Permit r ,.1
CITY TIGARD MASTER PERMIT
PERMIT #: _la- F ,�i11 DEVELOPMENT SERVICES DATE ISSUED: 3/11/0404 00071
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12330 SW THORNWOOD DR PARCEL: 2S110BC - 05900
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 030 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: DM139 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,605 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,720 sf GARAGE: 442 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 321, 622.60,
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,325 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 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: 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: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'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: 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: 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: $ 6,102.74
This permit
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Municipal is subject to the regulations contained Co i ode s and
the
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other applicable Code, State OR. Spec
cable l . All wo rk will be done Codes
STE 100 LAKE OSWEGO, OR 97035 all applic approved it
LAKE OSWEGO, OR 97035 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: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg #: 4 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins[ Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Issued By : ,,,r.Yi/,,/,.,.,r 4. Permittee Signature :z\
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
' lb Pr 3 -5 - ° y ga i ' •WC* —tom'
4 ii . Buildiaig Permit Application = -
Date received j : Q Permit no .:015> , _0 p '
• i!i r City of Tigard -
r V Project/appl. o.: . . Expire date:
City of Tigard Phone:. 13125 SW Fil ! 2 3 Phone:' (503) 639-41 Date issued: arm Receipt no.:
Fax: (503) 598 -1960 4
[ g 2 6 2° Case file no.: Payment type:
Land use approval: L Ti ARD 1 &2 family: Simple Complex:
U1TY
of • ■
TYPE OF PERMIT
'O 1 & 2 family dwelling or accessory CI Commercial/industrial ❑ Multi- family . j 'New construction ❑ Demolition '
❑ Addition/alteration/replacement . ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: PW— Sil=1 17r0N_L-r _ Bldg. no.: Suite no.: .
Lot: '71M Block: Subdivision: W A'fAIMIE Tax map /tax lot/account no.: .
Project name: ,
Description and location of work on premises/special conditions: .
OWNER FOR SPECIAL INFORMt1TION, USE CHECKLIST1
Env unit <� (Floodplain, septic capacity, solar, etc.)
Mailing address: 'min ram i/ i im ;��' 1 & 2 family dwelling:
13321111D IZEM'� ZIP: '2)- Valuation of work $
Phone:. r` �J M, o No. of bedrooms/baths
Owner's representative: , L r _ Total number of floors '
Phone: Fax: E-mail: New dwelling area (sq. ft.) � _
APPLICANT Garage/carport area (sq. ft.), --
I JJ• ��^ 1 = Covered porch area (sq. ft.)
Mailing address: L ! Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustrial/multi- family:
CONTRACTOR Valuation of work.... $
Existing bldg. area (sq. ft.)
1 Ul rlrl%� New bldg: area (sq. ft.)
Address: .Ave ,11 Number of stories
City: State: ZIP:
Type of construction
Phone: Fax: E -mail:
CCB no.: Occupancy group(s): Existing:
New:
City/metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
' ir� ,. provisions of ORS 701 and may be required to be licensed in the
�� jurisdiction where work is being performed. If the applicant is
Address: , j C r7 �1. 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 cam, please call jurisdiction for more information.
attached checklist. A ' . rovisions of I ws and o din aces governing this ❑ Visa ❑ MasterCard
, . work will be comp - • wr •, whether cified lierei t. Credit card number: / /
l _ •
Authorized si a . /1 1 e: / Name of cardholder as shown on credit card Expires
Print name: 1 leiffair . f 1 ( ,e. Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within days after it has been accepted as complete. • -" " "' "4 (6.oacoM) - -
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One- and Two - Family Dwelling
� � Checklist s _ Building Permit Application Chkli
Reference no.:
l,L . Associated permits:
City of Tigard City of Ti and
�J g 0 Electrical O Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 • O 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. V
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 location of
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. / X `
•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. K
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
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.
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 ". X(
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 (eroOICOM)
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. ., ,.:.
• - Mechanical Permit Application
� �
RECEIVE ate received: Permit no. 37 ,4 J
)� �dMl'�i City of Tigard �E
, : ty g Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd,'Tigard, pgp9722A I
Phone: (503) 639 -4171 �t LLUU 2004 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 • Case file no.: Payment type:
CITY OF TIGARD
Land use approval: MI WING DIVISION Building permit no.:
TYPE OF PERMIT •
a 1 & family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
• few construction 0 Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION • • • COMMERCIAL VALUATION SCHEDULE - • Job address: 0 j�/. �ilni ra r 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: 1.' Block: Subdivision: nv er' 'See checklist for important application information and
Project name: - jurisdiction's fee schedule for residential Permit fee.
. City/county: ZIP: 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and location of work on premises: AND CO1 EQUIPI.4IENTSCHEDULE
. Fee (ea.) Total -
Est. date of completion/inspection: , Description • Qty. Res. only Res. only
Tenant improvement or change of use: • HVAC: •
Is existing space heated or conditioned? 0 Yes 0 No Air handling i unit CFM
g P Air conditioning (site plan required)
Is exi space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
- ' MECHANICAL CONTRACTOR Boiler /compressors •
Business name:��}� � . State boiler permit no.:
40M1711 _ a& _ HP To ns BTU/H
Address: ��[l• Fire/smoke dampers/duct smoke detectors
City: \Nit L r State' "i ZIP: °li ra Heat pump (site plan required)
Phone . --j Fax: E -mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent 0 Yes 0 No
CCB no.: F- l - InstalUreplace/relocateheaters- suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): j p e 7 - 1 --
1 .PjV'' (�EZ.� Vent for appliance other than furnace
. Refrigeration:
CONTACT PERSON - - Absorption units BTU/fl .
Name: o ,1 (`N i__, Chillers HP
• Address: Compressors HP
Y..-l1 C ' C Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent ,
Phone: Fax: E -mail: Dryer exhaust
Hoods, Type I/ lUres. kitchen/hazmat .
hood fire suppression system
Name: ti 41 Exhaust fan with single duct (bath fans) _ .
Mailing address: � yy s 1 Exhaust system apart from heating or AC
ry Fuel piping and distribution (up to 4 outlets) .
City: , ,.dp ; State ZIPR)j ype: •
T LPG NG Oil
' Phone: 27 - ,ice Fax: E - mail: Fuel piping each additional over 4 outlets .
- : - .- , ENGINEER ' • - Process piping (schematic required)
Name: Number of outlets • ,
Other listed appliance or equipment:
Address: Decorative fireplace ,
City: [ State: I ZIP: Insert - type
Phone: Fax: E -mail: • Woodstove/pelletstove
'�� � Other:
Applicant's signatu" ,p, Date: � / i f Other.
Name (print): (( -s rir f 11/.ii'ni' / / -
$
Not all jurisdictions accept &edit cards, please call jurisdiction for more information. Permit fee
Notice: This permit application Minimum fee $
0 Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: Es
Expires wi thin 180 days after it has been Plan review (at _ %) $ •
p State surcharge (8 %) .... $
Name of cardholder as drown on credit card s accepted as complete. TOTAL $
• Cardholder signature Amount 440 -4617 (600/COM)
Plumbing Permit Application . . .
pplication .
Datereceived: Permit no.: /I' ea, •—UDo i
is c ' City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall B R OR 97223
City ofTigard CD Project/appI.no.: Expire date:
Phone: (503) 639 -4171 I VC
Fax: (503) 598 -1960 FEB Date issued: By: Receipt no.:
D 2 6
Land use approval: 2001
Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 aomgt 1p tria1 0 Multi- family 0 Tenant improvement
►- ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: �V J I I) (1 Y 7 I r , �_ Description Qty Fee(ea.) Total
' New 1- and 2- family dwellings only:
Bldg. no.: I Suite no.: - (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: %� , SFR (1) bath
Lot: Block: Subdivision: T T � 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.)
PLUMR • I ING CONTRACTOR Manufactured home utilities
Business named ) R) L ' II-16 , Manholes
Rain drain connector ' T r Address: ,i�j_ I IL, Rain
sewer (no. lin. ft.)
City: `j • _kip ■ State•• .. ZIP: Sanitary
E -mail: Storm sewer (no. lin. ft.) Phone: y r - Fax: - Water service (no. lin. ft.)
CCB no.: E i - 7 . Plumb. bus. reg. no:
Fixture or item:
City/metro lic. no.: N/A ' — Absorption valve
Contractor's representative signature Back flow preventer
Print name: , '` ' , • . ID. jrM�1 Backwater valve
CONTACT PERSON Basins/lavatory
Clothes washer . -•
Name: c l i\N--1 , S�f_DI ,....le Dishwasher
Address: _ 4k` 0 0 1 e, Al Drinking fountain(s)
City: State: ZIP: Ejectors sump
Phone: Fax: E -mail: Expansion tank
T'= x
OWNER Fixture/sewer cap
} , Floor drains /floor sinks/hub —
Name (print): 1 _��� ti Garbage disposal
g ` -2 C. ' • —
Mailing address: It 1 • Hose bibb ,-- City: L ..( . �1ggNi 70 5 Ice maker
Phone: l , - Air 1 1I. E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Pnmer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) M
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) 1
Owner's signature: Date: Sump
Tubs/shower /shower pan
ENGINEER Urinal
Name: Water closet _
Address: Water heater
City: State: 1 ZIP: Other. .
Phone: Fax: E -mail: Total
Minimum fee $
Na all jurisdicuoru accept coedit cads, please call jurisdiction for more informa Notice: This permit app % $
Plan review (at __ %)
0 Visa 0 MasterCard expires if a permit is not obtained / / State surcharge (8 %) •••• $
w ithin 180 days after it has been
C.edit card number.
Es piles TOTAL $
accepted as complete.
Name of cardholder as shown oa credit card S
■
30-4616 (6 U6R OM)
Cardholder signature Amount J
•
Electrical Permit Application
A Date received: Permit no.: /1 r eg .0 I
llvIiir City of TigartR EC E I V E D Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: l Receipt no.:
Phone: (503) 639 -4171 FEB 2 6 2004
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
BUILDING DIVISI•
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
►' New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION •
Job address: 'lmin _a.��j, IP Bid:. no.: Suite no.: Tax map /tax lot/account no.:
Lot: .' Block: Subdivision: UM jae r
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLlCA PION FEE SCHEDULE • • - -
Job no: II C;) Fee Max
Description Qty. (ea.) Total no.lnsp
B usiness name: — '� New residential - single ormulti- fatnilyper
Address: #` �, , f, ` del • Ai dwelling uuit Includes attached garage.
City: t Wit ' ECM ZIP: • Service included:
Phone: ! ..3-- l _ d Fax: E -mail: 1000 sq. ft. or less 4
, �' i t Each additional 500 sq. ft. or portion thereof 2
CCB no.: Elec. bus. lic. n (� Limited energy, residential _
C Limited energy, non - residential 2
Each manufactured home or modular dwelling
- � Service and/or feeder 2
�alure of supervising electrician (required) Date �;IL F
� Services or eders - installation,
Sup. elect. name (print): ....a... r9-- 9 A 2.j License no: I O� alteration or relocation:
PROPERTY OWNER 200ampsorless 2
Name (print): %.t. �` '� '[►At�� 201 amps to 400 amps 2 401 amps to 600 amps
Mailing addres �f'V dpi, :S • 601 amps to 1000 amps 2
City: L___,.0, S tate 1 - ZIP:9 7()3c, Over 1000 amps or volts 2
Phone: ? 7J Fax: --7f 61;E-maiL: Reconnect only 1
Owner installation: The installation is being made on property l 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: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first brunch 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 0 Health-care Each pump or irrigation circle 2
are facility - 2
O Service over 320 amps -rating of 1 &2 0 Hazardous location Each signor outline lighting -
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O 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 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other Per inspection 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
Permit fee $
Not jurisdictions all jurisdictio accept credit cards, please call jwisdicuoa for more information. Notice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _____ %) $
Credit card number / / within 180 days after it has been State surcharge (8%) .... $
, Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 - 4615 (6n00ICOM)
AA s - J 2D -vr5-67 (
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THE EC ST REET ..
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. . . I , g c p(fe T i_ , Ow ner /Agent for Do h) Ovi ;nnf� Pr 5 ■
(PERMIT HOLDER)
(PLEASE PRINT) •
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►
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• Do hereby .certify that the following location ►
•
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• meets City of Tigard /Washington County t• . , • land use and development standards for street tree installation. ■ ■
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4 ADDR / Z 3 a Sw r acz , ■
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! • S UBDIVISION: �y�i�N`v0o,0 ■
• LOT: � �
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1 BY G DATE: 6 -2 , a' ■
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A RECEIVED BY: Alliati,., _ DATE: (- -4 - ► •
A ITTVITVIVVVV•v®yyv ' vvvY V VYVVV*VVVVVVVVVVVVVVVYVVVYYY!YY
CITY OF TIGARD 24 -Hour
BUILDING Inspection,Line: (503) 639 -4175 MST � �
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received r Date R quested I AM PM BUP
Location � "-1-3Q V811 Suite MEC
Contact Person Ph ( ) 909 -(437 PLM
Contract Ph ( ) SWR
UILDI Tenant/Owner ELC
ing 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 Cei ing
Roof
z s_).pAR T 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
Dampers
4 1 - - RT 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 6 _ A _ v 4-
Approach/Sidewalk Dat 5'' Inspector Est
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 ez,26,0 q`-d2:0-7 /
INSPECTION DIVISION Business Line: (503) 639 -4171
// BUP
Received Date Requested to — 3 AM PM BUP
Location - • 4 _ %1 46I _ . ii■■.. / L Suite MEC
Contact Person Ph ( ) 090 Q 37 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear ,
Int Sheath/Shear
Framing _
Insulation C,Labs�� _ A,p I9 fI H `2 3 ,3 o F Drywall Nailing Y
Firewall V< 5k41›.i .. zpJ- In iA Or'
Fire Sprinkler
Fire Alarm 'n (C- l j 4kW 1 Cn ikoO F
Susp'd Ceiling u 1 ,n
Roof �
U I l 51 VW � lJ
. � I o 5-0 v---.
Other:
Final
PAS *ART FAIL
Under Slab
Rough -In
Water Service
Sanitary Sewer `"'� Nov F0 2 N G-C - g, vo N
Rain Drains ii !
Catch Basin / Manhole 1. LS N $W( S •
Storm Drain
Shower Pan
Ot
c-Filig: 1 .-E V=4. 1 11(L \ c1V RQ 1.kVI\
SS PART FAIL — �- 1 I
C1
MECHANICAL , 0 1 - NLL c is t N
Ro Beam i t k L V �� (
Rough-In � �7
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
AS ART FAIL
0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S) Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA * �
Approach/Sidewalk Date L — 3- Inspect �w Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL