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail' of service or feeder fee, first branch circuit 2
Each additional branch circuit
P I . . - N Rll\ IF.,, (Please check :ill that :ipplr) Me. (Service or feeder not included):
O Service over 225 corps- commercial O Health -care faality Each pump or irrigation circle 2
O Service over 320 amps - rating of l&2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan O Other: Per inspection I I
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 $
O Visa O MasterCard expires if a pewit is not obtained Plan review (at _ %) $
Credit card number. / / within 180 days after it has been State surcharge (8 %) S
Ex TOTAL $
Name of cardholder as shown on credit card accepted CO�lete
$
Cardholder signature Amount 440.4615 (6/00 /COM)
.1
CIeanWate Services JUL 2 3 2003
Our commitment is clear. File Number 1 32. 65 I
By TT„'— - = Pre - Screening Site Assessment
Jurisdiction i` Date 7 a l -
Map & Tax Lot 4 Owner 7.1'1 Vt d t /l�or�o/�ef /VQ k3
Site Address /0/030 Su) ark
rd Dr@ ei79013 Contact 0 30 ,S& ParK
ProposedActivityltoo' itat4o, add. -¢o Address 9erd ore q1? 3
/GGlkhe>? rt'mtritI
Phone 503_ tap-1553
Official use only below this Use
Y N NA Y N NA
❑ _ ❑ Sensitive Area Composite Map Storrnwater Infrastructure maps
Map # 5 /1U4 QS# 1 i18
Y N NA Y N NA
❑ ❑ ® Locally adopted studies or maps ri ❑ ❑ Other
Specify Specify ;Loos, t4 „Jam,
Based on a review of the above information and the requirements of Clean Water Services
Design and Construction Standards Resolution and Order No. 00 -7:
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST
PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER
LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or
within 200 feet on adjacent properties, a Natural Resources Assessment Report may also
be required.
® Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect water
quality sensitive areas if they are subsequently discovered on your property. NO
FURTHER. SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS
FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION
PERMIT.
❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
6 c. i'e elf on vev; e.4) i 2 at. vie of p kyrel porunriall/ f•ser:Ave
Ar,e�
d `. sr air'Pete TO ePJSo' ...a 174:4. :L oo Aye N
Reviewed By: Date: -ex. / 3
Returned to Applicant
Mail,_ Fax Counter
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Date 7/ xylo By
Phone: (503) 846 -8621 • Fax: (503) 846 -3525
www.cleanwaterservices. org
•
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (5Q3) 639 -4175 (4 -
DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested '//l AM F PM BUP
Location Suite MEC
Contact Person 21.1P Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDS Tenant/Owner ELC
, oo�fing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: //ll SIT
Post & Beam �U
Shear Anchors /� u " �t
Ext Sheath/Shear 0/l[ O/! /,C,(� g 3-
Int Sheath/Shear .V66.--0
Framing `"
Insulation Z E a�
-1;7.p – ��--o - � ' 5r
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �G' 7/c'®
Susp'd Ceiling
Roof
O.=
.' AIL
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
Rough -In
UG/Slab
Low Voltage
Fire Alarm
`Inal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PA SS PART FAIL
SITE D Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA & Date ¢ Inspector Ext
Approach/Sidewalk p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD . 24 -Hour
BUILDING 0 Inspection Line: (503) 639 -4175 , 1 MST '" —00373
INSPECTION DIVISION Business Line: (503) 639-4171
BUP
Received Date Requested /o — e AM PM BUP
Location /o 636 Suite MEC
Contact Person Ph ( ) 3/e-6 q l'q PLM
Contractor Ph ( ) SWR •
ILDING Tenant/Owner ELC
Fo
ELC
Foundation -
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
. in:
�aion
' _ _ ding
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
11 17,7 - PART FAIL
P.' MBI1NG
Pos : -Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pa q "t v+
Other: )6
oral
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
D EL cE t
ery
Low Voltage
Fire Alarm
F Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
SIDE 0 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line /� am
ADA D /2/ l7 ! / D Ins ector / 0 y / Ext
Approach/Sidewalk p
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
3 — 60 3 73
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�[ /I BUP
Received Date Requested /6 — a ( AM PM __ SUP
Location /t 6o 3 d r C ..dam Suite MEC
Contact Person Ph ( ) 6 Z V 15 S -3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: v 1 , 1
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam a - 00 — 3
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler j
Fire Alarm
Susp'd Ceiling
Roof k776(_
Other:
Final
__PASS PART FAIL
Post & Beam
Un• _ - -.•
•ou•• n
e ater Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
F'•
•ASS *ART- __FAIL
(_ T r ANIC I • • _ n
Gas Line
Smoke Dampers
Fi
PA PART FAIL
CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ( /hi / U 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL