Permit .. .
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST20
I � DEVELOPMENT SERVICES DATE ISSUED: 9/23/03 03
- F.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12305 SW THORNWOOD DR PARCEL: 2S110BC - 05100
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 022 JURISDICTION: TIG
REMARKS: Const. new SF detached residence.
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,920 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,380 sf GARAGE: 412 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 317,056.40
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,300 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: ` VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS 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:
EAADD'L 500SF: 6 201 - 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: SIGNAUPANEL: 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 0CC:
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: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,956.42
This permit
MORISSETTE HOMES DON MORISSETTE HOMES INC Municipal is al Code, , State of OR. Specialty regulations contained Co i ode the
Tigard Municipal C, ialty Ces and
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035 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: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
5o
Reg #: Ll 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain Insp Electrical Final
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insi Storm drain Insp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Service Gas Line Insp Water Line Insp Plumb Final
Footing I • Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service Insp Building Final
Fo - •ation Insp PLM /Underfloor Framing Insp Insulation Insp Appr /Sdwlk Insp
. ► r I ) li - 'f �
Iss ed By : , I 1-; A/_ /ill.— Permittee Signature :
Call (50 ) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
''T y - /S-O3 Mn+/
. . , aOo; � )
/37ar l•fib P ° i AppliCaton ' . "
Date received: -1 -0 . 6 Permit ,S• •- %- c , _ 4 3
<' City of Tigard . � � ! g Project/appl. no.: Expire date:
City njTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 J
Phone: (503) 639 -4171 Date issued: By: Receipt no.: v
Fax: (503) 598 -1960 to Case file no.: Payment type: p
Land use approval: a : ; 1 &2 family: Simple Complex:
TYPE OFPERMIT _ . • . -
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi family ›'New construction 0 Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other
_i 1 i, -.w Mk• MFA, t;1 �S LTI
: NF OR1� LttV. 9- :. ,"+-..-4,.. , w.. - < •xM 41 4 .-
Job address: 4',M= M Bldg. no.: Suite no.:
Lot: ,, .1 „FAN Block: Subdivision: rMITOPILIIIMI Tax map /tax lot/account no.:_ a. /Q 4 do t
Project name:
Description and location of work on premises/special conditions:
OWNER ; - -, - FOR SPECIAL INFORMATION, USE CHECKLIST
_v A Far (Flood pla in, sept ic ca pacity, solar, etc.)
Mailing address: ' fs�Eil _ a�
I �I�i� 1 & 2 family dwelling:
�� A' ZIP: 1 1 M 3"'' Valuation of work $
Phone: • rs �J , o No. of bedrooms/baths
Owner's representative: , MT4 i __ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
. APPLICANT Garage/carport area (sq. ft.) .•
I . M Ji Covered porch area (sq. ft.)
' Mailing address: L! _ Deck area (sq. ft.)
City: • State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustriallmulti- family:
CONTRACTOR Valuation of work $
rEMZEIP 11.1t>L+► Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: _11v`r &il Number of stories
City: State: ZIP:
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
• ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
�, ,�a provisions of ORS 701 and may be required to be licensed in the
Address: _ ,a_ ° jurisdiction where work is being performed. If the applicant is
C ` exempt from licensing, the following reason applies:
City: State: ZIP:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -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. • • rovisions of l ws and �
o dinances governing this ❑ Visa O MasterCard
work will be compll • wt • , whether cified �t ere�t riot. i Credit card number: / /
Expires
Authorized si a atu • , ' ii t� i e. �J � 7 .3 Name of cardholder as shown on credit card
$
Print name: 1 s_ a � fzt12.. t I .K- 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 (6100/COM)
One - and Two-Faintly Dwelling
►` `�*.. ss r�
Building Permit Application Checklist Reference no.:
City of Tigard Associated permits:
City of Tigard - . 0 Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TILE 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. k
8 Soils report. Must carry original applicable stamp and signature on file or with application. �(
9 Erosion control CI plan 0 permit required. Include drainage -way protection, silt fence design and location of , f
catch -basin protection, etc. J�
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 r-
if copyright violations exist. J�
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. n
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. rr
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, `l
fireplace construction, thermal insulation, etc. J�
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 y
over 10 feet long and/or any beam/joist carrying a non - uniform load. x
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.
