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Permit
Alt° C I MASTER PERMIT CITY OF TIGARD PERMIT #: MST2003 -00497 - tyliti DEVELOPMENT SERVICES DATE ISSUED: 11/5/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 11581 SW SHEFFIELD CIR PARCEL: 1S133DB -02800 SUBDIVISION: BRITTANY SQUARE NO. 2 ZONING: R -12 BLOCK: LOT: 052 JURISDICTION: TIG REMARKS: Interior remodel. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: 5,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 • 200 amp: W/SVC OR FOR: PUMP /IRRIGATION: PER INSPECTION: EA AMYL 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: 2.00 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps 1000v: MINOR LABEL: 1000+ amp/volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 301.21 This permit is subject to the regulations contained in the ROTHENBERGER, THOMAS A AND PETERSEN CONSTRUCTION INC Tigard Municipal Code, State of OR. Specialty Codes and ROSALINDA PO BOX 2226 11581 all other applicable approved All work will be done i 1581 SW SHEFFIELD CIRCLE WILSONVILLE, OR 97070 t accordance with approved plans. This permit will expire if TIGARD, OR 97223 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: 503 312 - 0043 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 96688 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing lnsp Final inspection Electrical Rough In Framing lnsp Electrical Final Mechanical Final AIN / ¥AWW Issued B ",,,/ By : eL. Permittee Signatu e : W/.!_:I'� Call (503) 639 -4175 by 7:00 p.m. for an inspection needed - ext business day 0.44/2AL 0 lia3Do nne-LF.-#.1 A% I - Bun 41ri 'Perm' i �Q FOR OFFICE USE ONLY g Received Building th/ b /� S . Date/By: 7 6 Permit No.: City of Tigard 3 Planning Approval Other � Date/By: Permit No.: ' 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: /1 /1d 1 a 9' - 07 . - A Permit No.: Phone: 503- 639 -4171 Fax: c4 `� °®/��""'� i'� Post Review Land Use Internet: ww ar d.or.us w.ci.ti 8 UIL Dl � 1 � � %' °' I Date/By: Case No. g " Contact ®See Page 2 for (ii 24 -hour Inspection Request: 503- 639 -4175 . Name/Method: 09 Supplemental Information TYPE OF WORK .:REQUIRED DATA :° ❑ New construction ❑ Demolition , , 1 & 2 FAMILY DWELLING ❑ Addition/alteration/replacement ❑ Other: - CATEGORY OF CONSTRUCTION . Note: Permit fees* are based on the total value of the work performed. Indicate ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family �/--., ❑ M aster Builder ❑ Other: Valuation $ . , JOB SIT E• INFORMATION nd LOCATION -. No. of bedrooms: No. of baths: Job site address: I \601 5u-) c5heffieta C irdde,, Total number of floors New dwelling area (sq. ft.) Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) Project Name: Roi-tv.mber6er Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) . REQUIRED. DATA :: - • • . " - COMMERCIAL = USE CHECKLIST Subdivision: Lot #: Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate " DESCRIPTION' OF ` W _ ORK the value (rounded to the nearest dollar) of all equipment, materials, labor, remodel l< ii -e he h o�.tncd l�0."i overhead and profit for the work indicated on this application. Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ❑ •PROPERTY OWNER • l ❑ TENANT Type of construction _ Name: ' r'otn-+- Rosa, Ro ex- Occupancy group(s): Existing: New: Address: l i V3i SUL) Sh.eff-1Pld ircl c, City/State /Zipiloas - d ark Qi- zz3 Phone: C%-co") 524 -111% Fax: NOTICE: MI contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under • ❑ APPLICANT - - ❑ CONTACT PERSON provisions of ORS 701 and maybe required to be licensed in the Business Name: PA p ta r ■I CoLI4r ]4 Cr jurisdiction where work is being performed. If the applicant is exempt Contact Name: \c' � `c_ 5 from licensing, the following reason applies: Address: (D ec•)( 2224 -9 City /State /Zip: 11/4),ML5DkJVILI -E.- 0 rz‘ Phone: .`33-312 -c5O A' I Fax: BUILDING PERMIT FEES* E -mail: Please refer to fee schedule. CONTRACTOR . Business Name: Petersen Ce,N5i t .CL ton -I:1e-• Fees due upon application $ Address: ECDx 221-C.o City /State /Zip: V5C..S•r..1 V'LLE— ©r-, Amount received $ Phone Sol -0.043 Fax: Date received: CCBL'-. #:' 4g 't,- 1.a —d5 Authoriz. d • �� /r Notice: This permit application expires if a permit is not obtained within � — � Date: 6 6 O 180 days after it has been accepted as complete. Signatur. : TW - Ptrzy 617 *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 . . • One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard j g O Electrical O Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 • 0 Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 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. 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 0 plan 0 permit required. Include drainage -way protection, silt fence design and 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 Oregon and shall be shown to be applicable to the project 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 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. ink is reserved for department use only. 44o-4614 (6/00/COM) • •� FOR OFFICE USE ONLY Electrical Permit A lica on --r �I Received " ^ Electrical , EG " Date/By: g o al D , Permit No.: l'T�,/�0 �Q 97 City of Tigard Planning App oval Sign y g DateBy: Permit No.: 13125 SW Hall Blvd. 6 � a ,) Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -199660p Post- Review Land Use Internet: www.ci.tigard.or.us CITY OF TfGAP+DEeralll I Date/By: Case No.: 24 -hour Inspection Request: 519$11 MlVlS "!Ll Contact Juris.: 1$1 See Page 2 for P Q Name/Method: Supplemental Information. TYPE OF WORK PLAN REVIEW (Please check all that apply) ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility El Addition/alteration/replacement El Other: commercial Sevice ❑ Bilding Hazardous over 10,000 ❑ Service over 320 amps - rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more El Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: I1 5e,1 SIJJ - G fr le, FEE* SCHEDULE Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential - single or multi - family per I dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 I Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 Services or feeders - installation, alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2 Over Name:Tbrn t- Rosa. Ro. er Reconnect only 66.85 2 amps or volts 454.65 2 t r a=r \ ►,he Reconnect Address: I 1 vat 15 Shef'fiel'd C1f U e. Temporary services or feeders - installation, ty cu' . OR CR 12-Z3 alteration, 00 m o s or relocation: C1 /State /Zi �o� 200 am or less 66.85 I Phone: 6c ) 5 Z-z 11 Fax: 201 amps to 400 amps 100.30 2 ❑ APPLICANT ❑ CONTACT PERSON Branch n 600 ch amps 133.75 2 c Bran circuits - new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of 6.65 2 service or feeder fee, each branch circuit City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 1 - ar 46.85 2 Phone: Fax: Each additional branch circuit 2.. 6.65 2 E -mail: Misc.(Service or feeder not included): C N A('T �� / / Each pump or irrigation circle 53.40 2 � R t i. 'C ( _ Each sign or outline lighting 53.40 2 Job No: �} ID / .Ci -ice S c or a limited energy panel, alteration, or extension Page 2 2 Business Name: F_ Description: Address: City /State/Zip: Each additional inspection over the allowable in any of the above: Y p Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: qyL DK Lic. #: c`J�(� , ( —c Other: 9 Electrical Permit Fees* Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: Lic. #: � � __a�(_ I State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) is \Dsts \Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard " Page 2 - Supplemental Information - LIMITED ENERGY PERMIT FEES: • RESIDENTIAL WORK ONLY: Fee for all systems $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 COMMERCIAL WORK ONLY: Fee for each system ... $75.00 • (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls • ❑ Clock Systems — • . ❑ Data Telecommunication Installation ❑ Fire Alarm Installation • ❑ 1-EVAC n Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control ❑ Medical I ❑ Nurse Calls ❑ Outdoor Landscape Lighting ❑ Protective Signaling ❑ Other • Number of Systems * No licenses are required. Licenses are required for all other installations is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 ■ , Mechaical Permit Application n FOR OFFICE USE ONLY Received , L/ E' � D Date/By: � /� 03 / r r7 ��40 2 ✓— 7 Building City of Tigard REC Planning Approval DatDate/By: Permit No.: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 OCT 6 no AA. Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use ' 1 t Date/By: Case No.: Internet: www.ci.tigard.o S F TIGARD .4...i: � Contact 1uris.: El See Page 2 for 24 -hour Inspection Regti IL i j N-6 I$I N —4 Name/Method: Supplemental Information. • TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. ❑ I & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 Job site address: 1 l r ( w S µms(; Ft t2.p CRL Gas heat pump 14.00 Suite #: Bl dg. /Apt.#: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue/vent (for any of above) 10.00 Subdivision: Lot #: Repair units • 12.15 Other Fuel Appliances Tax map /parcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner /flue /vent 10.00 ❑ PROPERTY OWNER I El NANT Other: 10.00 - Names t 7 � Environmental Exhaust & Ventilation _u � A i.1 - ' i e ' • a �� -• Range hood/other kitchen equipment 1 10.00 to o� Address: \kS'$ _ 1 ■,_- i., _ Clothes dryer exhaust 10.00 City /State /Zi.. p,,, p(L q1�3 `� Single duct exhaust Phone .{1 Fax: (bathrooms, toilet compartments, ❑ APPLIC T ❑ CONTACT PERSON utility rooms) 6.80 Name: 4 C1p x Z� Attic /crawl space fans 10.00 Address: f ,, Other: Fuel Piping 10.00 City /State /Zip:kk) 1\AL .It, ene CO elo * *($5.40 for first 4, $1.00 each additional) Phone> ,.W. , A" I Fax: Furnace, etc. •* Gas heat pump •* E -mail: Wall/suspended/unit heater •* CONTRACTOR 1 Water heater ** Business Name: SeA r• Fireplace *• • Address: Z .ZZ.Cp Range. ** Cit City/State/Zip: BBQ y p �lc.�oa�V�c -c_.> -®I?. Clothes dryer (gas) ** Phone55> 1 044 Fax: Other: ** CCB Li -. #: -IMP) Total: Authoriz d Mechanical Permit Fees* Subtotal: $ Signatur : '/' . P'�—� Erat Minimum Permit Fee $72.50 $ A • ie— 31*-G∎s • Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE 5 Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri - County Building Industry Set Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 .• 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. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. nitrl • i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc CITY OF TIGARD • 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE 8 -1 QlOb DAVID CHANDLER ELECTRIC 8732 SE ANKENY PORTLAND, OR 97216 REC EIVED Electrical Signature Form NOI 12 2003 Permit #: MST2003 -00497 Date Issued: CITY OFTIGARD Parcel: 1 S133DB -02800 Site Address: 11581 SW SHEFFIELD CIR • Subdivision: BRITTANY SQUARE NO. 2 Block: Lot: 052 Jurisdiction: TIG Zoning: R - BUILDING DIVISION Remarks: Interior remodel. 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: ROTHENBERGER, THOMAS A AND DAVID CHANDLER ELECTRIC ROSALINDA 8732 SE ANKENY 11581 SW SHEFFIELD CIRCLE PORTLAND, OR 97216 TIGARD, OR 97223 Phone #: Phone #: 503 - 245 - 7774 Reg #: LIC 94908 ELE 26 -1081C SUP 688S AN INK SIGNATURE IS REQUIRED ON THIS FORM X 0f,,, Signature of Supervising Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour 2 BUILDING Inspection Line: (503) 639 -4175 . MST J 0d (127 INSPECTION DIVISION Business L(tte: (503) 639 -4171 • BUP Received Date Requested ° °73 6 AM j PM BUP Location //5 5Z 571e. uite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) / SWR UILDINS2 Tenant/Owner ELC n oting Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear • Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: •:1211 •. ;_ RT FAIL Post & :eam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan ot .:1 PART FAIL • MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final P • - T FAIL • '9- Rough-In UG /Slab Low Voltage Fire Alarm PART FAIL fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. idia) I 111 Please call far reinsp ction RE: Unable to inspect - no access Fire Supply Line / /'� ADA -2 0 2 3 (/ Wp1.7 Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL •