Permit C ITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00444
111 DEVELOPMENT SERVICES DATE ISSUED: 1/6/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13101 SW ST. JAMES LN PARCEL: 2S109AB -07300
SUBDIVISION: RAVEN RIDGE ZONING: R -
BLOCK: LOT: 002 JURISDICTION: TIG
REMARKS: Construction of new SF Detached residence. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 15 FIRST: 1,535 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,018 sf GARAGE: 420 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 Twls: sf RIGHT: 5
VALUE: 248,842.20
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,553 sf REAR: 62
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 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: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
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 FD R: PUMP/IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps -1000v MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO E. STEREO: X VACUUM SYSTEM: X AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: X OTH: ALL ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
•
HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,555.00
DECAL CUSTOM HOMES DECAL CUSTOM HOMES LLC This permit Municipal al C ode subject , State the regulations contained Co i ode s and
the
2345 6TH ST. 2345 SIXTH STREET all other Muncipal C, work will ill by Specialty Codes
COLUMBIA CITY, OR 97018 COLUMBIA CITY, OR 97018 all oher applicable laws. All w
v ok w done i
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 366 - 0797 Phone: 503 366 - 0797 Oregon Utility Notification Center. Those rules are set
forth in OAR 952- 001 -0010 through 952- 001 -0080. You
Reg #: LIC 147174 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp & Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Sprinkler Final
Grading Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insi Rain drain Insp Elec • - inal
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line • : • echani - Final
Foundation Insp Footing /Foundation Dn Electrical Rough In Gas Line Insp • '• - - ou• • 'Iumb F al
Issued By : `, , , ...1 /. _A . /!0 Permittee Sign -.- 411111L-2
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed e next business day
• p cL 17( -/ -a2- it Zw - av
, ' Building Permit Application
Datereceived: / -
� 2S o2 - Permit no.: S c /� - -mtvvq'
City of Tigard .. - , `K�G� 7 A.,,,,,,., - Address: 13125 SW Hall Blvd Ti gaid v � , P rojectiappl.no.: Expire date:
City of Tigard '
Phone: (503) 639 - 4171 `i , Date issued: By ' l Receipt no.:
Fax: (503) 598 -1960 O CT 2O�12 Case file no.: Payment type: I
Land use approval: It t ` - : . 1 &2 family: Simple Complex: l)v
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition /alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: - /(3' u) - nHMMIIIMIIMIIIIMIII Bldg. no.: Suite no.:
Lot: 0 2_ Block: Subdivision: ' • ) ' o Tax map/tax lot/account no.: A6 -07 •
Project name: r • t/ j'J ' p(yit_
Description and location of work on premises/special conditions: &) C.b# ,1 Qc)C1tb.l S !N3t 4404
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST -
Name: 11 KA(_ COSE'e • /LS LLC . (Floodplain, septic capacity, solar, etc.) ,
Mailing address: e2 1 C.I:C, -. 1 & 2 family dwelling:
City: Cc7i...01 '.6 .11 j State js 0 2 ZIP: l y Valuation of work $ 2 0/45 1 1Z.
Phone *- CO S Fax 34 C. "D8id E -m No. of bedrooms/baths ___Y__.
Owner's representative: *ALA_ 44 C1.6 j.+1. Total number of floors Z. _
Phone., 6 -- I Fax: C. - CV E New dwelling area (sq. ft.) oZ,5
APPLICANT Gatagelcarport area (sq. ft.) ylo
Name: it, CA (.... Cte1/4).S.. Covered porch area (sq. ft.) —
Mailing address: 641‘. -. Deck area (sq. ft_) , /tr.dg
City CoLovsN, b r rt z(.1 I Stater I ZIP: C70 Other structure area (sq. ft.)
Phone: 344, —err/ , . Fax . X 4.Crac, E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
Business name: ■ CAL- ( )5��.JC.- „ Existing bldg. area (sq. ft.)
Address: ( < New bldg. area (sq. ft.)
City: . ' Sta ZIP: 20l Number of stories
Phone:34 4... ax� .G�y(d E -mail: Type of construction
CCI3 no.: �a7 t.( Occupancy group(s): Existing:
pi
New:
City /metro lie. no.: 6,16, Ce Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 5rkffjCf SAIA OM' At x,Bpte,4c,Q s provisions of ORS 701 and may be required to be licensed in the
Address: 'ii') s(A.5 - 5rAnie-44 Sr{ • jurisdiction where work is being performed. If the applicant is
City: A,,,4 N Statc:OeIZIP: C/704 2... exempt from licensing, the following reason applies:
Contact rson: p.tO.t Plan no.:
Phone: 6 11- 0800 Fax: E -mail:
, ENGINEER
Name: %A t- .A.,(^) . of A Contact person: Fees due upon application $
Address: gZ sr VrC€ • s . Date received:
City- S r /j.� • Istate• 1ZIP :g 7fC l • Amount received $
_Phoic 21_3 !e4 ]Fax v3 -3$07 E -mail: Please refer to fee schedule.
I hereby certify I have read and ex . • ' ' _W hi : pplicatio and the Na all o audit te
juri� iedona f t as, please cart jurisdiction for more information.
attached checklist. All provisio n s and .rdinance :overning this O Visa O MasterCard
work will be complied wi specif • herein • not. credit card aumeer —� ii
Eximas
Authorized • tune a ate: �0 /OZf 241 2. Name of cardholder u showw on credit card
Print name: . _ — ,/I[._ - ,. _ s S ld -
Cardboer signalize Amo
s. - -- tml �
Notice: This petrinit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 4619 (6A)o oM)
VI /V1 /LV VL .aV ry a/a/• •rv• ..- - - V - -
1
• Mechanical Permi Application •
_ Date received: Permit no.: �a� -X'
U-
City of Tigard -
1 Pro ect/e ! no.: Expire date:
of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 •
City J 8 Phone: (503) 639 - 4171 Date issued: By: l 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.
JOR SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
lob address: J 3 /0/ .5 c i 5`F- TC.Wt.ir.0 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 $ 37(ec :CO .
Lot: Block: J Subdivision: gild*) P/QGC, ' See checklist for important application information and
Project name: JO '1ti4}1,, jurisdiction's fee schedule for residential permit fee.
City /counly: lI-JA- I ZIP: 1 & 2 FAMILY DWELLING PERMIT FIDE SCHEDULE
Description and location of work on premises: AND COMMERICAIJINDUSIRIAL EQUIPIMIENTSCIIEDULE
Fee(ea.) Total
Est. date of completion/inspection: . . Description Qty. Res. only Res. only
Tenant improvement or change of user HVAC: �d I
Is existing space heated or conditioned? 0 Yes (No Air handling unit�fl CFM
/ Air conditioning (site plan required)
Is existing space insulated? 0 Yes • o • Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: / ��) State boiler permit no.:
. .jrz:i:u HP Tons BTU /H •
Address: V O g ox • 36 Pire/smoke dampers/duct smoke detec tors
City: 62, 40 State e ZIP: ' Oi - Heat pump (site plan require.
Phone: i 9 / 5' s31?... Fax: / ' $= ` ' , E - mail: nstalUreplace furnace/burner : f /H
�y Including ductwork /vent liner 0 Yes 0 No
CCB no.: 1Sf9 � �� L Install/replace/relocate heaters -suspended,
City /metro lic. no.: wall, or floor mounted _
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: 'jam L._ /14L - �olah. () kj . Arm) , J - Chillers HP
Address: s Ac f ( Co •ressors HP
Environmental exhaust and ventilation:
City: (oci_ %6r,a► C4 i y I stated d_ ] ZIP: q)a /8 Appliance vent Z
Phone 69 —/b7') Fax:3G(4 - b$iO E-mail: •�,..aNK� • Dryer exhaust .
OwwE<t Hoods, Type I/ II/res. kitchen/hazmat •
hood fire suppression system .
Name: it y . ■ a ar I Exhaust fan with single duct (bath fans)
Mailing address: V AO Exhaust system a Sart from seating or AC
970/ e p p. g and button (up to 4 outlets] 3
City: it CIfy State a ' ZIP: i Ty LPG NG Oil
Phone .0 - 7 Fax: , O • E-mail: ue pipmgeac additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: - Number of outlets
� - r Ot ■ er 1 . app . ce or egtupment:
Address: yL "2 -Si 044 44 s a Decorative fireplace
City: sl, t{ I State e 1ZIP: ! 2 ' ( Insert -type
Phone: _ y Fax: ;r . 7. .., , `.'l: T' oodstove/pelletstove • — Other.
Applicant's signature: �_�� ig Other _
Name (print): rogr"
Nos au imisdicuom accept credit card:, please call PM/diction for mare informeioa Permit fee $
O Visa O MasterCard Notice: This permit application mi 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%) .... $
Nude d cardholder as shown on credit card s accepted as complete. TOTAL $ ---
` Cardholder sianahne Amami , 440-4617 (6#OO OM)
V! /J1 /LVVL 1V.G1 r'AA JVJUUYA GOB z ' - — -
. A Electrical Permit Applicat
Date received: Permit no.: M57ag0 y-- poi /
J 4. All City of Tigard Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: 1 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: •
TYPE OF PERMIT
& 2 family dwelling or accessory 0 Commercial/industrial O Multi family ❑Tenant improvement
New construction 0 Addition/alteration/replacement 0 Other: O Partial
JOB SITE INFORMATION
Job address: 13 /Q / &t Jun.,e4 pi._ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: a I Block: ]Subdivision: A (wJ — • Zea
Project name: No44/ Pj rc_ I Descri .tion and location of work on premises: / A%) 6d l e )C,i ot_
Estimated date of completion/inspection: a) Z
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name:We /er -E+ 1 v Z .'L Description m Qty. (ea) Total no. insp
New residential - single or multi-family per
AddreAs: swag, 54,$ 54. /3r fis dwelling unit. Includes attached garage.
City0o it f (*N4D I State I ZIP:17 .Z3 c. Service induded: •
Phone:740_ IITlz I Fax: R1./8271E-mail: woo sq. ft. or less I 4
CCB no.: - / 0 7" I c 7 I Elec. bus. lic. no::. - 33 Z, t_ Each additional 500 sq. ft. or portion thereof / 2
� Limited energy. residential
City /metro lic. no.: p[4/7r Limited energy, non-residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Serviceand/or feeder 2
•
Sup. elect. name (print): i IL ( r(_, . , aa S ,,II License s Services or [seders— Installation,
e no: ' alteration or relocation: I
PROPERTY OWNER 200 amps or less ! 2
Name (print): , (,14L e O +O.A A . >KOINd(S LLL, 201 amps to 400 amps 2
401 amps to 600 amps
Mailing address: f4 .4- • 601 amps to 1000 amps 2
City:6C(h),440,4 C 1 I S tate:Q,� I ZIPCi7o, Over 1000 amps or volts 2
Phone - 0 17 Fax: IE -mail: I Reconnect only I
Owner installation: The installation is being made on property I own Temporaryservitesorfeeders -
which is not intended for sale, lease, rent, or exchange according to Jnstallatlan , dteretion , orrelocation: I
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2 •
Owner's signature: Date: t 401 to 600 amps • 2
Branch circuits - new, alteration,
• or extension per panel:
Name: �1�'� 14-5 C"^-) 3 h/4 , . A. Fee for branch circuits with purchase of
Address:SA r �� * = � P V, service or feeder fee, each branch circuit 2
City: I State: I ZIP: /t. /, . B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: , Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Mc. (Service or feeder not included):
O Service over 225 amps commercial 0 Health facility • Each pump or irrigation circle 2
O Service over 320 amps - rating of lea O Hazardous location Each signor outline lighting 2
family dwellings 0 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 0 Feeders, 400 amps or more *Description"
O Occupant load over 99 persons O Manufactured 'avenues or 1W park EJ1ch additional Inspection over the allowable In any of the above:
0 Egress/lightingplan 0 Other. Perinspection I I I I
Submit sets of plans with any of the above. ; Investigation fee
The above are not applicable to temporary construction service. _ Other •
` Na all jurisdictions a eept credit cards, please call Jurisdiction for mere information. Notice: This permit application Permit fee $
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit cant number. / / within 180 days after it has been State surcharge (8%) .... $
p accepted as complete. TOTAL $ -
Name of cardholder as shown on credit card
Cardholder 'laminae S Amount 440-4615 (6■00ICOM)
Uf /J1 /LUUL 10.L1 rnn uyvvy.,... - - -.. -- - --
Plumbing Permit Application _ /
Date received: Permit no.: c apipac t
. _44.'..1 it
City of Tigard
_ -y g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTigard Phone: (503) 639-4171 ProjecUappl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
Tl•PE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
p ew construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: / 3 /01 S +• jLtrA,e. ?L Description Qty. Fee(ea.) Total
New I- and 2- family dwellings only:
Bldg. no.: 1 Suite no.:. (Includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: E.4u4AJ E.,,b4 SFR (2) bath / {
Project name: tit"! E% SFR (3) bath
City/county: 17,444 // Z IP: Each additional bath/kitchen ,
Description and location of work on prrmises: Siteutilities:
LM (NSA Y:h0e J Catch basin/area drain •
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.) ?S
Manufactured home utilities
Business name: COM4t4 . yi kM S =.40t . Manholes
Address: 60 (4J• (Oj C 41/f,AMJte— Rain drain connector
City: l /6 0 444). I State pt I ZIP:97223 Sanitary sewer (no. lin. ft.) J e
Phone: Fax a E-mail: Storm sewer (no. lin. ft.) 10
�9� - ��� I �� -� Water service (no. lin. ft.) 3e
CCB no.: 13,6&3 I Plumb. bus. reg. no:
Fixture or item:
City/metro lic. no.: Absorption valve
Contractor's representative signature: Back flow preventer .
Print name: Date:' Backwater valve
CONTACT PERSON Basins/lavatory
Name: rV •�►�. Clothes washer /
• V Dishwasher
Address: a3`f S f 4 S} Drinking fountain(s)
City:60Lo a. A ei. I SAM-- I ZIP: 72 Ejectors/sump
Phonea0 9 -4)) Fax:3 4 -O8 /O E -mail: Expansion tank
OWNER Fixture/sewer cap •
• Name (print): CAL. Cod -f o� • - Garbage drains/floor sposal sinks/hub
Mailing address:,23yr S/7t4. 4 54- • Hose bibb
City: CA.A.b4V1r4 ('> y I State: pQ I ZIP: 97o/0 Ice maker l
Phone: 364 I Fax:3 .0gto 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 per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sum
Tubs/shower /shower pan •
Urinal
' Water closet
Water heater /
• t' C?‘" Other. ,.----
Phone: E-mail: Total
Minimum fee $
Pica all Jurisdiction' accept credit cards, please call jutisdicdm fai mote informatics. Notice: This permit application
Plan review (at _ %) $
O Visa O MasterCard
expires if a permit is not obtained State surcharge (8%) $ _—
Credit card number . w 180 days after it has be $
Name of cardholder as shown on credit card
tai accepted as complete. TOTAL
S 440-46t6 (6.000,0 Cardholder signature Amount
Tuesday, July 08, 2003 9:00 AM Plugs & Switches 503- 925 -0489 p.02
07407/2003 13:04 FAX 5035981960 CITY OF TIGARD Qh 002
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 RECEIVED
IMPORTANT PERMIT NOTICE JUL 0 8 2003
PLUGS & SWITCHES CITY OF TIGARD
P.O. BOX 111 BUILDING DIVISION
SHERWOOD, OR 97140
Electrical Signature Form
Permit #: M5T2002 -00444
Date Issued: 1/6/03
Parcel: 2S109AB -07300
Site Address: 13101 SW ST. JAMES LN
Subdivision: RAVEN RIDGE
Block: Lot: 002
Jurisdiction: TIG
Zoning: R -7
Remarks: Construction of new SF Detached residence. Path 1
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate Individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
DECAL CUSTOM HOMES PLUGS & SWITCHES
2345 6TH ST. P.O. BOX 111
COLUMBIA CITY, OR 97018 SHERWOOD, OR 97140
Phone #: 503 - 366 -0797 Phone #: 503 - 925 -8450
Req #: LAC 141529
ELE 34 - 527C
SUP 45465
AN INK SIGNATURE IS REQUIRED ON THIS FORM
1 , ! , , 0
x • :%
Sig , -' I re • 1 pervising Electrician
If you have any questions, please call 503.718.2433.
VIIJIil.VVL 1V.t.V (/1/• uvv vv'ir.i v+ . �� u -� -
FIXTURE UNIT WORKSHEET - WATER METER
Contractor Name ffC4( 1-6mirS
Billing Address c 23C/C s _wet, S.f •
(bL-0.V 4 CV ,0. ' 7 Vie)
Address of New Meter ll n -
Lot # Subdivision 2.¢' wfN K-tb$ •
Please fill in the number of each fixture as detailed on the plans, then multiply
quantity by the point value given to arrive at the point total. Add all point totals together
for total fixture unit points.
Fixture Unit Quantity Point Value Point Total
Bar Sink X 1 =
Darcy Tub X 4 =
Tub with shower stall at end of tub. They are separated by glass.
Bidet <.:. X 1 =
Clotheswasher X 4 =
Dishwasher X 1.5 =
Hose Bib 1 X 2.5 = 2.5
Hose Bib, each Adt'l X 1 =
Kitchen Sink X 1.5 =
Laundry Sink X 2 =
Lavatories X 1 • =
Water Closet, 1.6 GPF X 2.5 =
Bathtub /Whirlpool X 4
Shower Stalls X 2 =
Bath/Shower Combo X 4 =
• Total Fixture Points
Meter Size Meter Cost
****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
FOR OFFICE USE ONLY
Fixture Count Verified with Plumbing Permit
Meter #
Receipt #
Emp. Name
Revised 3 -18 -02 •
CITY OF T" "AID 24 -Hour
BUILDII Inspection Line: (503) 639 -4175 'o? 60 yv
INSPECTION DIVIerOK Business Line: (503) 639 -4171
BUP
Received Date Requested 7//9/ - AM PM BUP
Location / ? /6/ 5r' .79-�," S' Suite MEC
Contact Person 7? Ph ( ) PLM
Contractor Ph ( ) SWR
_MONIS 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
Otter:
PART FAIL
MB ,
Post & Beam
Under Slab
Rough -In L�
Water Service ,_
Sanitary Sewer O
Rain Drains
Catch Basin / M- �: • le
Storm Drain
Shower Pan
Other:
•S - • RT FAIL
AgiltEntl-
Po Beam
Rough -In �
Gas Line
Smoke Dampers •
P3R'T ' FAIL
E TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: D Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2//9/0_7 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 — Od 4 1 14 / < /
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 9 AM PM BUP
Location / / D 1 Suite MEC
Contact Person Ph (j j f( 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 FA
h!
Und GAS
Slab i b
Roug In
Water ' ce G I
3/0 Sanitary ! ewer
Rain Dr - n
Catch :asin Manhole
Storm ID rain
Sho i =r Pan
_ _ =- FAIL
r= "" HA N • i%
Post & Beam
Rough -In
Gas Line
Smo.: Dampers
u
,0 PART FAIL
RICAL
- rvice
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 1423 Inspector 4 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection L ne: (503) 639 -4175 MST a — Vc k C itq
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Q
Received Date Requested ! -g AM PM BUP
Location D i Suite MEC
Contact Person 4 �-w►� Ph ( ) '4 #1 — 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
/j
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 / �► J�Wra.71, •
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage 4,9 L
Fir: _ arm
' ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PA = PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line 44 /
ADA
Approach/Sidewalk Date Inspect // Ext
Other:
Final DO NOT REMOVE this inspection recor from the ob site.
PASS PART FAIL