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12690 3W Cafield Court
CITY OF TIGARD BUILDING INSPECTION DIVISION MSTf _���
24-Hourispection Line: 639-4175 Business Line: 639-4171
B U P
Date Requested_ �Z Z_ �_-AM ___PM BLD
L-ocation '�G'U S crJ / -« S f Suite _ MEC
Contact Person — Ph _ — PLM
Contractor — — _ Ph — SWR —_
UILDII -Fenant/Owner _ ELC
Retaining Wall ELR -- _
Footing Access-)
Foundation /�� /�i i(/�C _)���e�/rr��� FPS -- -_--
Fog Drain / SGN
Crawl Drain Ins�ectior: Notes: c'Tkrc4_ - -
Slab _. SIT _
Post&BeameW
T-
Ext Sheath/Shearee•N / --- --- --
Int Sheath/Shear
Framing ----- - -- --- -- - _-----
Insulation
Drywall Nailing ----
Firewall
Fire Sprinkler _-_.-. - ----------------- -- - _.__--_—_--
Fire Alarm
Susp'd Ceiling - --- -------- ------ -___ ------ ___
Roof
Misc: --- -------
Fina --
12T FAIL -- ---- -- - --------- --- ------ -- _
ost 8 Beam ----- ------ - - -- -- --_ - ------ -- -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
m
-ti4 T FAIL - ----
ECHANICAL
Poseam - -----_..--- - --- - --- ..- _ -- --- -- ----
IRough In
Gas Line -- --- -- ---- -- - ---- - -- - ----- ---
*o�u
mpers
T FAIL
CICL
UG/Slab - -- ---------- ------ - - ------ -
Low Voltage
Fire Alarm - --- ------ ---- --- - -- - -
in . -1 PART FAIL
4 - - - -- -- -------- ------- -----
SIM
Backfill/Grading
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$.--_ -required befr,e next inspection pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ] Please call for reinspection RE: _- [ ] Unable to inspect-no access
Fire Supply Line -'-
ADA
Approach/Sidewalk Date / ?� 17� ' �j Inspe(( toff Ext
Other -
Final �
PASS_ PART FAIL 00 NOT REMOVE this inspeZ�liar. record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175Business Line: 639-4171 MST �vz' GUI
BLIP
_Date Requested �' AM PM
Location C�G ,Sw �G � e l � .—_-- ._-- BLD
-I i- y �� Suite - MEC
Contact Person ph _ r
_ PLM
Contractor Ph --- _ SWR
BUILDING — Tenalit/Owner ELC
Retaining Wall - ELR
Footing --
Foundation ACC@S£: --
FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab _ - --
Post& Ream - - SIT
Ext Sheath/Shear
Int Sheath/Shear
Faminq -
Insulation - -- ---__ _-
Drywall Nailing
Firewall --- -- --_-_
Fire Sprinkler
Fire Alarm - ---
Susp'd Ceiling _ �t
rtoof — --- -----
Misc:_
Final ----- ------ - -
PASS PART FAIL ----___ -_--_
PLUMBING --- ---N -- ---
Post& Beam - ---- -------- ----
Under Slab
Top Out --------- ----------- - -- - --- ----
Water Service
Sanitary Sewer -
Rain Drains
Final ---------------- - ^-
PASS PART FAIL
MECHANICAL ---------- ---- - —
Post& Beam --- --- — ----- — ---- ---
Rough In --- _
Gas Line --- -- --- ------
Smoke Dampers — - - -
Final ----- ---- ----- -------
PASS PART FAIL - -� --
'Service
Rough In -- -
IJG/Blah � ��, ----- __- -_---- -- --.--..- -- __-
I ow Voltage - -- --- - ----- --
Fi Alarm
S
PART FAIL -
Tr-
Backfill/Gradiny - --- --------- --- ------- - ---
Sanitary Sewer
Storm Drain ( J Reinspection fee of$_ — -required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ]Please call for reinspection RE:-`- - 0, ,—,,��Unable to inspect-no access
ADA
Approach/SidewalkOther Date =1�F� E%� Inspector_ TFinal Ext _
PASS PART FAIL DO NOT REMOVE this inspection record from the Job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION 7
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MSTL—
BUP _
-_.--_ Date Requested_ i-i 1 AM PM BLD _
Location_ , LG _5� G /moi�� Suite
MEC
Contact Person ---_— - (� P;t4E , C �;, 3 3 PLM ,
Contractor _ _— ph SWR
BUI^ Tenant/Owner ELC
Retaining Wall --
Footing ELR
Foundation Access: —
FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab
Post& Bearn --- -- -- -- SIT _
Fxt Sheath/Shear -
Int Sheath/Shear ----_
Framing
In"lation -� --- -- ---- ---- -.
Drywall Nailing _-
F irewall ---------- --- - --- - --- -
Fire Sprinkler --_-_--
Fire Alarm --- ---..-_---�----
Susp'd Ceiling ----_-
Roo( --- - --- -- ---
Misc
T'u_ -- --- --� - --- --------- -------- -----
ASS PART FAIL
PLUMBING ---- -
Post&Beam - ------- ------- -— -- _ _ __ _
Under Slab -
Top Out ---- --- --------- - --- --- -----
Water Service
Sanitary Sewer ----- -. --_-_-
Rain Drains
F i n a l ------- ------ -- -- -- --- ----- -
PASS PART FAIL
:HANIC -- ------- ----
osl & Beam — _--_-�--- --_—
Pough In
Cas Line
----------------
Smoke Dampers
r X`§S PART FAIL - --_ -- - - --
ELECTRWAL -
Seivice
Rough In ------- --- — ------
UG/Slab
Low Voltage — -- --- _—
Fire Alaim
Final —
PASS PART FAIL __._---
SITE -----.---- ------- _—_.— __
Backfill/Grading ------ — --
Sanitary Sewer ---
Storm Drain [ ] Reinspection fee of$_— — _required before next inspection. Pay at City Hall, 13125 SW Hal Blvd
Catch Basin
Five Supply line ( ]Please call for reinspection RF _ —-- - — [ ] Unable to inspect- no access
ADA --
Approach/Sidewalk
Other -- Date _ U _ Inspector Ext
Final ------- ---- --
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITYOF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-00443
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/5/00
SITE ADDRESS: 12690 SW CAFIELD CT
PARCEL.: 2S 104DA-01500
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: I
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS.
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention valve.
S
Owner: _��--- FEES -- -
-' Type By Date Amount Receipt
,l & S CONCRETE INC �—
19690 S LELAND RD PRMT GTR 12/5/00 $36.25 27200000000
OREGON CITY, OR 97045 5PCT CTR 1215/00 $2.90 27200000000
Total $39.15
Phone 1: 656-9992
Contractor:
GROVER LANDSCAPE
5005 SW MEADOWS RD
LAKE OSWEGO, OR 97035
REQUIRED INSPECTIONS
Phone 1: RP/Backflow Preventer
Reg #: LIC 7067 Final Inspection
This permit is issued subject to the rFgillations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all otW applicahle laws. Ail work will be done in accordance with approved plans.
This permit will expire ii work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-00811
You may obtain copies of these rules or direct questions to OUNC �y calling (503) 246-1987.
Issued By: / ; ,, Permittee Si,,lature:
r-� �- - -
Call (5031 639-4175 by 7:00 P.M. for an inspection needed the next busines-- day
Plumbing Permit Application
"received: � ;.-00 1'ermit no.:C>ty of Tigard
Sewer permit
no.: F•lila.ng permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 --- —
('itvu(ligord Phone: (503) 639-4171 Project/appl.no.: Gxpirecate:
Fax: (503) 598-1960 Date issued: _ 13y: — Receipt no.
Land use approval: Case file no.: Payment type:
U 1 & 7family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New ruction U Addition/alter ition/replacement U Food service U Other:
!-h address: 1.-� `/e- r%Qr l r Descrition (fit . I ee(ea.) 'total
Bldg.no.: Suite no.: New 1-and 2-(amity dwellings only:
Tax map/tax lot/accouni no.: - (includes 100ft.for each utilftyconnecUor.)
SIR(1)bath
Lot: Block: Subdivision: SFR(2)bath --
Project name: :�/ _ SFR(:3)bath _ __ - `-
City/county: � ZIP: tach additional batln/kitchen
Description and i anion of work on premises: Slteuttlttfes:
_ Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain__
Footing drain(no.lin.ft.) —
Manufactured home utilities
Business name.: '�� �jt�G ��, /� ' Manholes
AdJress: f� `� "` Rain drain connector
City: [ _ State c ZIP: Sanitary sewer(no.lin.ft.)
6 - _ -
Phon 61 Fax: E-mail: Storm sewer(no.lin. ft.) —
CCB no.: Plumb.bus.reg.no: 6 ` Water service(no.lin. ft.)
City/metro lic.no.: Fixture or item:
Absorption valve
Contractor's representative signature: Rack flow reventer _
Print name: _ Date: Backwater valve
Basins/lavatory _
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
_
City: _ _Mate: ZIP: Ejectors/sumE__ _
Phone: — Fax: E-mail: Expans.on tank -
rxturc/sewer cap
Name(print): Floor drains/floor sinks/hub
Mailing address: ---- -� Garbage disposal _ -
---
City: Hose bibb
__— State: ZIP_ Ice maker
E-
Phone. Fax: 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 ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's sign-Ature: Date: Sum — _ w
Tubs/shower/shower pan _
Name: Urinal — -
-- — --- -- Water closet _
Address: Water heater
City: _ State: ZIP: _ Other:
Phone: Vax—� E-mail: — Total -
---
Not all Jw isdictions accept credit cards.(+leave call jurisdiction fur more information. Notice:This permit application Minimum fee................$ -�
U visa U MosterCard %) $__Plan review(at
expires if a permit is not obtained - ----
Credit card number__ ____ _�L within 180 days atter it has been State surcharge(8%)....$
— D accepted as complete. TOTAL .......................$ _
Name of cardholder e!shown on ctrdit card P P -
-- Cardholder signature Amount 4404616(W)COM)
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
Lavatory 16.60 - for each utility_connection) _
Tub or TublShower Comb 16.60 One_lLbath $249.20
- _ _ Two 2 bath $350.00
Shower Only 16.60 Throe 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
Fioor Drain/Floor Sink 2." 16.60
3" - 16.60 - PLEASE COMPLETE:
4" 16.60
bit ter Heater O conversion O like kind 16.60 uantity b I Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. _ _ _ _ _ Capped
MFG Home New Water Servic3 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub/Shower
_ Combination
Roof Drains 16.60 Shower
Drinking Fountain 16,00 Water Closet _-
Other Fixtures(Specify) 16.60 - Urinal -
- _ Dishwasher
__garbage Disposal _
Laundry Room Tray
Washing Machine _
-
Sewer-1st 100' 5500 Floor Drair/Sink: 2"3„ -
Sewer-each additional 100' 46.40 4^
Water Service-1s1 100' 55.00 Water Healer -
Water Service-each additional 200' 48,40 ------ Other Fixtures
(Specify)
Storm 8 Rain Drain-1st 100' 55.00
Storm 8 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 _ er/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 _
Grease Traps 16.60
QUANTITY Tf-Tfi,L - - - --
Isometric or i diagram is required if -
Quantity Total >9
'SUBTOTAL -
8%,STATE SURCHARGE
PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty total Is>9
TOTAL5----
"Minimum permit fee Is$72 50+8%slate surcharge,except Residential Backflow
Prevention Device,which is$30 25.B%state surcharge
"All New Commercial Buildings require plans with reometrk or riser diagram and
plan review
I:\drts\forms\pim-fees.doc 10/10/00
CITY O F T I G A R D MASTER PERMIT
PERMIT#: MST2000-00167
DEVELOPMENT SERVICES DATE ISSUED: 07/13/2000
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12690 SW CAFIELD CT PARCEL: 2S104DA-01500
SUBDIVISION: QUAIL HOLLOW - W[-ST ZONING: R-4.5
BLOCK: LOT: 001 JURISDIC'rION: TIG
REMARKS: S/F PATH I
BUILDING
REISSUE _ STORIES. 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED _
CLASS OF WORK: NFW HEIGHT: 13 FIRST: 649 at BASEMENT`. at LEFT: 15 SMOKE DETECTORS: Y
T"PE OF USE: SF FLOOR LOAD: 40 SECOND: 907 at GARAGE: 455 at FRONT. 70 PARKING SPACES
TYPE OF CONST 5N DWELLING UNITS: FINBSMENT: al RIGHT 5
VALUE $1:4.741 1
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL153;00 at REAR: I'1
PLUMBING
SINKS: I WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: IOC TRAPS.
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS SEWER LINES: ton SF RAIN DRAINS: ' CATCH BASINS:
T'UBISHOWERS: 2 GARBAGE DISP: 1 WATER HEATf"RS: I WATER LINES: ton BCKFLW PREVNTR: I GREASE TRAPS:
OTHER FIXTURES'.
MECHA141CAL
FUEL TYPES _ FURN<TOOK: BOIUCMP�3HP VENT FANS: 4 CLOTHES DRYER: I
n; FURN-100K: 1 UNIT HEATERS: HOODS. I OTHER UNITS: I
MAX INP: blu FLOOR FURNANCES: VENTS-. I WOODS10VES: GAS OUTLETS 1
ELECTR:CAL _
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS. 1 0 200 amp: 0 200 amp: WISVC OR FDR I PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500sr: 3 201 400 amp: 201 - 400 amp- 1st W/O SVC/FDR: TIO SIGNIOUT LIN L T PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 - 800 amp: EA ADDL BR CIR: SIGNAL/PANEL IN PLANT.
MANU HMISVCIFDR: 601 • 1000 amp: 0014amps•1000V MINOR LARE'_:
1000 amp/volt
PLAN REVIEW SECTION
Reconnert only ---
> 4 RES UNITS. SVC/FDR> 225 A.. >600 V NOMINAL' CLS AREAISPC OCC:
ELECTRICAL-RESTRICTED E14ERGY
_ A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO' VACUUM SYSTEM AUDIO 8 STEREO- FlkE ALARM. INTERCOMIPAGING: OUTDOOR LNDSC I.•P.
BURGLAR ALARM: OTH. BOILER. HVAC: LANDSCA-rARRIG: PROTECTIVE SIGNL
GARAGE OPENER Cl OCK INSTRUMENTATION: 61EDICAL OTHR:
HVAC. DATA/TELE COMM: NURSE CALLS. TOTAL N SYSTEMS.
Owner: Contractor: TOTAL FEES: $ 3,400.77
J &S CONCRETE INC ECK CONSTRUCTION INC This permit is subject to the regulations contained in the
19690 S LEIAND RD PO BOX 204 Tigard Municipal Code. State of OR Specialty Codes and
OREGON CITY, OR 97045 SHERWOOD,OR 97140 all other applicable laws All work will be done i
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
Phone: Phone Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Reg 0 1 IC 1147`'`' fnrth In OAR 952-001-0010 through 952-001-0080 You
may obtain copies of these rules or direct questions to
OUNC by calling(5031 246-1987
REQUIRED INSPECTIONS
Erosion 844-8444 Underfloor insulation Mechanical Insp Shear Wall Insp Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Plumb Top Out Low Voltage Water Line Insp Final inspection
Foundation Insp Footing/Foundation Dr; Electrical Service Gas Line Insp Appr/Sdwlk Insp Building Final
Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Fireplace Electrical Final
Post/Beam Mechanical Mechanical Insp Framing Insp Insulation Insp Mechanical Final
Issued By : 916 'g CZ- _ _ Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD _SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2000-00126
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 07/13/2000
SITE ADDRESS; 12.690 SW:;AFIELD CT PARCEL: 2S104DA-01500
SUBDIVISION: QUAII. HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG _
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: S/F PATH I
Owner:
FEES
,I & S CONCRETE INC -- — _
19690 S LELAND RD Type By Date Amount Receipt
OREGON CITY, OR 97045 PRMT DLH 97/13/200( $2,300.00 0003692
Phone: 656- 992
INSP DLH 07/13/200C $35.00 0003692
---
Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulation.- of the Unified Sewage Agency. The permit expires
180 days from the date issued T'ie total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions frorn the distance given If nr,'. so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral ATTENTION. Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center Whose rules are set forth in OAR 952.-001.0010 through OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued by: L z, '.j< Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY* OF TIGARD Credit No.: 3
Date Issued: June 8, 2000
Engineering
Authorization
Date: June 8, 2000
TRAFFIC IMPACT FEE
CREDIT VOUCHER I-and Use
Casefile No.: 97-51 -PD/S/DHA
In accordance with Ordinance 379 _ Cypress Ventures
(norm or d•v"f)
is entitled to $ 292,254.91 in Traffic Impact Fee Crea)ts that can be applied to TIF
EAST M.o
charges for development on lot(s) all of the Quail Hullowv WE5,j Developments. To use
this credit, present this form at the time of issuance of the building permit.
Q 1°. 0-
Date Permit Numbers _ Lot Numbers Credit Used _ Balance
Beginning Balance $ 292.254.91
Balance carried forward to TIF Credit No.
• Ordinance 379 provides for an expiration 7 years from authorization.
Use Additional pages if necessary.
109mW OMP109
Date Permit Numbers Lot Numbers Credit Used Balance
Beginning Balance _
Balance carried forward to TIF Credit No,
• Ordinat ice 379 provides for an expiration 7 years from authorization.
H'engooc\?iFrm,
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13125 a W HALL R LV 7. Y�'I7� ��6 Z / Date Recd ILI '�s-
TiGARD, OR 97223 Singl plex) Date to P E.
V 503-639-4171 Date to DST :--3✓-%s
F 503-684-7297 Permit#/Yl-5Wt o u-u U I G.7
Called `
Incomplete or illegible applications will not be accepted
NaT-of Project Name
Job GtsC��jY �> —!�>�/s Architect Mailing Address
Address site Address � / C���
_ %_l'F RC1 �'`r � - C' /State Zip Phone
Name
Name f
Owner _.ailing ddress _
's- 1/'m/"��'�`� Engineer Mailing Address
City/State - Zip phone! � J �✓/,fr
O/*< :!" 7o y� 6s"6- ��' City/State zip R� n
General Na c;, _a', Jcfj�,s?
Contractor �GlZ ��1//�1c'-1 �`�'� Describe work Nmok Addition O Alteration O Repair U
Ma ' g Addres to be done:
Prior to pemmft . 0 ,�O� Additional Descriptiun of Work:
Issuance,a copy C. State Zip �Ph�on�e — —
of all licenses �U 1J a_- 9
are required If Oregon Const.Cont.Board Exp.Qate PROJECT
expired In COT t.lc.# "r _ VALUATION $database
"I
Mechanical NanleJ !, NEW CONSTRUCTION ONLY:
Sq. Ft.HousR� Sq. Ft. Garage
Sub-
Contractor Mailing Address --
Indicate the restricted energy installation by the electrical
Prior to permit subcontractor in the following areas
issuance,s copy City/State Zip Phone Restricted AUdioFStere.1_
of all licenses Energy ¢ sy tem _ -_- Alamis
are required H Oregon Const.Cont. Board Exp.Date
expired In COT Llc.# Installations Vacuum Ir-.igation
database System — -System
Plumbing None (check all that Other:
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ROLL' # 22
FOR
LARGE
DOCUMENT
CITY OF TIGARD
13125 S.W. KALI_ BLVD.
TIGARD, OR °7223 I� F���•f;��`Jr�'�
IMPORTANT PERMIT NOTICE � JUL 2 4 2000
�fJY:
WOLCOTT PLUMBING CONT. !NC
PJ BOX 2007
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2000-00167
Date Issued: 07/13/2000
Parcel: 2S104DA-01500
Site Address: 12690 SW CAFIELD CT
Subdivision: QUAIL HOLLOW -WEST
Block: Lot: 001
Jurisdiction: TIG
Zoning: R-4.5
Remarks: S/F PATH
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUKIBING CONTRACTOR:
J & S CONCRETE INC WOLCOTT PLUMBING CONT. INC
19690 S LELAND RD PO BOX 2007
OREGON CITY, OR 97045 GRESHAM, OR 97034
Phone #: 656-9992 Phone #: 667-1781
Reg # 1 Ir: 00023847
P1 M 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Sig ature of Authorized Plumber
If you have any questions, please call (503) 639-4171. ext. # 310