Permit e
Aill CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00010
�I� DEVELOPMENT SERVICES DATE ISSUED: 2/18/04
`�'` `'-' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12058 SW WHISTLER'S LP PARCEL: 2S103CD -WW270
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 070 JURISDICTION: TIG
REMARKS: New SF. DEMO CREDITS FROM BUP2003 -00589 TO BE APPLIED TO THIS PERMIT.
BUILDING
REISSUE: DM199AS STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,620 sf BASEMENT. sf LEFT: 5 SMOKE DETECTORS: V
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,680 sf GARAGE. 630 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: NONE DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE: 320 00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,300 sf REAR: 15
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: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp' 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY' 401 - 600 amp: 401 - 600 amp. EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR• 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS. SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOWPAGING: 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: $ 3,954.39
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES INC DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
4240 GALEWOOD ST #100 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
work is not started within 180 days of Issuance, or If the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #• i.g 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insf Gyp Board Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electncal Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
P Beam Structura Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
ued By : , . 411 -�-. 4 /<L ✓ Permittee Signature : y "...\---, -2 .-------,_____
Call (503) • • • -4175 by 7:00 p.m. for an inspection needed the next business day
• • �w2ae.., -OA0/
Building Permit Application : =
s ., Date received: / 4 py Permit no.: W .�
E" i ii City of TigardE� — o
' ---- Project/appl. no.: Expire date:
CityojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 JAN 1 b 2004 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
OVOtTIGARD 1 &2 family: Simple Complex:
TYPE OF PFR:1I1T.
0 1 & 2 family dwelling or accessory 0 Commercialindustrial 0 Multi- family 'New construction 0 Demolition
0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: I S \.1 -LiQ.IS X• Bldg. no.: Suite no.:
Lot: I Block: Subdivision: \ 0.5 M k K. ')— I Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: 11J�t d �' , ; j ;(I loodplaiii,septiccapacit
Mailing address: ' er l ftjr l3�R 1 & 2 family dwelling:
City: A ZIP: . �"' Valuation of work $� I
Phone:. r si -� No. of bedrooms/baths ,
Owner's representative: , ; La if Total number of floors _It
Phone: Fax: E -mail: ; ' New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Yli1 ' ^ &.' Covered porch area (sq. ft.)
Mailing address: ,ys /� a a" Deck area (sq. ft.) _
City: `State: I ZIP: Other structure area (sq. ft.) —
Phone: Fax: E -mail: CommerciaUindustrlaUmulti- family:
CONTRACTOR - Valuation of work.. .., $
Existing bldg. area (sq. ft.)
Business name: .„ New bldg. area (sq. ft.)
Address: .I d v `r �� 411110111111.11M11111 Number of stories
City: State: Type of construction
Phone: I Fax: I E -mail: Occupancy Existing:
CCB no.: y group(s): New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
A RC! IITECTIDESIGNER - licensed with the Oregon Construction Contractors Board under
Name: ( -ia,.0 � provisions of ORS 701 and may be required to be licensed in the
Address: _ ,L • C j,F 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 $
Address: Date received:
City: 'State: IZIP: Amount received $
Phone: 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. A a rovisions of 1 ws and o dinances governing this Cl Visa 0 MasterCard
work will be complt • wr . • whether cifred &1ere r Credit card number: / /
-- Expires
Authorized si atu /� ! I Name of cardholder as shown on credit card
Print name: •: ����_ f � I ( 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 (6/00WCOM)
r r
One- and Two - Family Dwelling
Build's' Permit A he 'o 510,y. It Reference no.:
pose
VO ta.0 8 ,1 Associated permits:
City of Tigard
City of Ti arU
g 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ¢(itIS j NAL O Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 GR , i
--
THE- FOL-LOIVING- lTE%1S- ARE REQUIRED FOR - PLAN REVIEW — Yes — No — N/A -
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved plat/lot. ,c
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit. 3‘
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.
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 -R 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,
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. J�
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists Y
over 10 feet long and/or any beam/joist x
/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 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. - - 4404614 t6i)0/("oM)
. O 2
Mechanical Permit Application on .
�, Date received: Permit no.: y , ,p •
.....10.4- ^11. City of Tigar E®
Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW � d, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -41 q 6 �ooa -
Fax: (503) 598 -1960 `SW A. C ase f ile no.: Payment type:
Land use approval: rel ►� Building permit no.:
cl TYPE OF PERMIT •
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family O Tenant improvement
,iew construction 0 Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION - COMMERCIAL VALUATION SCHEDULE - •
Job address: l a, s
14- I STLE kts _ 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: Subdivision. t g.` 'See checklist for important application information and
Project name: ■ tar 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 COMMERICAIJINDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: l3VAC: •
Is existing space heated or conditioned? 0 Yes 0 N o Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes Cl No _ Alteration of existing HVAC system
- _ -_ ti1EGFIANICA . CONTRACTOR -__.- -"- -- Boiler/compressors
Boiler /compressors I
�����}}�� State boiler permit no.:
�..1�Stoi�Il-f1, HP Tons BTU/H
Address: ����` Fire/smoke dampers/duct smoke detectors _
4. ECUM126111111)1.'' Heat pump (site plan required) ME
Phone:_ u" . 'Fax: E-mail: Install/replacefurnace/burner BTU /H III
Including ductwork/vent liner 0 Yes 0 No
CCB no.: '?),9'j(f) - Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): d , t •1JjV NELL__ Vent for appliance other than furnace
CONTACT PERSON Refrigeration: I
Absorption units BTU/H
Name: • EA- c`1ELj Chillers HP
Address: Compressors HP MN
V_ G 4i, �' Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust ,
- - OWNER Hoods, Type 1/11/res. kitchen/hazmat
hood fire suppression system
_�.i+ lA 1. gInt Exhaust fan with single duct (bath fans)
Mailing address: I. M / Vi� a' P IE /b] Exhaust system apart from heating or AC EN
�e rtai9rLiI� � Fuel piping and distribution (up to 4 outlets) ■
�� Cii Type: LPG NG Oil
f
Phone: � / 41 Fax: E -mail: Fuel piping each additional over 4 outlets _
"
"ENGINEER_ ' _ .. Process piping(schemaucrequired) I♦
Name: Number of outlets
• Other listed appliance or equipment:
Address: Decorative fireplace
City• I State: {ZIP: Insert - type
Phone: // Fax: E -mail:
I
l� ax: //
W oodstoveipellet stove
g ,'Iif I tI Other
Applicant's si Haiti" � Date:
Name (print): r • * • , • f
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been
accepted as complete. State surcharge (8 %) .... $
Name of cardholder as chows on credit card P P
S TOTAL $
Cardholder signature Amount 4444617 (6A0/COM)
. - i.
Plumbing Permit Application
® Date received: ' ' �O //
M— i l City o f t Tigard . . Sewer permit no.: Building permit no.:
Address: 13125 SW Hall 1' " 'C n %'i,_6, -a• VR V7223
City Expiredate: of Phone: (503) 639 -4171 Project/appl.no.: P •
Fax: (503) 598-1960 110 16 100 Date Issued: By: Receipt no.:
Land use approval:
Case file no.: Payment type:
Wi �j!
. 'if if PE OF PERMIT
Cl 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 SIIEINFO ATION SCHEDULE S ULE (for special information use checklist)
Job address: 1 945 p &t WWI _ WTI 6rt- - jJ Description Qhr• Fee(•) Total
New 1- and 2- family dwellings only:
Bldg. no.: [Suite no.: (includes 1009. for each utility connection)
Tax map /tax lot/account no.: "�► SFR (1) bath
Lot: m' Block: Subdivision: i.jj. � ' 7 SFR (2) bath
Project name: /y aMISIN SFR (3) bath
City/county: ZIP: Each additional batlt/kitchen
_ Description and location of work on premises: Siteuntities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
__ Footing drain (no. lin. ft.)
PLLNIIRING, :CONTRACTOR Manufactured home utilities
Business name: is, ` 7 L i Manholes
Address: k�/�i�rk. i Rain drain connector
P�! �'� ZIP: Sanitary sewer (no. lin. ft.)
" —
Phone: Storm sewer (no. tin. ft.)
y , 1 Fax
.�. E -mail: _�ti Water service (no. lin. ft.)
CCB no.: ( ` • - 7 1 - I Plumb. bus. reg. no:
V Fixture or item:
City/metro lic. no.: N/A / ; , Absorpt valve
Contractor's representative signature
�✓t/ �� Back flow preventer
inK i L Backwater valve
• - _ CONTACT PERSON Basins/lavatory
•
Name: 1 f -t . p.\--f__D I Clothes washer .. .
Dishwasher
Address: aA . • / 1c . ,Ni. Dnnking fountain(s)
City: State: Ejectors/sump
Phone: Fax: Expansion tank
=• =s` O\� \l R • • . Fixture/sewer cap _
4 " Floor drains/floor sinks/hub
Name (print): • ,j .. Att Garbage disposal
Mailing address: _ �i► b Hose btbb
City: _ • , EtareMfiit�% Ice maker
Phone: - 7—"�j Fax: 4 ,7-71 i E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Pnmer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) _
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
ENGINEL'K ' . _. Urinal
Name: Water closet
Address: Water heater
City State. ZIP• Other. - --1
Phone. I Fax: E -mail. Total
Minimum fee $
Not all iunsdscuotu accept credit cards, please call iunsdicuon for more inform Notice. This permit application Plan review (at %) $ --�
0
visa 0 MasterCard expires if a permit is not obtained State surcharge (8 %) •••• $
C.edit card number / / within 180 days after it has been $
—'
Expires accepted as complete TOTAL
a
Name of cardholder as shown on credit card
$
Cardholder signature Amount 1.70-3616 (6,U(LCOM)
Electrical Permit Application
Date received: Permit no.: , .00,(
_- ><!!l City of Tigard Et) Project/appl. no.: Expire date: .:
City of Tigard
Address: 13125 SW Hall Blvd, 1: z °; ►' 2i Date issued: By: Receiptno.:
Phone: (503) 639 -4171 16 nn
Fax: (503) 598 -1960 101 2ou Case file no.: Payment type:
Land use approval: °r76GAAD
CITY
1''i1=i OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
►' New construction 0 Addition/alteration /replacement ❑ Other. 0 Partial.
JOB SITE INFORMATION
Job address: , • 58 Lo , S _ I Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 7 Block: Subdivision: ■ V TIO'n t Oystirst>y ri
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE S _ -
Job no: ?j ` Business name: - a- Fee Max
/�++ �� ] Description Qty. (ea) Total no. tncp
CA V--) `! L 1 New residential - single or multi- family per
Address: g, I. `` ialC • C" dwelling unit. Includes attached garage.
Service included:
Wit' 1 �:�t91ii 10,20,16-1 4
Phone: 22 j r� � Fax: E -mail: 1000 sq. ft or less 'J Each additional 500 sq. ft or portion thereof
CCB no.: y Elec. bus. lic. no: p�/r Li mitedenergy,residential 2
C Limited energy, non - residential 2
� Each manufactured home or modular dwelling
n ature of supervising electrician (required) Date I �l l T Service and/or feeder 2
�� Q Services or feeders — Installation,
_ Sup. elect name (print) � 1 C _ o w Zj License no 1 alteration or relocation:
``. - PROPER'L'Y OWNER - 200 amps or less 2
a' 201 amps to 400 amps 2
Name (print): Grilkit-rl•� 401 amps to 600 amps 2
Mailing address: �� �_ - , * 601 amps to 1000 amps 2
City: .., 113121141 Z I P : 70 C Over 1000 amps or volts 2
Phone: , T nr -mail: 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 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: 1 State: I 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):
irrigation circle 2 irri
Each pump or g
O Service over 225 amps-commercial 0 Health-care facility E 2
0 Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* - 2
O Building over three stories 0 Feeders, 400 amps or more •Descnpuon:
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/lighungplan 0 Other Per inspection 1 I I I
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 junsdicuons accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (a[ _ %) $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number. / / within 180 days after it has been State surcharge (8%) .... $
Ex accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440 -4615 (6+00PCOM)
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• CERTIFICATION
. .
. .
• STR EE T TR EE
;. ►
,, 1 LC Owner /Agent for �ro f'wCi53G °� � .-s
I, S,° `/ _s i ^^ € „, z (PERMIT HOLDER)
(PLEASE PRIM)
■
Do hereby certify that the following location ■
A meets City of Tigard /Washington County
r ■
t land use and development standards for street tree installation.
4
, , ADDRESS: (2908 co k;54. lefts / f
1 l
.41 U SUBDIVISION: (�)k�S +lee -5 (-Jai K
LOT: 70 ,
BY: A &411 \_ _ DATE: S ( — ° 4 ►
i
RECEIVED BY: I�l1'I'I.: // / / /6 ■
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•
CITY OF.TIGARD 24 -Hour
503
Inspection Line:
BUILDING P (503) 639 -4175 MST'T V
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP `—
Received Date Requested ))�,"A " /z / AM PM BUP
Location I _ �'Lt/J ( l� 2.! /J> Suite MEC
Contact Person S G 7' Ph ( 7439 - 7 / o .71? PLM
Contractor Ph ( ) SWR
BUILDING R 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
Othe
i al
P ASS PART FAIL
LUMBING
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 ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line I
ADA /_ 0
Approach /Sidewalk Date S 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 lb Nisi a 2 JZ 4 OZ)0 /0
INF4ECTION DIVISION Business Line: (503) 639 -4171
/� p / Y z� BUP
Received / 5(� Date Requested _ 7 7 AM PM BUP
Location /1- 05 /J)A..i... 1Lil4..., 42_ Suite MEC --
Contact Person : >,rc Ph ( ) . / Z3 7 PLM /�_ _.
Contractor Ph ( ) SWR
BUILDING /GQ 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 1 M 7,400 0-0 ax
Framing
Insulation
111 W C L� `-Q (....,,, �1
Drywall Nailing
Firewall eUM 1 _ A I / ( 3/-" I Cy f
Fire Sprinkler
Fire Alarm `n � J 4 V$ 5 `z-v, Er ' T )
Susp'd Ceiling Y t/ / 1 _
Roof N�-C �.XN� %
Illib
PAS _-�,-T 4,i: - *Q
Post &Beam '' I _ ._ k. S S f t " g
Under Slab �_•- - -- . -
Rough-In s
- Water Service �� � - %� ' �� �� `
Sanitary Sewer w� \ Q `S c r,
Rain Drains ` - r �, .
Catch Basin / Manhole �� `J 1-:- .e .- --
Storm Drain
Shower Pan l.ti.1 ( -- ' i
i = _ -- - ' 2- e`er /G L,f - � �-✓ LA � f
� in • � vJ t:� � � J
'' S' = .T FAIL J /, �/
CHANICAL v u S 7 c C■/
Po -am
Rough -In
Gas Line
ampers '
\Fial
A PART FAIL
RICAL
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 VI. 4 0
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING `; Inspection Line: (503) 639 -4175 MST7 'V -- 7,721 - )
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 5- - 7) V AM PM BUP
Location 7 `,(> Suite MEC
Contact Person 6, Ph ( ) Z 9 — 4/c`'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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling Roof /.7*/ „ "'" 1 f;
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 4L
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fir :: farm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date 7 d Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour // //��� UC�Q` /
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
// // BUP
Received Date Request d _�D "9c54M PM BUP
I
Location /2r) 5 U/ G� Suite MEC
Contact Person / �fi�-C Ph ( ) 9 '9 3 2 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 ��V�
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
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
Z Y6/
Approach/ ide Date - • Inspector ill
Ext
Final DO NOT REMOVE this inspection record from the Job site.
rjr PART FAIL