Permit 1�
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00058
II DEVELOPMENT SERVICES DATE ISSUED: 2/8/02
-- -:-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11825 SW WALNUT ST PARCEL: 2S103BA -00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: Addition 1569 sf Path 1.
BUILDING
REISSUE: STORIES. 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 27 FIRST: 748 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 821 sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 10
VALUE: $ 152,371 50
OCCUPANCYGRP: R3 BDRM: 1 BATH: 1 TOTAL: 1,56900 sf REAR: 99
PLUMBING
SINKS: 1 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 5 WOODSTOVES. GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 1 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR• SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL 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: $ 2,316.63
GAARDE, RICHARD J II AND VITA CONSTRUCTION This permit is subject to the regulations contained in the
11515 S MULINO RD. Tigard Municipal Code, State of OR. Specialty Codes and
JUDITH O 11825 SW WALNUT 11515 S OR 97013 all other applicable laws. All work will be done in
11 1 accordance with approved plans. This permit will expire if
1825 SW WALNUT LNU
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone' Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rea #: LIC 84795 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Underfloor insulation Plumb Top Out Exterior Sheathing Insr Rain drain Insp
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Electrical Final
Foundation Insp Footing /Foundation Dr Electrical Rough In Gas Line Insp Mechanical Final
Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Plumb Final
Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Final inspection
AP
Issued By : -11 Permittee Signature C- /. A. AO - . _ ,./'Ea-
Call (50 9 -4175 by 7:00 p.m. for an inspection needed the next business day
d
d,-f (7 2 _ 7,v L /3 T
Building Permit Application
4. Date received: a' �/ ,OP"' Permit no.: fgovo •-' OOD 6"
°). tIyi Ci ty of Tigard
Project/appl. no.: Expire date:
Gay ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: Byj� Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
( !r e / ' " �, 1 &2 family: Simple Complex: v
Land use approval/ . ,�., .
1 'Pi. OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
IS Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: 1 t 9.5 » L) L po_wt r ST . Bldg. no.: Suite no.:
Lot: I Block: ` Subdivision: ,G= I Tax map /tax lot/account no.: 9244€44wecrito K ,„ .
Project name: (4Ap�YAP _ t��t k0f7A '14..., A c lri .1- acid_. 2s' 03 BA -O 0 7C7>
Description and location of work on premises/special conditions:
OWNER ; . FOR SPECIAL INFORMATION, USE CHECKLIST. •
Name: - Rtchp.ea . - SO .:IA CP►ARA>✓ (Flood plain, septic capacity, solar, etc.)
Mailing address: 118 5 t=j L Jo or 1 1 & 2 family dwelling: 052.-37/..1:1"/
Cit State: Co( IZIP: g7da3 Valuation of work
Phone: O.- 3 /t3 Fax:6543 -1 i 22.IE -mail: /No. of bedrooms/baths / _
Owner's representative: 50-N--4,— . - . _ _ (Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) / .5 - —
- . . -
.. . . APPLICANT ° Garage/carport area (sq. ft.)
Name: SiMrtE As Cl ■w IvEQ. . Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.) 6 Z 7
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: CommerciallindustriaUmulti- family:
CONTRACTOR Valuation of work
• Business name: Existing bldg. area (sq. ft.)
Ride_ V t i A � ow- .Tr2.UCTi V New bldg. area (sq. ft.)
K
/ Address:
Number of stones
City: I State: p<2,1 ZIP: Type of conAruclon
Phone:soj-730 75171 Fax: I E -mail: Occupancy group(s): Existing:
CCB no.: Sy `79 5 New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
` ARCI1ITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: ( €•∎NAaS 00 r ,bS A'2.8Mte cAS provisions of ORS 701 and may be required to be licensed in the
Address: a sill . jurisdiction where work is being performed. If the applicant is
City: -K State: ZIP: q 7,,.) c/ exempt from licensing, the following reason applies:
Contact person:rnme i Plan no.: OW 1
Phone:a 5. Fax: E -mail:
Name: jAi me J Lim Contact person: Sy € . Fees due upon application $
Address: p0_ i 2.7 to 6. Date received:
City: IState: t?!. IZIP: Amount received $
Phone:AS el _ I Fax: I 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. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied t whether s cified herein or not. Credit card number: / /
Authorized signature 1� Date: 9 -, -0 Z. • Name of cardholder as shown on credit card
Print name: . J . -74A I rye - Cardholder signature $ Expires
Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/O0/COM)
P/..-A) lee !/• !-1if 3.Et)
t ,
One- and Two - Fancily Dwelling
• • Permit • ti
�.���,�
Building Per A pp h ca o n Checklist Reference no.:
Associated permits:
City of Tigard city of Tig y b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ 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
r 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 ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location 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.
Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer 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 — -- —
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 must include street tree size, type & location per City of Tigard Street Tree List booklet.
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 (6/00 /COM)
1. t
Mechanical Permit Application
04 y D ate received: Permitno.: s opt) ti-I'i� City of Tigard " __.. City g Projecdappl. no.: Expire date:
City of Tigard Address 13125 SW Hall Blvd, Tigard, OR 9722
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
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 115/ 25 5/,u to LLhA t , sr - Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.:a,Sl f3A- 00 profit. Value $ .
Lot: IBlock: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSChIEDULE
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 unit CFM
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: 0-101/4/6..-4,_ State boiler permit no.:
Address: HP Tons BTU/H
ddress:
Fire/smoke dampers/duct smoke detectors
City: [ St ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner O Yes 0 No
Install/replace /relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON. Refrigeration:
/ Absorption units BTU/H
Name: R) r a Yel-t_ /0l t)►tocr • Chillers HP
Address: Comyressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER • Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: . R tr ,`. t �,,,D y i"� /i. i -6 Exhaust fan with single duct (bath fans)
Mailing address: / j gZs st,,j (fie 4,4. ,$T Exhaust system apart from heating or AC
City: 72 e „,„...) State: ! ' I ZIP: G/.? Z'L3 Fuel piping and disc b on up to 4 outlets)
Fax: Type: LPG NG Oil
Phone:
cj - . '7 6 6/13 - / / LZ, E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pelletstove ,
Applicant's signature: I Date: Other:
Name (print):
Not all jurisdictions accept credit cards. please call jurisdtcuon for more informauon. Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: E
Expires expires if a permit is not obtained wi thin 18 0 days after it has been Plan review (at %) $
x
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (6/00/COM)
MECHANICAL PERMIT FEES ,`
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: - Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or induding ducts & vents 14.00
fraction thereof, to and including 2) Fumace 100,000 BTU+
$10,000.00. induding ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14 00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and induding 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp **
Minimum Permit Fee $72.50 SUBTOTAL: Bb unit
$ to to 1 100K 00K BTU 14.00
u) unit 10 k to absorb
8% State Surcharge 500k $ unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal) u) 15 absorb
$
Required for ALL commercial permits only unit .5 --1 1 mil l BTU 35.00
10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP: absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APP LIANCE: 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Fumace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Fumace > 100,000 BTU induding 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor fumace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not induded in 656
appliance permit Other Inspections and Fees:
Hood served by mechanical exhaust 656 1. Inspections outside of normal business hours (minimum charge -two hours)
Domestic incinerator 1,170 $72.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $72.50 per hour
inserts, etc. 3 Additional plan review required by changes, additions or revisions to plans (minimum
Gas i in 1 - 4 outlets 360 charge-one-half hour) $72.50 per hour
P 9
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION:
i:\dsts \fomis\mech- fees.doc 08/06/01
Plumbing Permit Application
414' y n Date received: Permit no.: '. �oa -o b ' ;
Ci of Ti
� ,�i� I ' J b Sewer permit no.: Building permit no.:
Address: 13125'SW Hall Blvd, Tigard, OR 97223
City of-Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
. TYPE OF, PERMIT : .
❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement
❑ New construction Addition /alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION . FEE SCHEDULE (for special information use checklist)
•
Job address: pc ,2 S sw U ja,(mj " sr - Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: �51 3 (34 - 00 SFR (1) bath ,
Lot: I Block: I Subdivision: 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
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: O w NV6.'4- . Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: 1E-mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
• City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: t Clothes washer
Dishwasher
Address: Drinking fountain(s) •
City: I State: I ZIP: Ejectors/sump
Phone: - Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): '., r I ,{- 9JAdi,t ‘ Floor drains/floor sinks/hub
Mailing address: j ,� Z5 (, sk Garbage disposal
Hose bibb
City: Il I State: I ZIP: e! 9.x..23 Ice maker
Phone: � p 3 r, 3 I Fax: (fl3 ii 21_j E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s) '
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per O Chapter 447. Sink(s), basin(s), Iays(s)
Owner's signature: ,, F K Date: .2 2-, Sump
Tubs /shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete
$
Cardholder signature Amount 440-4616 (6r00 /COM)
,, r
PLUMBING PERMIT FEES: '„ -
PRICE TOTAL New 1 and 2- family dwellings only: .
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL'
- Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato 16 60 for each utility connection)
ry One (1) bath $249.20
Tub or Tub /Shower Comb. - 16 60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet - 16.60 SUBTOTAL
Urinal 16.60 _ 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16 60 TOTAL
Laundry Tray - 16 60
Washing Machine 16.60 ,
Floor Drain /Floor Sink 2" 16.60 PLEASE C
3" 16.60
4" 1660 i i ' ' sr , I
Water Heater 0 conversion 0 like kind 16 60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New ' Moved Replaced _ 'Removed/
permit. , 'Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) ' 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3"
- Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55 00 Water Heater
Other Fixtures -
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 '
Residential Backflow Prevention Device` 27.55
Catch Basin 16.60
Inspection of Existing Plumbing'or Specially - 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE: '
Rain Drain, single family dwelling 65.25
Grease Traps 16.60 .
QUANTITY TOTAL ' ., .
Isometric or riser diagram is required if
Quantity Total is > 9 ,
*SUBTOTAL - '
8% STATE SURCHARGE - . J
"PLAN REVIEW 25% OF SUBTOTAL ' . -
Required only if fixture qty. total is > 9
TOTAL , $
* Minimum permit fee is $72 -50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review
i:\dsts\forms\plm-fees.doc 10/10/00
.1•
Electrical Permit Application
� Date received: Permit no.: 5i is U O 1
y ,� l City of Tigard Project/appl. no.: Expire date:
CiiyofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
• TYPE OF PERMIT -
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction CV Addition/alteration/replacement ❑ Other: ❑ Partial
. "
JOB SITE INFORMATION
Job address: f 1 , , W W k '-'c S'S . Bldg. no.: Suite no.: Tax map /tax lot/account no.:2 3'A o • a
Lot: Block: Subdivision:
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
1 , 7 . ` CONTRACTOR APPLICATION , .. FEE SCIIEDULE
Job no: Fee Max
1122122 Description - Qty. (ea.) Total no. insp
1 New residential - single or multi- family per
Address: dwelling unit. Includes attached garage.
City: State: ZIP: Service included:
Phone: Fax: E -mail: 1000 sq ft. or less 4
Each additional 500 sq. ft. or portion thereof __
CCB no.: Elec. bus. lie. no: Limited energy, residential ___ 2
City /metro Ilc. no.: Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling ■■111.
Signature of supervising electrician (required) Date Service and/or feeder
II
Sup elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
- ¢ I'ROPERTY` OWN ER - — -- 200 amps or less II 2
Name (print): - Q, .. j o c_,A.A19_,A15 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 11 462.5 (,J wa.l a ST 601 amps to 1000 amps ___ 2
State: CIsf ZIP: 7 3 Over 1000 amps or volts ___ 2
Phone: 5' v 3 (, IMMIZEB E -mail: Reconnect only ___ I
Owner installation: The installation is being made on property I own Temporarr services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation ,alteration
200 amps or less .. 2
ORS 447, 455, 479 670, 701. 201 amps to 400 amps =__ 2
Owner's signature:0 W. ,... Date: -S . 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: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: Ell
Phone: Fax: E-mail: Each additional branch circuit: MI=
_—
i•. PLAN. REVIEW (Please check all that apply) • Misc.(Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or imgation circle ■■ . 2
❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting ::: 2
famllydwellings ❑ 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 ❑ Feeders, 400 amps or more *Descn .lion:
❑ Occupant Toad over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighungplan ❑ 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 junsdictions accept credit cards, please call jurisdiction for more Information. Notice: This permit application Permit fee $
❑Visa ❑ 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 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq ft or less $145 15 4 n Audio and Stereo Systems*
Each additional 500 sq ft or
portion thereof $33 40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular III Garage Door Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80 30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems* ,
401 amps to 600 amps $160 60 2 .
601 amps to 1000 amps $240 60 2 n Other
Over 1000 amps or volts $454 65 2
Reconnect only $66 85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits 111 New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
• , feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 ❑
Each additional branch circuit $6.65 HVAC . I
Miscellaneous ❑ Instrumentation ,
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑
Each sign or outline lighting $53.40 Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over El Medical
the allowable in any of the above -
Per inspection $62.50 n Nurse Calls
Per hour $62 50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other '
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i.\dsts \forms\elc- fees.doc 08/30/01
Permit #: MST-0E962- — WO
OF
Z � - - Address:
t Q : rt _s:c
' " Date: oZ`�O .2.—.) 1 : 5 9 Issued by: � /
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and iboxes 1 and 2, and either box 3A or 3B:
`-
1 74 1. I own, reside in, or will reside in the completed structure.
,E,. , 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
-( 3A. My general contractor is - RICK \./17/4 CONS Y2.UCT f C1 \■ 21_q_ a_ Si
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
ri 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
i gnature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
q p r,.
linfo(rm litoon No lore to Property Owners -
About Co istruc Hon ResponsbMi Ues
. Note: This information Notice to Property Owners about Construction Responsibilities
Was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONISB[3BLBTBES: •
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945 -8091.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378 -3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs if One of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888.
U.S. hotel ai Revenue-Service: A's an enployer; you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040. -
OTHER f ESPONSB BLBTB S AND AREAS OF Ci CEf :
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe, punctures, fire, or work that must be
re -done. •
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish
trades, and to notify building officials at the appropriate times they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors_Board.(PO Box 14:140, Salem, OR 97309 -5052,
503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop- own.pm4
1 /94
CITY OF TIGARD 24Hour
BUILDING Inspection Line: (503) 639 -4175 0 000s
INSPECTION DIVISION Business Line: , (503) 639 -4171 MST
/ BUP -
Received 3" I 1 t/
Re ed Date Requested AM PM BUP
Location 1 g ?- 5 LOCU2Attdb Suite MEC
Contact Person A Ph ( ) 7 30 - 1s17 PLM
Contractor Ph ( ) SWR
ILDI Tenant/Owner ELC
Foundation Access: e 2 0
ELC
Ft. 'rai � r = ✓ ]. ` /�/ jff`, .v ELR
ab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing •
Insulation
Drywall Nailing /'
Firewall ,.C //� ii �_ i 0 ee /2- 17 - C 6 1-
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
'`: 9 •ART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer '
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan t
Other:
in
FAIL •
MECHANIC
Pos
Rough -In •
Gas Line
Smoke Dampers ' •
(aTi�'+1,-;.. FAIL
Ai3 LE
a ervi - ;- -
Rough -In '
UG /Slab
Low Voltage
Fire Alarm •
PART FAIL
III Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S E S Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA M Approach/Sidewalk Date q 1./ 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 _ �Y
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM BUP
Location [ � � L-CJ ' /YI1 Suite MEC
Contact Person R .0 ae, Ph ( ) 13e- 7577 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
D l ,/ - / S s
nsu a ion Gt/ ,� ®� 5 7 2 - x .c� � e 6nci ���-�i, 1J
Drywall Nailing ��,
Firewall " l i ,6 �7�-�J „ 5 i
Fire Sprinkler J CT v �- �-�
Fire Alarm
Susp'd Ceiling Z
Roof 6120).---3 C am! - - 5 /31) A5 - i2.4) 1j A--2.J
Other: ( l
Fin. ` ' ``a�� A ± ,L _ _F a 5 l / _ ) 7
. ; ! FAIL f ,
P 1 BING
Post & Beam 1 fit - 2 _ _ /` � n _ 6/6e/ & _ n
. Under Slab / R 5 n , :J ✓ l /� �/� 4-e---.0 J' 7 �Y`—�t -J'
Rough -In U/ &,i-.c 7 /:)) 6_,. -✓� ( 1,�,t�o) " d `'C _- 4_ Water Service Q
Sanitary Sewer C ' . ,C � e p/c 7 LeS f f
Rain Drains �' U
Catch Basin / Manhole __ - 3 4 )( 0) y , 1...,V — et ..
Storm Drain
Shower Pan 1 J - , ` r _
Other: )� - _ - i,1 �r - �
!�. s.
Final /.� �/�'U� --- r CAA- �, '4 ' ( _
PASS PART FAIL �i . � iiii
MECHANICAL t -- . A, • --- mil - A. ■ A_ . _ ."...
Post & Beam
(Rbugn -m
Gas Line
Smoke Dampers
Fin-
PA - 4i FAIL
CTRI AL
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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /� /�
ADA Approach/Sidewalk Date �j Z Inspector `� r v p Ext���
Other:
Final DO NOT REMOVE this inspection record from the Job site: .
PASS PART FAIL
. . . .
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CITY OF TIGARD " 24 -Hour • r
BUILDING Inspection Line: (503) 639 -4175 MST 2 — 47)0 � �b �
.INSPECTION DIVISION - Business Line: (503) 639 -4171
` BUP
/
Received Date Requested c P l ,3 AM 9 BUP
Location - S 1.0° . Suite MEC
Contact Person ,c.C�7� Ph ( ) 7 3 d 7 ' / 7 PLM
Ci,ntractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: 6 77 cro.1 ( / S A-7-)
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear Q
Alait-raw nsu ation
Drywall Nailing ii
Firewall \\ T
Fire Sprinkler — U
Fire Alarm � o l C (p g
Susp'd Ceiling
Roof
Other: ` , �y
Final t,/Uw ATh
PASS PART IL
PLUMBING I2_Q e 614
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
/MSu -In l
ne f
'mo ampers
Final
PASS • PART AI
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
1C
Approach /Sidewalk Date Inspector J1 Ext)-14 d"
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 CT �,s��t'
IIPECTION DIVISION Business Line: (503) 639 -4171
\z-.: ,(/ BUP
Received Date Reque ted S AM /U / C. 7 PM BUP
Location /1 E v---S a— .P.0t . Suite MEC
Contact Person l2 j • Ph ( ) '2 7S/ 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: V ,M <A.— S VJ�� - SIT
Post & Beam
Shear Anchors /, ,{ 7 �, Q _ _ Q
Ext Sheath/Shear !C� 6 � �-°�
githeath/ 4I? I • C1 1
�u ai�tion k)Ios
‘2,e--( C<Or .
Drywall Nailing i
Firewall 0 �Q-tit� ( ( L -� �A ) L , n
Fire Sprinkler l I _ "�
Fire Alarm., C \/�
Susp'd Ceiling
Roof n t A P/ 1 c--...i2. L
Other: (V1r
Final V t.'•, -t= 5 k r/NC A--r..) • ..
'
PASS PART AD A
PLUMBING L c_4 (-4 A •
Post & Beam 0 = k (I S t _
Under Slab <.D �LJL
Rough -In )2_51--
Water Service b , ■K v`g-Q G, G-- S i
Sanitary Sewer '' 1
Rain Drains
Catch Basin / Manhole _ � �
_ 1 LAN ` ► eL �,N , - I • Storm Drain
Shower Pan b, - lz Y� t,v L, -S
Other: /
Final fL S 6i2--g;L--41-e—A ` "'� Q� , PASS PART FAIL IN 1 U
‹..). l • ,06
MECHANICAL i� Q2c S T - 4, QX - %
Post & Beam '5 " ✓ I 7/ U v L 0 . - .W'
Smo e Dampers
Final �+ ��.. I 1 [�� ' _ : S A- ' L - e
PASS PART AI - ' ELECTRICAL �. o • C •
Service pp
y. Rough -In ./1 d/ / CM o
Low Voltage i °
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 Approach/Sidewalk Date �� C Ins V(/‘V Ext (9
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL '2.---
CITY OF TIGARD 24 -Hour
'BUILDING Inspection Line: (503) 639 -4175 MST P-- 00° Cs
WPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location Suite MEC
Contact Person Ph ( ) 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 n la 1 �: . t - C (_ -�--✓ _ � r
Framing
Insulation ('..� ��— S
Drywall Nailing ��77
Firewall L C. , `--- CA 4-\ L S
Fire Sprinkler
Fire Alarm 0 "t---e_.,k C , -1/4---1.--.42- C
Susp'd Ceiling
Roof .('
Other:
Final it
PASS PART FAIL •
PLUMBING �\ - _04-->\ L� S �
Post & Beam � "T (1 \ /'�
Under Slab ` � ' - mil' S — `---.� �`
Rough -In 4)( \ d-\--�-
Water Service
Sanitary Sewer • I
Rain Drains
Catch Basin / Manhole -N (�LL�A . • Y _-
Storm Drain t
Shower Pan 0` _ S ie S L ,)/ 0 a 4t 0_ � / t
Other:
Final < I ^ �� L--c0-.1„-^. 421 PA SS P ART FAIL IlIllI
MECHANICAL e ► / % . 2 cJ >.)•+ +5 .
Post & Beam �� �
Rough -In
Gas Line /" ..4 S� S `� �� �S
r 0 t�
Smoke Dampers S
Final
PASS PART FAIL
ELECTRICAL e'''' \
Service
� _� r \ %,...,./1 (� 1
Rough -In x
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 c �C,'Z- '�
� r
Approach /Sidewalk Date / Inspector " �� '. . 1
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL ^ '
v�
CITY OF TIGARD 24 -Hour J�'
BUILDING Inspection Line: (503) 639 -4175 MST �
INSPECTION DIVISION Business Line: (503) 639 -4171 .
BUP
Received Date Requested SAM PM BUP •
Location 1/ &I--Q___&ii.te Suite MEC
Contact Person Ph ( ) 73) 7517 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
S ear Anchors
Sheathie�
nt Sheath/Shear,
Framing .57w47 A. 12/ArS. 11 4.4 ' , e5 d 470,c-c.
Insulation - r /J (?ivd� IA ''
Drywall Nailing Ai o v 'Gioo..vAc S • �i?/or /.- SrW
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS T FAIL
PLUM
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer .
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In .
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line
ADA
Approach /Sidewalk Date 4 / – - 5 `d — 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 -66= cjD d
INSPECTION DIVISION Business Line: (503) 639 -4171
1/1)) Q BUP
Received i • � Date Requested 3 " z--- AM PM BUP
Location 1/ Q' a S Cr- ? l-c -. : Suite MEC
Contact Person L , Ph ( ) 73 Za 7. V7 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
�S iah Inspection Notes: SIT
(post & Bea
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Insu ation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Fi
,_PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post &Beam •
as ine .
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 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 •
Approach/Sidewalk Date 3- zS ° Z-- 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 O D— ° ..C8''
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 3 AM PM BUP
Location / 1 3 .5" cOecOitt Suite MEC
•
Contact Person Ph ( ) 30 7 O
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
• • - • atio Access:
g ' rain ELR
Crawl Drain
Slab Inspection Notes: / : SIT
Post & Beam 0 dait_l_AA
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ot : •
F�
•
PART FAIL
MBING
Post & Beam
- Under Slab
Rough -In
•
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: .
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
2i
Approach/Sidewalk Date / D� Inspector a 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 e; ()-00
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 5 7 AM PM BUP
Location / l R a S £)O 3 _4 Suite MEC
Contact Person .t Ph ( ) 730 7.5 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 •
Insulation
Drywall Nailing /�
Firewall
Fire Sprinkler r U UI
Fire Alarm 5'77 ee_4, ,', i 5 ',z / 6 f
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam r
Under Slab
A o Rough-In
Water Se
rvice
Sanitary Sewer '
Rain Drains
Catch Basin / Manhole
Storm Drain •
Shower Pan
Other:
Final
PASS PART FAIL •
MECHANICAL _
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
RT FAIL
•
ICA
Service
<< ••:mil
Slab
Low Voltage
Fire Alarm
Fi ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
g PART FAIL
❑ Please call for reinspe tion RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA 1 e"\ Approach/Sidewalk Date ✓ 0 Z 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
` yZ -00 GJ P
INSPECTION DIVISION Business Line: (503) 639 -4171
•
1 / BUP
Received Date Requested / t G ' AM / 3 PM • BUP
.Location / / 1 St-) Itia,4 tI Suite MEC
Contact Person Ph ( ) 73 75 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
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final •
PASS PART FAIL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
torm Drai
Fina
PART FAIL
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 El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA lq Approach/Sidewalk Date / v Inspector Ext��Z�
Other:
Final DO NOT REMOVE this inspection record from the job
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST d - o`er 8'
INSPECTION DIVISION Business Line: (503) 639 -4171
Received Date Requested 66 BUP AM PM BUP
Location g - L -c_ff Suite MEC
Contact Person at Ph ( ) 7 C -7 Sl 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
_ Under Slab
Rough -In
Water Service
Sanita Sewer
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
e Fin-
PART FAIL
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line 9 r, Ext
ADA
Approach/Sidewalk Date / ■ I nspocto
Other:
Final DO NOT • EMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 639 -4175 MST 70 0 1 ' reP
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested -7 AM PM BUP
Location / / z 5 t-C Suite MEC
Contact Person Ph ( ) 7.c/ 7
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
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
ai�n rams
Catch Basin / Manhole
Storm Drain
Shower Pan /` 4/ 4 4 " Pce?f N 4t14 i.-r d2rr irez.. 5,T � ��,
Final
PASS FAIL
MECHANI
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 E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA S / ' 1(
Approach/Sidewalk Date / I nspector ! qu -e • 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 c v G
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested �� PM BUP
Location 7/ g S � �C � . Suite MEC
Contact Person _ Ph ( ) 3 c) 7/7 PLM aDc - 7,6
. Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain ti/A) Alv t
Slab Inspection Notes: SIT
Post & Beam -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
7 141 7:-/✓ e� � 0 4 4 rte+ •-•-•
Drywall Nailing /
Firewall � �` f f/ �.. sdy G,' 0- 73-2 "' ► c
Fire Sprinkler
Fire Alarm �d Cgvc -P ,
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
s & Beam y�,�
/!/ / � , 6259.e—e
Water See Fr V' c, d-r"
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: •
Final
PASS PART FAIL
ANICAL
Post & Beam
Rough -In ,
Gas
Smoke �/
Smoke e 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 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date - ' - Inspector 7// 1 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL