Permit A
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00478
fit' DEVELOPMENT SERVICES DATE ISSUED: 12/20/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12125 SW WHISTLER'S LN PARCEL: 2S103CC -WW048
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 048 JURISDICTION: TIG
REMARKS: Model home - New SF detached, Path 1.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,610 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,790 sf GARAGE: 420 sf FRONT: 21 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 25
VALUE: 324,366 00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,400 sf REAR: 20
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 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: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: 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: 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. W /SVC OR FD R. PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp. 1st W/O SVC/FDR• SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: 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 & 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: $ 8,265.42
This permit
DON MORISSETTE HOMES INC DON MORISSETTE HOMES all otMu is Municipal Code, d State Spedthe regulations ec Co i ode s and
the
4230 SW GALEWOOD ST #100 4230 GALEWOOD STREET Tlga h e r ap plica bl a lawlaws. All w
work w ill be d Codes
LAKE OSWEGO, OR 97035 SUITE 100 hr applicable law will i
LAKE OSWEGO, OR 97035 accordance with approved plans. Th is 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
33 3R forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: L�C _� 3873755533 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control lnsp & Post/Beam Mechanical Mechanical lnsp Shear Wall lnsp Insulation lnsp Electrical Final
Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Insf Insulation lnsp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Rain drain Insp Plumb Final
Foundation lnsp Footing /Foundation On Electrical Rough In Gas Line Insp Water Line Insp Final inspection
Post /Beam-Structural�\PLM /Underfloor Framing Insp Gas Fireplace Appr /Sdwlk lnsp
Issued By : J2 (Q� `���4�` -/�j Permittee Signature : D e/i/v4 , . 4 i i iipth i Ly_____
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. 7 PT / Z - / L ---G Z /3 / cow24.4oa -c 03 g.
Building Permit Application ,
Date received: /.? 3� 2 Per n o.: W5T , f,Y3 5/
W .,�,�l, City of Tigard
7
Project/appl.no.: A illi date:
City of d Address: 13125 SW Hall Blvd, Tigard, OR 97
Phone: (503) 639 -4171 • % �t Date issued: , Receipt no.:
Fax: (503) 598 -1960 �•i Case file no.: Payment type:
Land use approval / o orv. — 600 - l &2 family: Simple Complex:
, s 7<1 PL OI" PERM'''. 1 '.: r '.
(a 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family , 'New construction 0 Demolition
0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other.
. . - JOB SITE - INFOR11�17ION'.. _
Job address: l ` ' j , Loh- 16ra g.'S � N ) Bldg. no.: Suite no.:
Lot: AI M! Block: Subdivision: r '� _ ( AA. r Tax map /tax lot/account no.:
t Project name:
Description and location of work on premises/special conditions:
., O■VNER FOR SPECIAL lNFORll177OiN, USE (HLCKLIS'I'
■ g . "( IIootlplt in;septiccapacrt■,sold!,etc.)
Mailing address: ' e ' 'I t�i�ii3�rtiall 1 & 2 family dwelling:
Egiffirg '� ZIP: ,,. in Valuation of work $ 3- 36'
Phone: . No. of bedrooms/baths Ail lWate
v Owner's representative: . A ' L if _ Total number of floors i _ _
j Phone: Fax: E -mail: New dwelling area (sq. ft.) :
^
, APPLICANT ' Garage/carport area (sq. ft.) q se.
. ^ � 'a � .= Covered porch area (sq. ft.)
Mailing address: ♦ Deck area (sq. ft.)
City: �L State: ZIP: Other structure area (sq. ft )
Phone: Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work .. $
������ Existing bldg. area (sq. ft.)
� l �r�_ New bldg. area (sq. ft.)
�
Address: - v�r ice,.. driwralliMMI /
City: State: ZIP: Number of stories
Phone: Fax: E -mail: Type of construction
CCB no.: Occupancy group(s): Existing:
r New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
-4:; <,. ,, .ARCH1 l l.(I IDF SIGNF R , licensed with the Oregon Construction Contractors Board under
4 f: . , provisions of ORS 701 and may be required to be licensed in the
Address: i c r7` .� jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
,� Contact person: Plan no.:
Phone: Fax: E -mail:
- ENGINEER
Name: Contact person: Fees due upon application $
4 Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. • provisions of 1 ws and o', dinances governing this ❑ Visa ❑ MasterCard
work will be compl • wt . ' , whether cified tierei r�tot. Credit card number: / /
A J Expires
Authorized si aril ' / f --w7, Name of cardholder as shown on credit card
Print name: 'us _ Air 4Z I ( ,K_ Cardholder_ signature $ Amount
N I Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6N0/COM)
4 ,, One- and Two - Family Dwelling
u ,, - Building Permit Application Checklist Reference no.:
_
CuyofTigard City of Tigard Associated permits:
g 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TILL FOLLOIVING ARE FOR PLAN - Yes — No — N/A - . -
I Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
•
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. ,(
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and 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 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. ' l( \
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. 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 Vall 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. y
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. 440-0614 (&OOICOM)
Mechanical Permit Application - :., ` ` . - -: ,
� � Date received: / /Q .'ti Permit no.: T' . ,t -dU
�.,i„•� ,, City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Date issued: By: Receiptno.: _
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
. TYPE OF PERMIT . • "
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
few construction 0 Addition/alteration /replacement ❑ Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE -
Job address: ` c , Lo1-f 0 Lk) _ 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.: profit. Value $ -
Lot: Liy IBlock: I Subdivision: 'See checklist for important application information and
Project name: \nia 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 CO1 MERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
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
g P Air condiuoning (site plan required)
Is existing space insulated? D Yes 0 No __ Alteration of existing HVAC system
M1ECFLWICAL CONTRACTOR Boiler /compressors
•
State boiler permit no.:
Business name: / E�I
, / HP Tons BTU/H
Address: alr Fire/smoke dampers/duct smoke detectors
City: \N., - � r State: " ZIP: ' 'i , Heat pump (site plan required)
Phone :,p5S - -;7-)-)DI 5 � J I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes 0 No
CCB no.: '? ' 'T Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): Ili . t 1 ob MEZL_. Vent for appliance other than furnace
. CONTACT PERSON Refrigeration: •
• Absorption units BTU/H
Name: # 7 S . T Zi - E `_� Chillers HP
Address: , VVN-•�� c Compressors HP
Environmental exhaust and ventilation:
City: I State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
_ OWNER Hoods, Type U II/res. krtchen/hazmat
hood fire suppression system
Name: AI 1111 ea Ai Exhaust fan with single duct (bath fans) —
Mailing address: gip / , ��_ EWAY41 Exhaust system apart from heating or AC ,
City: , r , State 4 ZIPq i 5 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone:. 7- _Alt Fax: E -mail: Fuel piping each additional over 4 outlets
. • ENGINEER Process piping (schematic required) —
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: [ZIP: Insert - type
Phone: Fax. E -mail: Woodstove/pelletstove
Other:
Applicant's signaru" - , � '��' Date: a i d j j , �r� Other.
Name (print): 'r , S
Not all lunsdicuons accept credit cards, please call junsdreuon for more information. Permit fee $
Not Th permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number / Plan review (at _ %) $
Expires within 180 days after it has been
accepted as complete.
State surcharge (8 %) .... $
cr
Name of cardholder as shown on ed a cre coin o card P p
S TOTAL $
Cardholder signature Amount 440 -4617 (GOO/COM)
FA
Plumbing Permit App
Date received: ! 3 09. Permit no• 56 0 ,2 — G'0 7g'
. ,
. llt,jy� City of Tigard
a � Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 97223
City ojTigard 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
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi family 0 Tenant improvement
►: ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITE INFO RMATION • ; _ FEE SCHEDULE (for special information use checklist)
Job address: (� ( ;;AA/ Lit +1 S1'C _,c_S Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: �j� Block: Subdivision: j ^ ` L _�' SFR (2) bath IIIII
Project name: ,f 7M111 SFR (3) bath N
City /county: 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.)
I'LL'\llIING CON']RACTOR Manufactured home utilities _
Business name: 11,, ♦ L • Manholes I ___
Address: o Rain drain connector
�� / Sanitary sewer ft.) ME
Phone:
r (no. l.
�i !1J�i•1 _�.. �'a ZIP: Storm sewer r ( . l . M
— Fax: E -mail:
�/ _ .� — �.� Water service (no. lin. ft.) M
CCB no.: (, Jo - 7 1.. Plumb. bus. reg. no:
vilp Fixture or item:
City/metro lit. no.: N/A / Absorption valve
Contractors representative signature � ✓t/ Back flow preventer
Print name: • Ili i r g al Backwater valve _ _
CONTACT ACT PERSON • Basins/lavatory =
Clothes washer
Name: fJ
{h I E Dishwasher
Address: .AA' - / ` te ., ,V � Drinking fountain(s)
IIIIIII
City: State: ZIP: Ejectors/sump
Phone: Fax: E - mail: Expansion tank
O W N I i R Fixture/sewer cap
Floor drains /floor sinks/hub III
Name (print): ,t :ate Garbage disposal N =
Mailing address:���� ►�g1 Hose bibb
City: _() . State ZIP: ' 7C� , Ice maker M
Phone: l , — A pr Fax: - 7;70 • E-mail: Interceptor /grease trap IIII
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)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
I
Owner's signature: Date: Sump
- ENGINEER - Tubs/shower /shower pan
Urinal
I
Name: Water closet
Address: Water heater
City State: ZIP: Other. IIIII
Phone. Fax: E -mail: Total MM.
Na all unsdreuons accept cnnrt cards, please call unsdreuon for more Information Minimum fee $
1 p p � Not This permit application
Plan review (at %) $
Pisa O MasterCard expires if a permit is not obtained State surcharge (8 %) •••• $ �—
Crrdrt card number w ithin 180 days after it has b een S
Expires TOTAL
accepted as complete
Name of cardholder as shown on crab( card
S
Cardholder signature signature Amount 440-4616 (64)0+COM)
• • Electrical Permit Application - - , - .
Permit no.: H5 //
Date received: / 5 O � r o{' OD. -d0 r 71
4 jj 1 ,•) City of Tigard Project/appl.no.: Expire date:
City ofTigard 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:
I
. .. TYPE OF PERb Tf
0 I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
v. New construction 0 Addition/alteration /replacement 0 Other. 0 Partial
- - JOB SITE INFORMATION '
Job address: 1 - i ) j. f ST f 3 1- Suite no.: Tax map /tax lot/account no.:
Lot: , Will Block: Subdivision: . Al _' r L
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR RA\CTOR APPLiC:\ - I ION FEE SCHEDULE -
Job no: Fee Max
� / Description Qty. (ea.) Total no. Imp
New residential - single or mufti- family per
Address: rrip `` M dwelling unit. Includes attached garage.
En =t 1 4 in 7'X Serviceincfudeb
Phone: ii .3 - I r j,] Fax: E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft or portion thereof __
CCB no.: Elec. bus. I no:.. Limited energy, residential ME__ 2
C: Limited energy, non- residential ___ 2
Each manufactured home or modulai dwelling ■111 .
nature of supervising electrician (required) Q Date 74 �U. Service and/or feeder 2
Sup. elect name (print) 9 A 'J � License no l� Serncesor(eeders — installation,
alteration or relocation:
PRON Y OWNER • 200 amps or less II
AIL 2
Name (print): _ ` P '��j�s� 201 amps to 400 amps ___ 2
___
Mailing address: � - f I� 1� ; 401 amps to 600 amps 2
g � Z i 601 a mps to 1000 amps ___
City: t di s
`� 2
���+ ZIP: Over 1000 amps or volts ___
Phone: ,-1.,Ca-2�T' Reconnect only ___ 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .. .
which is not intended for sale, lease, rent, or exchange according to installation, alteration orrelocation: 2
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps MEM 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: 2
Phone: Fax: E -mail: Each additional branch circuit •EI
PLAN REVIEW (Please check all that apply) . Misc. (Service or feeder not included): ■■
O Service over 225 amps - commercial Cl Health-care facility Each pump or irrigauon circle 2
n
O Service over 320 amps - rating of 1&2 0 Buildings location Each sign or outline lighting 2
:■ 2
family dwellings O Building over 10,000 square feet four or Signal circuits) or a linuted energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension
O Building overthree stones O Feeders, 400 amps or more •Descnption:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all junsdicuons accept credit cards, please call jurisdiction for more informauon. Notice: This permit application $
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %n)
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
S
Cardholder signature Amount 440 - 4615 (6At1COM)
M 41 - pro #78
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TREE
CERTIFICATION STR EET ►
• .
• .
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. . .
. I, /4(,) ,,,_.,., , Owner /Agent for do.. / °'t_ - G 4 c_ f O•
I (PLEASE PRINT) (PERMIT HOLDER) ► •
•
• •
• • •
• •
• Do hereby ,c •
that the following location ■
■
• meets City of Tigard /Washington County ■
• It. • land use and development standards for street tree installation. O.
• ADDRESS: ) 24 .)-‹ S 1 - t1/4-i 3-l-f c. (5 Gh ■
•
I ( ■
• L � SUBDIVISION: L.1�� S-+' c.s 1;.-),���
l ,,, DATE: _ _ , /d —3/- U3 ■ ■
BY.
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j RECEIVED BY: ' DATE: /G - 3/- o 3 ■
•
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CITY OF TIGARD 24 -Hour
BUILDING ., Inspection Line: (503) 639 =4175 MST - D 0 47P /
INSPECTION DIVISION • Business Line: (503) 639 -4171
BUP
Received Date Requested ld — I AM PM BUP
Location / 02 / 2 tL Suite '/ MEC
Contact Person Ph ( �� 48 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 9 its —re c-55 I Q:1**ds-41 G #I y vs
Insulation
.. Drywall Nailing r.4 .1. t, 7'/V V fl '7-- D' J I nor /1i7,0- ' ( ILICZAS`: CA L CSu1-1
Firewall /�
Fire Sprinkler
Fire Alarm Be,iteliZe XyX -7'�
Susp'd Ceiling
Roof
Other: -
••A - 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
'.1, 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 Date re - d 3 Inspector /1<:7 Ext.
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OFTIGARD -24 -Hour �Ip
BUILDING Inspection Line: (503) 639 -4175 MST - b D <O
INSPECTION DIVISION Business Line: (503) 639 -4171 •
BUP
Received Date Requested / , 3 I AM PM BUP
/
Location [ f c Z � aG ' C�ta Suite MEC
Contact Person Ph.( ) ` 1 � 4 3 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
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 -
Smoke Dampers -
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
F' - = larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
FART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 0 ^ 3 / OS Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL ��
CITY OF TIGARD 24 -Hour 4 17 Er
BUILDING Inspection Line: (503) 639 -4175 MST — 6 ° 4
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received / Date Requested Jd — 3 t AM PM BUP
Location Suite MEC
Contact Person SD P — Ph ( ') . D ' --e i t?3 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 F h N r h ��. cu i - 4, a-- SG‘4\ \u re. Tt Vt"
Firewall a
Fire Sprinkler
Fire Alarm
Susp'd Ceiling p �vio "refr �'oc.I�C," DoLtblc GL.��1.� V6•\vim
Roof
Other:
S ✓ ' cj f-d .r S y r --1-t �-, Oull
Final Ni
FAIL t1 Vgc A 1p
��.,,,t .. 1�� ✓w.� - r ��..�,tc Cl..�c�v` Vt_lvt ��. 1�ir�
PASS PLUMBING ✓ • P✓.t v ,..r
Post & Beam
Under Slab
Rough -In `1 , e ve m✓ k�, J
Water Service �� S
� �' kD � w° �1
Sanitary Sewer PS ,`, w
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot er:
in
t ; _ PART
M ' ANICAL
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 ) Ext
Approach/Sidewalk Date / Oil/it Z / 1 c 1 Inspector (ID \ 1-.w i I �� '^�
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL