Permit CITY O F T I G A R D MASTER PERMIT
PERMIT #: MST2002 -00079
ql� DEVELOPMENT SERVICES DATE ISSUED: 8/29/02
" �,� I- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13058 SW PRINCETON LN PARCEL: 2S104DA -20400
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 030 JURISDICTION: TIG
REMARKS: SF rowhouse,Unit #30,BIdg 6, AS plan. STRUCTURAL FILL, REQUIRES GEO -TECH INSPECTION
AND REPORTS
BUILDING
REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: 320 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 744 sf GARAGE: 412 sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: 732 6f RIGHT:
VALUE: $ 173,305.60
OCCUPANCY GRP: R3 BDRM: 2 BATH: 3 TOTAL: 1,796.00 sf REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: 1 BOIL/CMP < BHP: VENT FANS: 4 CLOTHES DRYER: 1
LPG FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 1 0 • 200 amp: W /SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 3 201 • 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: 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+ 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 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 6 SYSTEMS:
Owner Contractor TOTAL FEES: $ 6,099.33
This permit is subject to the regulations contained i the
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES, LLC Codes all other Municipal Code, State work k w l be Codes and
12670 SW 68TH PKWY STE 200 12670 SW 68TH PKWY all other applicable laws. All work will by done i
PORTLAND, OR 97223 PORTLAND, OR 97223 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:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rep #: LIC 124627 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
Sewer Inspection Plm /undslb Insp Framing Insp Firewall Insp Electrical Final
Footing Insp Electrical Service Gas Line Insp Gyp Board Insp Plumb Final
Foundation Insp Electrical Rough -in Insulation Insp Rain Drain Insp Mechanical Final
Wtr Proofing Bsm't Wa Mechanical Insp Shear Wall Insp Water Line Insp Building Final
Slab Insp Plumbing Top Out Exterior Sheathing Ins l Smoke Detector Final inspection
Issued By Q5/21_21221,4 P ermittee Signature :.f►mm.....— �� •
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Po -cca55
• Building Permit Application , .
;1 =;� City of Tigard
Date received: y 09-- Permit no.: K st -aiv77
Address: 13125 SW Hall Blvd, T CEI 'Y E D Project/appl• no.: ' date:
City of Tigard Phone: (503) 639 -4171 Date issued: • Receipt no.:
Fax: (503) 598 -1960 FEB - A 2OF12 Case file no.: Payment type:
Land use approval: city of Tm( tA R D l &2 family: Simple Complex:
1YPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other.
JOB SITE INFORMATION
Job address: / 3 r 6 ' S w ' ` e4 • Bldg. no.: Suite no.:
Lot: 0 Block: Subdivision: Tax ma r /tax ot/account no.: A5 ` p VA -lab go
Project name:
Description and location of work on premises/special conditions:
•
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: r of`p •_ _ tl• ,,,., s J (Floodplain,septic capacity,solar, etc.)
Mailing address: to . , IN OI _ _..1 & 2 family dwelling:
City: "p ,..-41,- ,1 State:OR ZIP: • Valuation of work $
Phone• ' ; - _ i E -mail: No. of bedrooms/baths
Owner's representative: 139RINVE Total number of floors
Phone: g ; e ViZMYMEM E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Covered porch area (sq. ft.)
Mailing address: • • SCt) _ . Et, iA_ . _ ,L Deck area (sq. ft.)
_ n Z i.. 9 s Other structure area (s I . ft.)
Phone: - ,9-.. ` 65 Fax: E- mail: Commercial/Industrial/multi-family:
CONTRACTOR Valuation of work $
Business name: Existing bldg. area (sq. ft.)
�' O � t New bldg. area (sq. ft.)
Address: „ • _ • $'W tm,_�_ �u
m StateOlk to ) M1 Number o stories
• � Type of construction
Phone S . • - _ . - Fax:62.o - _�
no.:
.3g(f� Occupancy gro E
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: G G Lc provisions of ORS 701 and may be required to be licensed in the
Address: r v �, _ St._� }� O jurisdiction where work is, being performed. If the applicant is
fi , ' exempt from licensing, the following reason applies:
a•
Contact person: .1 ., - u . t r,, . .__: Plan no.: ,
Phone: _ . , E-mail: : =
ENGINEER
Contact person: II ,. , Fees due upon application $
Address: , • • • s (,V ,.,,, , a . - cA-rcc4' Date received:
r : ZIP: -"JAW. Amount received $
Phone: _ ,D, - p Fax: E -mail: - Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictioos accept =lit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and'ordinances governing this ❑,visa o MasterCard
work will be complied • • whether , .,reed herein or not Credit card number: //
Authorized sign —
. re: � :. . Name of cardholder as shown on credit card
Print name: e - cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4104613 (6 /001OOM)
•
• A . Plumbing•Permit Application
Date received: Permit no.: M5 0. 00 2- 0 0011
' ' City Of Sewer t no.: Buildin permit no.: • �' — Address: 13125 SW Hall Blvd, Tigard, OR 97223 P� 8 P
Cuyogard Phone: (503) 6394171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction O Addition/alteration /replacement 0 Food service 0 Other.
JOB SITE INFORMATION FEE SCIIEDULE (for special iuforn ation use checklist)
Job address: 13O'8 SW ar i-Ar e-t-n,. (_a. c,..s. Description Qty. Fee(ea.) Total
Bldg. no.: Suite ao.: New 1- and 2- family dwellings only
(includes 100 a. for each utility connection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: 3 P I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City/county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain .
PLUMBING CONTRACTOR
Footing drain (no. kin. ft.)
Manufactured home utilities
Rneinace name• Manholes -
Wolcott Plumbing Rain drain connector
PO Box 2007 Sanitary sewer (no. lin. ft.)
Gresham OR 97030 -0594 Storm sewer (no. lin. ft.)
503- 667 -1781 Water service (no. lin. ft.)
CCB:23847 PLM #:26 -208PB Fixture of Item:
Contractor's representative signature: - -
' Absorption Back flow valve
c flow preventer
Print name: Date: Backwater valve •
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: [ State: . I ZIP: Ejectors/sump
Phone: Fax: E-mail: Expansion tank .
OWNER Fixture/sewer cap
Name (print): Floor drains/floor sinks/hub
Garbage disposal
Mailing address:
Hose bibb
City: I State: IMP: Ice maker
Phone: I Fax: I E-mail: Interceptodgreaase 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 per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/showedshower pan - °-
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other.
Phone: I Fax: I E-mail: Total
'Nat all Judedimiorn accept ark cads, please call judadicdoo for more krformilica e Notice: This perm application Minimum fee $
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ 9b) $
ae6t card somber : --/---/-- within 180 days after it has ban State surcharge (8%) .... $
Earns Name d acdhotder a Moms m Una acct
accepted as complete. TOTAL »... $
S
Cardholder s Ammar , • 4444616 (6100V0014)
•
•
Mechanical Permit Application
. A Date received: Permit no. } 15r2 00 2 - () ;fl yd •
. City of Tigard
X 1,1.0 g P roject/appl.no.: Exphedate: •
Cityogard Address: 13125 SW Hall Blvd, Tigard OR 97223 •
Phone: (503) 639 -417 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: , Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCIIEDULE
Job address: so...) Pr i k,41... , v. ( moo, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ .
Lot: 30 IBlock: I Subdivision: *See checklist for important application information and
Project name: . jurisdiction's fee schedule for residential permit fee.
City /county: - I ZIP: 1 & 2 FAMILY DWELLING PERT lI1' FEE SCHEDULE
Description and location of work on premises: - AND COMMERICALIINDUSTRIA1 EQCIPMENTSCIIEDULE
Fee(ea.) Total
Esi date of completionrnspection: Desaiption Qty. Res.only Res.only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? 0 Y es 0 N Air handling unit CFM
g P Air conditioning (site plan required) .
Is existing space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
r _ : MECHANICAL CONTRACTOR : , iler compressors
State boiler permit no.:
Four Seasons Heating & A/C Service Inc - HP Tons BTU/H
_ Fire/smoke Box 66409 re /smokedampers/duct smoke detectors
Heat pump (site plan required)
Portland OR 97290 -6409 - Install/replace furnace/burner BTU/H
503- 775 -5919 - Including ductwork/vent liner CI Yes ENo
CCB: 48283 _ IrWalI/replacefrelocateheaters- suspended,
wall, or floor mounted
Name (please print): Vent for appliance other than furnace -
CONTACT PERSON Absorption units BTU/H
Name: i Chillers . HP
/ • III, ressors HP
Address: a. . mnentaLexhaust and ventilation:
City: • I State: I ZIP: Appliance vent
Phone: Fax: ' E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitche z ar
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system =from heating or AC
City: I State: ZIP: Fuel Piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel i ing each additional over 4 outlets
p (schematic required)
• Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: State: ZIP: - Insert -type
Phone: 1 Fax: E-mail: Woodstove/pellet stove
Other:
Applicant's signature: . I Date: Omer:
Name (print): .
N« u h
acisd m ietro accept «odic cards, please call iwiadiam i rcr mae lafamratiaa Permit fee .. $
0 Visa Cl MasterCard Notice: This permit application f M $
/ expires if a permit is not obtained Plan review (at _ %) $
art card O° E within 180 days after it has been
State surcharge (8%) sass $
Name or cardholder as shown on credit card s accepted as complete. irdrM $
Cardholder signature Amo®t 440 -4617 (6,V + M)
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2002 -00079
Date Issued: 8/29/02
Parcel: 2S1 04DA -20400
Site Address: 13058 SW PRINCETON LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 030
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse,Unit #30,BIdg 6, AS plan. STRUCTURAL FILL, REQUIRES
GEO -TECH INSPECTION AND REPORTS
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LLC WOLCOTT PLUMBING CONTRACTOR;
12670 SW 68TH PKWY STE 200 PO BOX 2007
PORTLAND, OR 97223 GRESHAM, OR 97030
Phone #: 503 - 598 -7565 Phone #: 667 -1781
Reg #: LIC 23847
PLM 26 -208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signatu�: Autr ed Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310
•
•
CITY OF TIGARD 3-{
13125 S.W. HALL BLVD,
TIGARD, OR 97223 •
IMPORTANT PERMIT NOTICE .
DAVID JEROME ELECTRIC •
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2002 -00079
Date Issued: 8129102
Parcel: 2S104DA -20400 .
Site Address: 13058 SW PRINCETON LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 030
Jurisdiction: TIG
Zoning: R4.5
Remarks: SF rowhouse,Unit #30,BIdg 6, AS plan. STRUCTURAL FILL, REQUIRES
GEO -TECH INSPECTION AND REPORTS
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:
BROWNSTONE QUAIL HOLLOW LLC DAVID JEROME ELECTRIC
12670 SW 68TH PKWY STE 200 PO BOX 751
PORTLAND, OR 97223 HILLSBORO, OR 97123
Phone #: 503 - 598 -7565 hone #: 648 -5144
Reg #: LTC 36051
SUP 2877S
ELE 34119C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
c,
Signature of Supervi n cian
If you have any questions, please call (503) 639-4171, ext. #
V it-
tool MN 9a'ffi Q?IVDX,L 30 A.LiO T99t 9CO WI 02: I I&I Co /ot /to
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CITY OFiGARD 24 -Hour
EMILDING J Inspection Line: (503) • 9-4 5 MST a -'d° 74?
INSPECTION DIVISION Business Line: (50 6 e 171 -
BUP
Received Date Re nested J • BUP
Location / 30 Sg r Suite MEC
Contact Person Ph ( ) 7 3 S3 y 5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: d 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:
; AS - PART FAIL /
• BING
Post & Beam
Under Slab
Rough -In 111
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
S i' • e Dampers
PART FAIL
CTRICAL
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 ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
C / `
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) 639 -4175 MST -o2o
INSPECTION DIVISION Business Line: (503) 639 -4171 •
BUP
Received Dat '' R �� equeste . '� AM PM BUP
Location O3 ,r` Suite MEC
Contact Person reti✓1 Ph ( 174 yS 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
c.;PC_U10IBINCj)
a
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth - r:
1s 1 ; 711. AO
PA . - PART FAIL
CHANICAL
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
Approach/Sidewalk Dat �a� 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 a —
INSPECTION DIVI • Business Line: (503) 639 -4171
BUP
Received r equested Date S / AM PM BUP
30 Cg Date
_
Location rih �>/� Suite MEC
Contact Person 7i"i Ph ( ) 79 537' S PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
galgagiW
e
Rough -In
Low Voltage L.v r IKY) L ��►-j 67) w\ 3
Fire Alarm
SS ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 111 Please call for reinsp- tion RE: ,Unable to inspect – no access
Fire Supply Line
ADA Ext
Approach/Sidewalk Date Inspector 0 _ ■
Other: /
Final DO NOT REMOVE this inspection record fr m the site.
PASS PART FAIL