Y , a 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. _
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (600/COM)
- 1
• • • • ,xa7 �`�} � 4. ' k` �' Y '��i�.z��,+ ; � s .fi S e ' �"j � � .c. Vii--":
Mechanical Permit Application . �... ,- _k .: „§ � ,, .
Date received: Permit no.: ` �.1 3 - Ga ya
.434.,,,,..„ � �! City of Y T. ig d _ Project/appl. no.: Expire date: .
City of Tigard Address: 13125 SW • ... - ,' t l ” i� to'•.7223 Date issued: By: Receipt no.:
IV Phone: (503) 639 -4171
Fax: (503) 598- 19660 Case file no.: Payment type:
Land use app o Wdls V O � oO,� Building permit no.: ' •
U r �
TYPE OF PERMIT .. .
0 1 & 2 family dwelling or accessory 0 Commercial/industrial . 0 Multi- family 0 Tenant improvement •
New construction 0 Addition/alteration /replacement 0 Other.
- 'JOB SITE INFORMATION c ;COMMERCIAL .VALUATION , SCHEDULE - ;
.. Job address: 4 , r jr7� L,'�• 7 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.: profit. Value $
Lot: Block: Subdivision:
ubdivision / >'jjil `See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: - - & 2 FAMILY. DWELLING PERMIT FEE SCHEDULE --
and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
• Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: 11 -
Is existing space heated or conditioned? 0 Y 0 No Air handling unit CFM
g P Air conditioning (site plan required) 11.i
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system IIII
_
' . MECHANICAL CONTRACTOR - Boiler /compressors • I
State boiler permit no.:
_,(� �I. J HP Tons BTU/H
Address: eel�� Fire /smoke dampers/duct smoke detectors
ES ZIP: g �ignal Heat pump (site plan required) .1. M
Phone: JI Fax: E -mail: InstalUreplacefurnace/burner BTU /H
Including ductwork /vent liner 0 Yes 0 No •
CCB no.: A Install/replace/relocate heaters suspended, ■ --
City/metro lic. no.: N/A ' wall, or floor mounted
Name (please print): ✓i ce � Vent for appliance other than furnace -
CONTACT PERSON
Refrigeration BTU/H Ill
-
Absorption units
IMINE i Chillers HP I
Address: Compressors HP I
rV_ ♦ �t Env exhaust and ventilation: ■ --
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer
oods, Type I
OWNER Hoods, ype U lures. kitchen /hazmat
hood fire suppression system
IMIL_.i► 1r 1 RJL Exhaust fan with single duct (bath fans) _ .
Mailing address: *�� / al' �iliring,] Exhaust system apart from heating or AC --
�.� �'� Fuel piping and distribution (up to 4 outlets)
�� CSiiZSiL7iti/�� Type: LPG NG Oil •
Ill RIOS
Phone: /li ji Fax: E -mail: Fuel piping each additional over 4 outlets _ --
ENGINEER - , Process piping (schematic required) Mil ==
Name: Number of outlets NM
Other listed appliance or equipment:
Address: Decorative fireplace III
City: State: ZIP: Insert - type
Phone: GEMPOIM E -mail: Woodstove/pelletstove
Applicant
signatu Date: !J Other: M.
—�
_ ,r.ILS;lA �l��i� Other M
Name (print): .(r.. --
Not all jurisdictions accept credit cards, please call jurisdiction for mole information. Permit fee $
Notice: This permit application Minimum fee $ -
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number' ExpirI within ISO days after it has been Plan review (at _ %) $
led as complete. State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted TOTAL $
• Cardholder signature Amount 440-4617 (6.0"COM)
,
. Plumbing Permit Application , z.;Y.. .-i,r -.� ,f,.
,�� E 1 i5 ::: e : tO.: o- City of T Building permit no.:
'#'+�' Address: 13125 SW Hall Blvd, Tigard, OR 97223 Project/appl.no.: Expire date:
Ciry ofTigard Phone: (503) 639 -4171 AUG 0 7 2003
Fax: (503) 598 -1960 GITy OF TlGAR® Date issued: By: Receipt no.:
Land use approval: BUILDING DIVISION Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
►: ew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: a G5\/v `1) 1n. Of, Descriptiion New Fee (ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account SFR (1) bath
Lot: wX'
Block: Subdivision: ,. f . 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
Footing drain (no. lin. ft.)
PLEI lliING CONTR,ACTOR. - Manufactured home utilities
Business named g_vI Lu t--1,i3 1 1 Manholes
Address: �--) YisN. I Rain drain connector
• ■ State• a ZIP: Sanitary sewer (no. lin. ft.)
City: `! v� Storm sewer (no. lin. ft.)
Phone: 1 Fax: F E -mail:
�C�� �� - ti Water service (no. lin. ft.)
CCB no.: I �, "7 i - 7 I Plumb. bus. reg. no: - ;
- ' Fixture or item:
City/metro Iic. no.: N/A �/ / Absorption valve
Contractor's representative signature �(! 1 b Back flow preventer
Print name: • \--•- \--•- • ' U • —. , Backwater valve I CONTAC•1 PERSON • - Basins/lavatory
S — Clothes washer
1
Name:,, `'i �f_D) ,le Dishwasher
Address: _. 'AA' / k ,V Drinking fountain(s)
City: State: Ejectors/sump
Phone: Fax: Expansion tank
� v O N I: R Fixture/sewer cap
, . Fl oor drains floor sinks hub
Name (print): 1 :��� t Garbage disp
Mailing address: - ( j � ( 1 H ose b
•
City: L _ State i ,gb=$ir711�5� Ice maker
Phone: f , — Fax: l .E 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: Sump
Tubs/shower /shower pan
Urinal
Name: Water closet ,
Address: Water heater
City: State: ZIP: Other. i
Phone: Fax: E -mail: Total l
Minimum fee . $
Na all jurisdictions accept credit cards, please call junsdict on fa' more inrormntion. Notice: This permit application
Plan review (at _ %) $
C Vi
c ❑ card numCe hMasterCard expires if a permit is not obtained State surcharge (8 %) ...• $
C.enumber w ithin 180 days after it has been $
Expires accepted as complete. TOTAL -�—
Name of cardholder as shown on credit card
S
Cardholder signature Amount 4io -4616 (6t01CoM)
• Electri Peranit Application ° ' '
i�d`.�`.t » tiJ � J - - . L hi.
Date received: Permit no.: ()ric 003 . ge _ IP
J : City of Tigard D Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blv Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 AUG 0 7 2003 Case file no.: Payment type:
Land use approval: GM OF TIGARD
. INV E 1.11' ►'ERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
I" New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
' ' ' - JOB S1lTE1NFORMATION
Job address: ( r a w n a' II ry '" , �� Blldgg. no.: - Suite no.: Tax map /tax lot/account no.:
Lot: �— 1 Block: (` Subdivision: (/145( l Z ±
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPIA'A I ION • FEE SCHEDULE • - -
Job no: ( .9._ -4 C/ 4.. Fee ' Max
_ Business name: CA—V-1 a...EL7124 C, Description Qty. (ea.) Total no. lnsp
New residential - single or multi-family per
Address: r ip _ or �` istla • C" - dwellingunitlncludesattachedgarage.
City: : = , CM W% ZIP: f Service included: ap.
Phone:2-W J j - I b' Fax: E -mail: 1000 sq. ft or less 4
/ _� n Fach additional 500 sq. h or portion thereof 2
CCB no.: Elec. bus. tic. no: lP ( � Vmimd energy, residenual
C` Limited energy, non- residential 2
Each manufactured home or modular dwelling
''
nature of supervtsmg electrician (required) Date 10 I Service and/or feeder 2
��p License no: q Services or feeders- installation,
Sup. elect. name (print): _A... 1 t'f- a J'1 l alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print):
201 amps to 400 amps 2
�[ ►��r� 401 amps to 600 amps 2
g j ;�� �� a 601 amps to 1000 amps 2
Mailing address: _
City: 4. 0 , State a � ZIP: '70 C Over 1000 amps or volts 2
Phone: -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporaryservicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: k Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
ty' I I of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps-commercial ❑ Health-care facility _ Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location - Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other. Per inspection
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 jurisdicuoa for more information. Notice: This permit application
Permit fee $
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. I / within 180 days after it has been State surcharge (8%) .... $
Ex accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440 -4615 (6/00/COM)
i M'ST 3 - clz9 ' 2. 3
• ■
. ■
• �TION
TIFIC
CER E ETREE . STR T
. .
. .
. .
J) ■
. .
I, g in-e 4_ TG- , Owner /Agent for rl ,) MCi�'sE1Tg. / -vNv5 ■
(PLEASE PRINT) (PERMIT HOLDER) ► ■
1 Do hereby certify that the following location ■
• meets City of Tigarcl /Washington County ► ■
• • land use and development standards for street tree installation. ■ ■
• :
1 ■
4 ADDRE /Z3o, � i--J 7140i∎,t..v 0 ■
A ■
•
►
LOT: Z - SU BDIVISION: - EZ-A- 0 V ■
• BY: -- DATE: / - z / - d 3 ;
• ► ■
•
• RECEIVED BY: DATE: ( ' 2� '0 /
.
ArvvyvvTYVV VY v®® v®® y®TV VVV VV VY VVVV*VVVV®®®®®VVVVVVVVVVYYyyy"
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 3 -0Q
INSPECTION DIVISION Business Line: ' (.503) 639 -4171 C�
• BUP
Received -- 1 L ; 0 /Cate Requeste. / - 2 2 7 �AM PM BUP
Location / 2-3 t 1I . X. Suite MEC
Contact Person r Ph ( ) pZ -441 / PLM
Contractor ii // .id Ph ( ) SWR
: 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 -
Oth •
nal
— . RT FAIL
. 1 y77fir.
•ost & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Other:
(I Pan
Other:
'ART FAIL
ICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART F L
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
na' El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Z Z
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 7 — nd y'
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / a ( AM PM BUP
Location ‘-- 17t-41Jtm u- 72-0 -d 4 Suite MEC
Contact Person Ph ( ) 02 O 5' 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
r I (�If � ry
Fire Sprinkler ` '� CT MN,M4\1■S I ) kI / 1\'" � � Firewall , A " ` ✓,, 'y \'''bi\o (
Fire Alarm
Susp'd Ceiling
Roof
Other: ,p
Final PART FAIL , l\12.. �� 1 , L \ 2 ^� 1 l 1 - 3 4 o
UMBi -
Post & Beam
Under Slab _ r 7:9 Rough -In /—_ � ' ' \ k \t J w ),) 1.10
Water Service
Sanitary Sewer y \ o AI I A i );).0
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan �2 S \/NC \ I L �� - 39 PP1w1
Oth
anal
S PART (FAI
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab "/
Low Voltage L r� 2-° O 3 ' c) 3 31 V /1 GC �/ e •
Fire.4Iarm
- ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
T
PART FAIL
S Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk • Date/ 2/ `d Inspector //% ' "/1 4) — ice''`_ Est
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL