8044 SW CAROL ANN COURT SITE PLAN
LOT: 30 BLOCK: N/A SUBDIVISION: DURHAM SCHOOL PARK
SECTION: SW 1 /4 12 T--2S R- 1 W W.M. CITY: TIGARD
COUNTY: WASHINGTON STATE: OREGON SCALE: 1 "= 8'
TAX MAP AND TAX LOT No.: TAX MAP 2S 1 -� 1 2C �
SITE ADDRESS: 8044 S.W. CAROL. ANN C=OURT
ZONING: R — 12
OWNER: HERB HOFFART & Co.
46.:52 S.W. VERMONT
PORTLAND, OREGON 97219
TELEPHONE: 244-0876
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IT IS DUE TO THE QUALITY OF THE No.35 -m-�• !�... -� �
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8044 SW Carol Ann Court
CITY OF TIGARD BUII.DING INSPEC'nON DIVISION MST
24-Hour Inspection Line: 63. 175 Business Line: 639-4
BUP _
Date Requested l f' • 3 AM__ PM BLD
Location i c "I L-��tAwCLy�.�-,_ Suite MEC _
Contact Person Ph 71 c PLM
Contractor Ph _ _ SWR
F61 ILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Acce�s.
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes, SGN
Slab
Post& Beam -� -� - ---- — SIT
Ext Sheath/Shear
Int Sheath/Shear — ---
Framing
Insulation —�- - - -- --
Drywall Nailing
Firewall —
Fire Sprinkler
Fire Alarm --- -- --- ---------- - -
Susp'd Ceiling
Roof --
Misc:_ _ -----------
Final -
PASS `PART FAIL
Post&Beam
Under Slab
Top Out
Water Service
Saliltary Sewer --- ---
Rain Drains
ilia I
PASS PART FAIL.
MECHANICAL
Post& Beam
Rough In
,as Line —
Smoke Dampers `
Final -
PASS PART FAIL
ELECTRICAL -- --�
Service
Rough In --- —
UG/Slab
Low Voltage �—
Fire arm
4U- SSV PART FAIL
Backfill/Grading -- -- -
Sanitary Sewer
Storm Drain I ] Reinspection fee of$ _ required before next ins.rrmction Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ] Please call for reinspection RF I ] Unahle to inspect no,ccess
ADA
Approach/Sidewalk / /Lt'
Other Date _ �� _ Inspector- __ _ _ _ Ext
Final
PASS PART_ FAIL DO NOT REMOVF this inspection record from the job site.
CITY OF TIGA►RD BUII DING INSPECTION DIVISION
24-Hour Inspection Line: 63t 175 Business Line: 639-4', L
1i� BUP
_Date Requested // j AM_ PM BLD
Location ---
Suite
-- MEC _
Contact Person � _---� Ph �7� _'� efc _PLM
Contractor Ph SWR _
BUIL.DING _ Tenant/Owner ELC
Retaining Wall -
Footing ELR _--
Foundation FAc.cess: ---
FPS
Fty Drain -
Crawl Drain Inspection Notes SGN
Slab ----
Post& Beam --------- ----------------- SIT - -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation - ---_...___-- --------.---- -------� ---_.___ -
Drywall Nailing
Firewall --------- -------—- ---
Fire Sprinkler
Fire Alarm - ---- --- -- -- - - ---- ------ --- --
Susp'd Ceiling
-----------------------------------
R c af -- -- --
Misc:
Final --- -- ..`--- — --------- — -_-._
*PASS l4itT FAILM. earn — - - ----------------- --
Under Slab ___. ---- --------------- ---
Top Out
Water Service - --
Sanitary Sewer --- - -- --------
Rnir grains
PAS �
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 _.- _------ --------- -----------
PASS PART FAIL
SITE � ------ —_ ------ -----
Backfill/Grading --- ----- -- _-- -_- _
Sanitary Sewer
Storm Drain ( )Reinspection fee of$- required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin -
Fire Supply Line [ ] Please call for reinspection RE _ _ [ ]Unable to inspect- no access
ADA
Approach/Sidewalk Date / 0 /CInspector
---7 +
Other - _ Inspector
Final -—-------'--_
PASS PART FAIL-J DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST �L��, -
BUP
Date Requested AM PM _ BLD _
Location_ U D(/O qC! LrJ CC(Y �'l � �1 C _ Suite _ MEC
Contact Person Ph PLM
T—
Contractor Ph SWR
-1 Tenant/Owner ELC _
Retaining Wall ELR _
Footing Access: -
Foundation FPS
Fig Drain SGN -
Crawl Drain Inspection Notes: - —
Slab _--- _ _- SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear -�
Framing �__ i --__------
Insulation
Drywall Nailing ---- - ------ _� ---__,_-- --------______._-,---
Firewall
Fire Sprinkler --------- _ _n - - -- u-..------ - ---- - -- --
Fire Alarm
Susp'd Ceiling
Roof
Misc: - - ---- -------- ---- ----- ---
r man
ASSPART FAIL ------ ------ -- -- ---- -- -- ..__.
PEUMBING
Post 8 BeamUnder Slab
Slab
Top Out
Water Service _
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post R Bearn
Rough In
Gas Line - ----- -- --- - -------
Smoke Dampers
A - PART FAIL
Service
Rough In
UG/Slab -- ----- -- - - _ - -- -- --
Low Voltage
Fire Alarm ------. -----------__ --
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ]Please call for reinspection RE:__ — ( ]Unable to inspect-no access
ADA
Approach/Sidewalk Date 7- d Ins eCto, Ext
Other -+�--- P , �-
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CRAFTWORK PLUMBING INC
7736 SW NIMBUS AVE
BEAVERTON, OR 97008
Plumbing Signature Form
Permit #: MST2001-00289
Date Issued: 5131101
Parcel: 2S112CC-16000
Site Address: 08044 SW CAROL ANN CT
Subdivision: DURHAM SCHOOL PARK
Block: Lot: 030
Jurisdiction: TIG
Zoning: R-12
Remarks: SIF Path 1
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 approrriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, f\TTN. Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
HERB HOFFART CRAFTWORK PLUMBING INC
4632 SW VERMONT STREET 7736 SW NIMBUS AVE
PORTLAND, OR 97219 BEAVERTON, OR 97008
Phone #. 503-244-0876 Phone #: 644-8698
Reg #: I Ir 79666
PI M 20-148PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
d ?//
Signature of AuthorizedPlumber
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
EASTGATE ELECTRICAL INC
1410 NE 106TH
SUITE 2C6
PORTLAND, OR 97220
Electrical Signature Form
Permit #: MST2001-00289
Date Issued: 5/31/01
Parcel: 2S112CC-16000
"te Address: 08044 SW CAROL ANN CT
Subdivision: DURHAM SCHOOL PARK
Block: Lot: 030
Jurisdiction: TIG
Zoning: R-12
Remarks: S/F Path 1
Your company hay, been indicated as the electrical contractor for the permit indicated above. In order for the
electrical pennit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return i its Electrical Signature Form prior to the
start of the work to the address above, ATT'N: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
HERB HOFFART EASTGATE ELECTRICAL INC
4632 SW VERMONT STREET 1410 NE 106TH
PORTLAND, OR 97219 SUITE 206
PORTLAND, OR 97220
Phone #: 503-244-0876 Phone
Req #: LIC 43701
ELE 26340C
SUP 1512s
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Sijnatulh cf Su c-rvising Electrician
If you have any (juestions, please call 1503) 6394i71, ext. # 310
�ya�—
CITY OF TIGARD MASTER PERMIT
PERMIT#: MST2001-00289
DEVELOPMENT SERVICES DATE ISSUED: 5/31/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS•. 08044 SW CAROL ANN CT PARCEL: 2S112CC-16000
SUBDIVISION: DURHAM SCHOOL PARK ZONING: R-12
BLOCK: LOT: 030 JURISDICTION: TIC
REMARKS: S/F Path 1
BUILDING
REISSUE STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 22 FIRST: e,3( sl BASEMENT: e1 LEFT: 5 SMOKE DETECTORS: v
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 929 at GARAGE: 380 of FRONT: 20 PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: I FINSSMENT: sl RIGHT: 5
VALUE: $143,685.50
OCCUPANCY GRP: R3 BDRM: 4 BATH: i TOTAL: 156500 at REAR: 16
PLUMBING
SINKS: I WATER CLOSETS: WASHING MACH. 1 LAUNDRY TRAYS' RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS* 1 CATCH BASINS:
TUBISHOWERS: 2 GARBAGE DISP. I WATER HEATERS: WATER LINES: 100 BCKFLW PREVNTR I GREASE-TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES _ FURN<10OK: I BOIL/CMP<3HP: VENT FANS 4 CLOTHES DRYER: I
6AS FURN-100K UNIT HEATERS: HOODS: I OTHER UNITS. i
MAX INP: btu FLOOR FURNANCES. VENTS. 1 WOODSTOVES: GAS OUTLETS: I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIrEEDERS BRANCH CIRCUITS MISCELLAN,OUS ADD'L INSPECTIONS_
1000 SF OR LESS: I 0 200 amp 0 200 amp: WISVC OR FDR: 1 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500Sr: 2 201 400 amp: 201 400 amp: 1st WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY 401 600 amp: 401 600 amp: EA ADPL OR CIW SIGNALIPANEL IN PLANT:
MANU HMISVCIFDR: 601 • 1000 amp: 601�amps•1000v: MINOR LABEL:
1000.amp/Voll
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVCIFDR,-225 A.: >100 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY _
A.SF RESIDENTIAL B.COMMERCIAL _
AUDIO&STEREO. VACUUM SYSTEM: AUDIO 6 STEREO. FIRE ALARM: INTERCOMIPAGING: 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 0 SYSTEMS:
Owner: Contractor:
TOTAL FEES: $ 6,160.01
This permit is sub)ect to the regulations contained in the
4632 SWW VERMONT STREET 4632 SW VERMONT
HERB T HERB HOFFART Tigard Municipal Code, State of OR Specialty Codes and
ER
PORTLAND,OR 97219 PORTLAND,OR 97219 all other applicable laws All work will be done in
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
R"p" 1" 1•`1 forth in OAR 952-001-00101hrough 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, Post/Beanl Mechanica Plumb Top Out Low Voltage Water Line Insp Final inspection
Sewer Inspection Underfloor insulation Electrical Service Gas Line Insp Appr/Sdwlk Insp
Footing Insp Footing/Foundation Dr; Framing Insp Gas Fireplace Electrical Final
Foundation Insp PLf1/Underfloor Shear Wall Insp Insulation Insp Mechanical Final
Post/Beam Structural Mechanical Insp Exterior Sheathing Insl Rain drain In!p Plumb Final
Issued By Z-� Permittee Signature : �c�� �Xlr _
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGAR[) SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S -00162
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/33 1/011/01
SITE ADDRESS; 08044 SW CAROL ANN CT PARCEL: 2S112CC-16000
SUBDIVISION: DURHAM SCHOOL PARK ZONING: R-12
BLOCK: LOT: 030 _ JURISDICTION: TIC
TENANT NAME:
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: L-T''S`/1/R IMPERV SURFACE:
Remarks: Sewer connection for new SF detached dwellirg.
Owner: _ FEES_ _
HERB HOFFART Type By Date Amount Receipt
4632 SW VERMONT STREE-r —
PORTLAND, OR 97219 PRMT CTR 5/31/01 $2,300.00 27200100000
INSP CTR 5/31/01 $35.00 27200100000
Phone: 503-244-0876 Tntal $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
180 days from the date issued. The total arnount 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 from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral ATTENTION Oregon law re:;uires �ju to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth ir.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: — — Permittee Signature: —
Call (503) 639-4175 by 7.00 P.M. for an inspection needed the next business day
Building Permit P'ermit Application ``
City of Tigard Datcrcccivcd: � •,�0/ Pcr�rtA.. z pct / —00L
Project/appl.no.: Expire dale:
Cirynfl'igard Address: 13125 SW Hall lllvd,'Tigard,OR 97223 --
Phone: (503) 639-4171 bate issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _— 1&2 family:simple Compl^;x:
7_�Xl & ly dwelling oraccessory UCommercial/industrial U Multi-fr.mily U New construction U Demolition
teration/n:plat enurnt U Tenant improvement U Fire sprinkler/alarm U Other:
JOB SITE INFORNIA]"ION
Job address: 77744 --:rCJ ,0.¢U L A.J,J Or Bldg.no.: Suite no.:
Lot: ,j p _ Bhxk: Sur division:Z)UWu,d! C�o.V riy�tva. Tax reap/tax lot/account no.: I - C VIC
Project name:1_2�G,,e,c�,p,t,{ S Czti/eec. �ra,e
De-scnption and location of work on premises/special conditions:
OWNER FOR INFORMA]ION, USE CIlt'.('KI.IST
_Name: t h h
Mailing addr--ss: 3� .S� �/ _ 1 &2 family dwelling:
City: �,y�L — state: "LIP: Valuation of work....ky.,.� ............... $
Phone: - w.pp Fax:.7,/,/-to f E-mail: No.of bedrooms/baths.................................
Owner's representative: -- � alas. 'Total number of floors................................. _�----
Phone: ,,f_p M Fa New dwelling arca(sq.ft.
) ..........................
Garage/carlwrl area(sq. ft.)......................... _ JIG
Name: Covered porch area(sq. ft.) ......................... _----
Mailing address: Deck area(sq.ft.) ........................................
jL --- -�
City: State:p ZIP: 7 Other shucture arca(sq. ft.)......................... _
Phone:a as" Fax:��Kod7 E-mail: Commercial/Industrial/multi-family:
CONTRACT Valuation of work................................ ..... $
Business name l atm (� Existing bldg.arca(sq. ft.) ..........................
Address: gCF a S� -- New hldg.area(sq.ft.) ................................
— Number of stories........................................ — —
City: State
Type,of construction....................................
Phone:,Q-/•/•c)� Fax_a��J __.
— - �E-mail: Occupancy group(s): Existing:
CCB no.: � ?�y --- ---
_ New:
--_— .. ..-----------
City/metro lic.no.: Y Notice:All contractors and subcontractors are required to:w
licensed with die Oregon Construction Conti actors Board under
r provisions of ORS 701 and may be requited to be licensed in the
Nam �d j �„�, �.y t�� lurisdict on .here work is my performed. I[the a li ant is
Address: // � C �+ {/ j be g l pP•
Cit State ZIP; 7 exempt tum licensing,the following reason applies:
Contact person: - A i a.:o.J Plan no.: ----
Phone: Fa-: _s.,a k 1i-mails ----
1
Name:�,„� Contact person: Fees due upon application ........................... $
Addr.ss: �---- — Date rcccived: -----
City: S to LIP: Amount received ......................................... $
Phone: Fax: '-n ail: Please refer to fee schedule.
hereby certify I have read and examined diis application and the Nor all juridictiom accept ctedr cards.please call jurisdiction for mm infomhaaon
attached checklist. All provisions of laws and ordinances governing this Udism UMasterCard
work will b�=gnit
complied wi .wl er specified herein or not. Cmdil card number: Expires
Authorized [,late,: _ .15",/ _ Name d canlholdrt u ahnwn on credit canf —
` _ S _
Prjni name: --- Cardholder sipature Amount
Notice:'lliis permit application expires if a permit is not onlained within 180 days after it has leen accepted as complete. 4404613(&%MM)
Electrical Permit Application
---— -- Date received: _ Permit no.:
City of Tigard Projectlappl.no.: Expire date:
C.•iryoffigurd Address: 13125 SW Hall Blvd,Tigard,OR 97''' bate issued: By: Receiptn :�
Phone: (503) 639-4171 a
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _
XI & 2 family dwelling or accessory U Commercial/uxjusiri;ll U Multi-family 0 Tenant improvement
ANew construction U Addition/alteration/replacenuvlt U Other: U Partial
'JOB Slii INIFORMAT
Job address: p r, HIT. nu: tiuitc nu.: Tax map/tax lot account no.: V'
lot: �p F3ltrrk: _ Subdivision: 3—� --�——
xia
Project nam , �, oo� ,oma Description and location of work on premises: �_ � �
Estimated dale of%simple lot,/inspection: - Y `i2, moo/
t t
Job no: Fee Max
Business name: q a> �( fM� Description Ory. (ca.) Total no.InsP
Address:/yio ,�� ry _
New residealial••single or multi-family per
---
dwelling unit.InchrAesallaclrcdgarage,
-City: , ,� Stale:ORL ZIP: '?'7_Ag 0 Serviceincluded:
Phone:ASa-jo qio Fax: E•m811: I(x)0 sq.It.or less _ 4
CCB no.: +sElec.bass. tic.no: _ G Bach additional 500 sq.ft.or portion thereof
Limited energy,residential 2
City/metro Ile.no.: Limiledenergy,non-residential 2
AEach manufactured home or modular dwelling
asps of sujrervising Icctricinn Ircyuired) Date Service anti/or feeder 2
Sup.elect.name(prinl): ,7".1 l �,{ Lwenseno:/ Servlcesorfeeders-Inalallrllon, -'
t PER t
alteration or
Pjlt200 amps or less 2
Name( rint):��,« f�eJFE�i _ 201 amps l0 400 amps 2
Mailing address: t:3 sac S Gc> (SGA? p J 401 amps to 61x)amps 2
�— 601 amps to lax)amps 2
City: O,e7.L.,o�a, Stale: ,Q zip: 9�a_�s Over 1000empsorvolts 2
Phonc:a -o Fax: E—mail: Reconnect only — 1
Owner installation:The installation is being made on propeny 1 own Temporary Services or feeders-
which is not intended for sale,lease,rent,or exchange according to Inosllatlon,alteration,orrelocali•rn:
ORS 447,455,479,670,701. 200 amps or less _^ 2
201 amps to 400 snips 2
Owner's si nature: Date: 401 to 600 noifis
Branch circuits-new,alteration,
or extension per panel:
Name: Yl -
A. Fee for branch circuits with purchase of
Address: _ _ _ service or feeder fee,each branch circuit 2
City: Slate ZIP: B. Fee for branch circuits without purchase
Phone: _ I a K: E-mail: of service or feeder fee,first branch circuit: 2
Each additional branch circuit
PLAN REVU.W(P1en%e check sill that nplils, —
Misc.(Service or feeder not Included):
U Service over 225 amps-comnkrcoa] U Health-care facility Fac_h pump or irrigation circle
O Service over 320 amps-rating of 1 de2 U Hazardous location Each sign or outFac lighting 2
family dwellings U Building over 10,(xx)square feet four or Signal circuits s',or a limited energy panel
U System over 600 volts nominal more residential units in oneslructute alteratlor,— xtt.nsion• _.
U Builth..;„verthme stories U Feeders,400 amps or more *I)r c i tion
U Occupant load over 99 persons U Manufactured structures or RV park rich e additional Inspection over the allowable in any of the above:
U Fgrcs.Jlightingplw, U Other' t'ertn%pection --
Submit_sets of plan%wilh any of the above. Investigation fer
�11te above are not applicable to temporary construction service. Other
Not all Jurisdictions accept credit cards,pteue call iud:diction far more informvion Notice:This permit application Permit fee....................•$
U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number: within ISO days ager it hits been State surcharge(8%)....5
acct tp .od ds complete. TOTA1, $ -
Name of cardholder as own on cit
--" act -----
Cardholder eianalure Amount
440a611(tiiU0lCOMl
�r
Plumbing Permit Application
Date received: Permit no.:
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 9722; Project/appl.no.: Expire date:
City of Fgard phone: (503) 639-4171
Fax: (503) 598-1960 Date issued: By: Receipt no..
"ase file no,: Payment type: l
Land use approval: — - -
ti 1
I &2 family dwelling or accessory U Commercial/industrial ❑Multi-family U Tenant improvement
XNew construction U Addition/alteration/re place nu•nt U Fecal service U Other• --
1 ' 1 iag; t
Descri tion Qty. Fec(ea.)) Totiol
Job address: ,)?Q t�R.Ot r4nJ - 7N�- -and Z-faAct
n[;s only:Bldg.no.: Sults no.: es 100tl.frconnection)'Tax map/tax lodaccount no.: e7b /�Z CC. /6000 Sl It(1)bath _ -
Lot: p Block: Suhdivision D&,t& AU Sc:w• R SFR(2)bath - -__ --
Project name. ,o So�c , . SFR(3)bath _Cit /count -7" zIP: 97.E aEach additionalnY y: /GO�O� A Siteli itilies:
Description and location of wor on premises: Catch basin/arcDrywells/leach drain
E :. /inspectiun: Oc8 .date of conlpletr � Fomting drain(no.lin.ft.)
PLUMBING CONTRACM
Manufactured home utilities
Business name:eeg riabU;'s ���� c3in/�,L Manholes
Address: 77,$� S•c.�l�t/• Rain drain connector -
City: State:p ZIP: / Sanitary sewer(no.lin.ft.) _
Phone: G _ Fax: y. E-mail: Storm sewer(no.lin.fl.)
Water service(no.lin.ft.)
CCB no. 7y Plumb.bus.reg.no: o- Fixture or Item:
City/metro lic.no.: 0 Absorption valve
Contractor's representative signatuBack flow preventer
Print name,: r- o c,ow Date: o7/y y r Backe,aler valve
Basins/lavatory
Clothes washer _
Name: a _ Dishwasher
F�Adss: ` uJ Drinkin};fountains)
State:
ZIP: qy�i Ejeclors/sum
� Ex ansion tank:a _o!y Fax:gip -� Gnutil: -
Fixture/sewer cap _ --
Floor drains/floor sinks/huh_
Name(print): , ����e T -—. - Garbage disposal
Mailing address_44j Ilose bihb
City: State:0'e I ZIP: 5;'7'Q/9 cc maker
Phone: Fax: -ol E-mail: Interceptorlgrease trap -
Owner installation/residential maintenance only: The actual installation Primer(s) _
will he made by me or the maintenance and tcpair made by my regular R(x)f drain(commercial)
employee on the propenv I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature:—v Dale: Sump
Tuhs/showe_r/shower pan
Urinal
Name: o NA- ?��a�"4 6'a _ — Water closet
Address: _ Water healer
City: State:--I�Z�IP: Other.
Phone:
Fax: E-mail: � - TOfA�
Minimum fee................$ _
Not toll jtrriadicuons aceepr credit cants,Plea me cell jurisdiction r«nww Inrw vion Noticc:•Ibis permit application Dian review(al _ %) S
U MAO U MutetCard expires if a permit is not obtained i -
Credu cud number ___ -- -- -�— within 190 days after it has been State surcharge 1 R9F) ....$ _ --
---- Expires accepted as complete.
- Name or cardholder u shnwn nn credit card $
Cardhnldet aiitnature Amount IIO Iti(UA1DX(1M'
Mechanical Permit Application
City of Tigard Date received: Permit no.:
City n/Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 ProlecVappl.no.: Expire date:
Phone: (503) 639-4171 Dale issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.:
Payment type:
Land use approval: Building permit no.:
1
1 &2 family dwelling or accessory U Commercial/industrial
New constructionU Multi-family U Tenant improvement
U Addition/altera(ioii/replaccr11C111 U Other:
Job address: yU 3rdd � e NS aAt
Bldg,no.: - Ad T Indicate equipment quantities in boxes below. Indicate the dollar
Suite no.. value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: ,y S r� wC,- /GaQ� profit.Value$ _
Lot: JBIock. Suhdivision;4,1., *See checklist for important application inl'ormahon and
Project name-
City/county: juri;diclinn'.s fee schedule for residtantial permit tec.
[ZIP.
�'�--
Desc ' tion and J atio of wo k on premises: _ i t i
F,st.date of compl .on/inspection- I cc(ea.) Notal
e Deseii on Vty. Res.only Res.onI
Tenant improvement or change of use: ---
Is existing space heated or conditioned?U Yes U No Air handling unit __CFM
Is existing space insulate(l?U Yes U No ircon ilioning(sitep antequire ) -- --
A lcration o existing A( sy,tem —
1 toiler compressors
Business name: State boiler permit no.:
Address:Qf/v�� S ) 2 lip Tons BTUAI
City:(�,�d — irelsmo e c amPer. uct smoke t eleclors
— Stale:pe, '!_IP: �!'7C eat pump(sn�p an rcqu re )Phone: ---
a_ / hax
.7- pi E-mail: nsla 1 rep ace lu:naeurne� ,
CCB no.: aij9a Including ductwork vent liner O Yes O No
City/metro lic.no.: nsla repine re ocaIe eaters-sIts pen ed,
Name(pleaseprint): _ wa'!,orfloormounted
ie + a ES ent fora fence of ert an furnace
Refergerat on:
Name: — �thototeirlms-o-n-u-n—is._-
Address:
_ HBTP UlH
—
s Cum Iressors Np
City: State:O e ZIP: nv ronmenh es usl an vent at on:
Phone: 99ai Applioncevent
aM Faz: C-mail: Dryercx gust
oo s, ypc res. nc enlha,,nat '—
Name: pe,,l hood fire suppression system
_Mailingaddress _ Exhaust fan with single duct(bath fans)
' ` xhaust s stem a art mm eatin or
City: sKX ov.eL Stale: neE71 r ue p p ng an 511 ut on(up to out cls)
_
li-mail 7y : i 1-PG _ NGFhonc: oil
veei n
ca11 itiona over out ets
rocessPiping(schematicrequire )
Name: Inyn Nurnhrr of outlets — -
Address: -- - N er st app ante or equ pment--
City: -- — Decorativefireplace
Stale: ZIP: nscrt-ty
Phone: pe
raX: I.-mail: --- no sinv pe cistove ----
Applicant's signatur 01 cr:
Dale:
Name (print):
NM all)urirlictions acccp credit cods,MW call)uNµtiction for more information.
U Visa U MasterCard Notice:"flus permit application Permit fee...............
rredlt cud number: _ expire-,:if a permit is not obtained Minimum fee................$
-- within Igo days oiler it has been Plan review(a( — `)F') $
ivtnne of cudhntde,as ohm-m on credit c accepted as complete. State surcharge(8%) ....$
Cardholder tianalues TOTA1. .......................$
Oft
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ROLL# 22
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DOCUMENT