Permit / /30103 f u/.2,1 t cz , 0 /C
• CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00295
v I DEVE H P I MEN TSERVICES 639 171 DATE ISSUED: 7/22/03
SITE ADDRESS: 12325 SW THORNWOOD DR PARCEL: 2S110BC -05000
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 021 JURISDICTION: TIG
REMARKS: New SF detached, Path 1. 10/30/03, adding a/c unit.
BUILDING .
REISSUE DM181 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT' 26 FIRST: 1,605 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE. SF FLOOR LOAD: 40 SECOND: 1.790 sf GARAGE: 604 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS' I THIRD sf RIGHT: 5
VALUE. 321,091 20
OCCUPANCY GRP• R3 BDRM: 5 BATH. 3 TOTAL: 3,395 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: BOIL/CMP <a HP: 1 • L -. VENT FANS: 4 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 8 STEREO' VACUUM SYSTEM: AUDIO 8 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 IS SYSTEMS.
Owner: Contractor: TOTAL FEES: $ 6,036.77
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit Is subject to the regulations contained in the
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 Tigard Municipal Code, State of OR. Specialty Codes and
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire rf
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 - 3875 Phone' Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg 0: g may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Framing Insp Exterior Sheathing Ins F Storm drain Insp
Sewer Inspection Crawl Drain /Backwater Plumb Top Out Shear Wall Insp Low Voltage Water Service Insp
Footing Insp PLM /Underfloor Electrical Service Shear Wall Insp Gas Line Insp Appr /Sdwlk Insp
Foundation Insp Mechanical Insp Electrical Rough In Shear Wall Insp Insulation Insp Electrical Final
Post/Beam Structural Mechanical Insp Framing Insp Exterior Sheathing Ins F Rain drain Insp Mechanical Final
Issued By : ...IL_ , _, 40 I 0 Permittee Signature :
Call (503) 639-417' by 7;00 p.m- for an inspection eeded the next business da
S lae 0-/ A..1 c ?) -- .,,,e-yi- iC / - . 4/3
* - - v Pr : 7 -lN -o3 .A0-9,0o .5'60 623
Building Permit Application •
Date received: t1 Permit no.: r /7 �ii� 4. , 9
�-,,... , City of Ti ar E C E I V E 1
11 ') I! g Project/appl. no.: — . • date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 • .
Phone: (503) 539 -4171 JUL 1 2003 Date issued: B • - PJ^
I Receipt no.: •
Fax: (503) 598 - 1960 4 ase file no.: Payment type:
CITY OF TIGARD
Land use approval: . _ • , I g0 &2 family: Simple Complex:
7'1'1'E OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial O Multi- family ? 'New construction ❑ Demolition
O Addition/alteration /replacement O Tenant improvement O Fire sprinkler /alarm O Other.
ti,.: J TE /M.°1 �lyl ":r . t t�pri - ; '� ., `w ° t ^c. r,.;- t.:,.. ;_•
OB SI 10 -
Job acu ess: .� � l`% ll . Bldg. no.: Suite no.:
Lot: 0 2 Block: Subdivision: a V`s,t.T -rA Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST.
Mi7f•___ (Flotidplain sepiicCapacity,solar,etc.) '
Mailing address: aer w11 1 & 2 family dwelling:
132311111 i i iS ZIP: i�tir�� Valuation of work $
rr T�yi
Phone : +0�IIIS 21 EiNg No. of bedrooms/baths
Owner's representative: , tM i _ Total number of floors _
Phone: Fax: E -mail: New dwelling area (sq. ft.) .
APPLICANT ,,_,. E, Garage:carport area (sq. ft.) RS
IMIRMIIMUNNIZ Covered porch area (sq. ft.)
Mailing address: '-y. a CC- Deck area (sq. ft.)
City: 1 State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
• - CONTRACTOR -.- ; ; Valuation of work $
IZEIN2 P A A �� Existing bldg. area (sq. ft.)
Address: A viii New bldg. area (sq. ft.)
Number of stories
City: State: ZIP:
Phone: I Fax: 1E-mail: Type of construction
CCB no.: j 5 -D-.7.-5-2--) Occupancy group(s): Exi sting:
Notice: All contractors and subcontractors are required CO be
- "` ARCHITECT /DESIGNER
licensed with the Oregon Construction Contractors Board under
Name: (--iet,u -- provisions of ORS 701 and may be required to be licensed in the
Address: ,L 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: 1E-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. A • rovisions of 1 ws and opdinances govern g this ❑ Visa 0 MasterCard
work will be compl - • wt whether cifred tiered t. Credit card number: / /
1� (1 Expires
Authorized si a atu , / f A ( D� Name of cardholder as shown on credit card
$
Print name: ... f Zpa t t .e._ Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6A0ICOM)
A116 One - and Two - Family Dwelling
Building Permit Application Checklist
Application Reference no.:
Associated permits:
City of Tigard City of Tigard g O Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, 04 97223 0 Other
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TIIE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. i
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 Cl 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 K
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 x
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, X
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. 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 ".
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 (6100/COM)
� � - Mechanical Permit Application Y
� Date received: 7 / 0 3 Permit no.:)� j act f'a •
� " City of Ti and
, ^_yl ty g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
Building permit no.:
- TYPE OF PERMIT =' s E t :. ` ? , a i ?' ' 1- ;r ' s •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi family ❑ Tenant improvement •
Iew construction ❑ Addition/alteration/replacement ❑ Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1?-): 5 ° 1 r h I'I* i . Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax ma /tax lot/account no.: profit. Value $ •
Lot: 'Block: 1 Subdivision: 1\e"\01 r , v n)a— ' See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMIERICALIINDUSTRIAL EQUIPME.iNTSCIIEDULE
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? ❑ Yes ❑ No Air handling unit CFM
8 P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
•; — Boiler /compressors
State boiler permit no.:
Business name: CI I 'i ► e ms,/ / _ HP Tons BTU/H
Address: tlr���b_ Fire /smokedampers/duct smoke detectors
City: - LI r State 'fiffil1li,1�a Heat pump (site plan required)
Phone:. ji,or - Fax: E-mail; Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: ?-. -,4.---507) lnstall/replace/relocate heaters - suspended, r--
City/metro lic. no.: N/A wall, or floor mounted
(please print): • , , , pAia i Vent for appliance other than furnace
Name lease tom (�f�Z(�
,,� . 4 F . 4 . , Refrigeration:
A. k C ONT \C "f' '' PERSON' >p, Absotpuonunits BTU/H •
Chillers HP
Com. ressors HP
Address: �_ Environmental exhaust an vent
City: State: ZIP: Appliance vent ,
Phone: Fax: E - mail: Dryer exhaust
O W N h R Hoods, Type I/ lures. kitchen/hazmat
hood fire suppression system
Name: . y ,��R f�L Exhaust fan with single duct (bath fans)
Mailing address: wiM � - / / � WA Faust system apart from heating or AC
City: .. • , State'`\ ZIPGq"x) j Fuel piping and distribut (up to 4 outlets)
■ Type: LPG NG Oil
Phone: t? - J2 Fax: E - mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schemauc required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: [State: I ZIP: Insert - type
Woodstove/pellet stove
Pc n ��77LL arc:, E r �(J -mail: Other. —
Applicant's signat t. i { { d I Date 9 3 ( Other.
Name (print). k(J Yr f Da/ n. ii t
P
$
Not all junsdicuons accept credit cards, please call junsdtction fa more tnfonnauon. Permit fee
Notice: This permit application Minimum fee $
❑ Visa ❑ bet. MasterCard / expires if a permit is not obtained
Credit card number Plan review a t _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440-4617 (6/00tC.'OM)
Plumbing Permit Application
, A, Date received: 7 / 0 3 Permit no.: grAvg -0029
C i t y of Tigard
�� ^ ,(� t Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 97223 dam:
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
. ..TYPE OF PERMIT...
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi family 0 Tenant improvement
►' New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)' ,
Job address: • 2 °( % (I) U Pr Din don Qty. Fee (en') 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: 'IAA A A ,'/, 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/•tnspecuon: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
Manufactured home utilities
Business name : (2V1 ,, LU f tla I 1.-1( Manholes
Address:
Rain drain connector
Sanitary sewer (no. lin. ft.)
City: f„,, • wip ■ State•) ZIP:
E -mail: Storm sewer (no. lin. ft_)
Phone :(' �j� i Fax: Water service (no. lin. ft.)
CCB no.: [ ( 7 l.( —] I Plumb. bus. reg. no: — Fixture or item: -- �
City/metro lie. no.: N/A ' Absorption valve
- Contractor's representative signature `� Back flow presenter
.....-1.1g,,,,,1„,
Print name: , • ' — I U. rIAM i Backwater valve
. C'ONT'ACT I'I:RSON Basins/lavatory
Name :.1 {\■- -1 • vN N .. `` E Clothes washer
Dishwasher
Address: aa i if ti , ',Ni — Dnttk ina fountain(s)
City: I State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewercap
Floor drains/floor sinks/hub
Name (print): \ 1■,.[ k-- if-' _alt '` Garbage disposal
Mailing address: ,, _ • • " a► `1 Hose btbb
I City: State , ZIP:q - 70. --) Ice maker
Phone: 7- ,� Fax: . E-mail: Pli ,7- Interceptor /grease trap 1
Owner installation/residential maintenance only: The actual installation Pnmer(s) i
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
Unnai
Name: Water closet
Address• Water heater
City State I ZIP. Other.
Phone: Fax: E -mail. Total
Minimum fee $
Notice: This permit application
Na all lunsdtcu ac
oru cep credit cards, please call lunuLcuon for more informatinforminformation (ouas ion % S �_
Plan review (at _ )
C visa MasterCard / / expires if a permit is not obtained State surcharge (8 %) •••• S
C.edtt card number w ithin 1 80 days after it has been S —_
Expires TOTAL
accepted as complete.
Name of cardholder as shown oa credit card
S
Cardholder signature Amount 440.4616 (64:0000M)
Electrical Permit Application
. .
. .
Date received: 7Ara Permit no.: N5 �� �_ ..5— w . v'g l "
�, ,.� I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 ,
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
.:;4' r* ., t` ^N lt i, ` r ;: et r } ... � .• t:IT"'C _4a J' .4, 7�T ' �j �D1� 1 Y4r,� i,wa ,-1 v'. . ', : .
f � .' ?�1'yPEt,OF' �'�'"�j 1'r ..� Y t �. t . i f 7 �
0 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
v New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION
Job address: Me j P %� Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: j Block: Subdivision:
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRAC l OR APPI.IC:\ ZION FEE SCHEDULE • - -.
Job no: lgi • Fee Max
� Description Qty. (ea) Total Insp
N ew residential -single or multi - family per
Address: • ini `` �� d welling unit. Includes attached garage.
ism t Ali �g • , Service included:
Phone: I r • Fax: E -mail: 1000 sq. ft. or less 4
err �� Each additional 500 sq. ft. or portion thereof __
no.: T� Elec. bus. lic. no: •
y L irrtited energy, residential ____ 2
r _
C'
/ Limited energy, non- residential 2
Each manufactured home or modular dwelling ■■
' ...Am, .
. nature of supervising electrician (required) Da[ =r WV
Service and/or feeder 2
Sup elect name (print) 1 _ . irl .1j License no A . Services or feeders—Installation, IMMO
AIL alteration or relocation:
PROPIiR"I Y OWNER 200 amps or less
o 201 amps to 400 amps ___ 2
Name (print): -* �, , 11T11:tl1.sonr 401 amps to 600 amps �M� 2
Mailing address: �� �� c g. , 601 amps to 1000 amps ME= 2
City: i. 11), CMS ZIP: Over 1000 amps or volts ___ 2
Phone: ,�dS I�T ' Reconnect only MEM 1
Owner installation: The installation is being made on property I own Temporary serricesor feeders - IIII
which is not intended for sale lease, rent, or exchan a accordin Installation , altention , orrelontion:
g g t 200 amps or less 2
ORS 447. 455, 479, 670, 701. 201 amps to 400 amps .1.1.. 2
Owner's signature: Date: 401 to 600 amps 1.1.1.11 2
:, .F IrN; / 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: State: ZIP: 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) misc. (Service or feeder not included): Ma
O Service over 22S amps-commercial 0 Health -care facility Each pump or imgation circle 2
O Service over 320 amps - rating of 1 &2 0 Hazardous location Each signor outline lighting __ 2
family dwellings 0 Building over 10,000 square feet four or Signal circurt(s) or a limited energy panel. ■■ 2
O System over 600 volts nominal more residenual units in one structure alteration, or extension •
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 inspecuon MEM.
Submit _ sets of plans with any of the above. Invesugation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all rtrrisd,cuon ca
s accept credit cards. please call jurisdicnoo for more infornuuon. Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card Dumber / / 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 (6130/COM)
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I, 6LF_„,, ,_ , Own /Agent for Ino Ake 1 S a r r� ►^tip , ■
(PLEASE PRINT) (PERMIT HOLDER) ►
•
I Do hereby certify that the following location ►
meets City of Tigard /Washington C ounty ■
.• •
A land use and development standards for street tree installation. ►
• ■
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 ' '''s °Z / J
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Received Date Requested 10 — 36 AM PM —'�' - BUP
Location / 3 a, 7 (,Jo Suite MEC
Contact Person Ph ( ) ° 1-6/ 7 Y8' 7 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 s- 2 6 0-3 _ o 7
Insulation
Drywall Nailing D S J_ 0 (14
Firewall 3 ,.... l.,/
Fire Sprinkler / /
Fire Alarm
-§Y
Susp'd Ceiling
Roof • ' M
Other: ��. �/ ..4/, Final !�� �� /
PASS PART FAIL
PLUMBING Al / .mod " 1
Post & Beam
Under Slab —
Rough In /
Water Service ///
Sanitary Sewer
,/, --y ):') ii.
Rain Drains -
Catch Basin / Manhole /1U) #
Storm Drain /
Shower Pan )
Other:
i t? PART rf •I/ I
r CHANICAL /
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE I=1 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ApAoa ch/Sidewalk Date ° ' � Inspector Ext
P
Other:
Final O NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspectione tne: (503) 6394175 MST 3 -00 i' ?--
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /U — 3 O AM PM BUP
Location / a " 3 �S h�-�- Suite MEC
Contact Person Ph ( ) 020 ! — ( 1e? 37 PLM
Contract. Ph ( ) SWR
'ILDING Tenant/Owner
Foer
Foundation ELC
Ftg Drain Access: /9
Crawl Drain _AV �e 67
Slab Inspection Notes:
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Othe •
Other: V
Fina
OM PART FAIL
BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
, FAIL
Rough -In
Gas Line
Smoke Dampe 7 Fi t7`
PART FAIL
E RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
'llar:76 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
415:TO PART FAIL
Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date ���3 v /v � Inspector ( /
ADA
cS;" Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL