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13208 SW BROADMOOR PLACE a 1. PROYIDj:- A MINIMUM 8' DEEP GRAVEL BASE FOR ALL DRI VE4JAY AREAS. 2. MAXIMUM >RIVEWAI' SLOPE SHOULD 8E vERIFIEJ WITH g G THE BUILDING DEPARTMENT PRIOR TO COIv' TRUCTION. /// E r 3. PROVI:.)E A MINIMUM 4' DEEP GRAVEL BASE FCR ALL O 5I'-.`r-WALK ANG: PATIO AREAS. C� cn 0 � 4. PIPE ALL 570R:1"I DRAINAGE FROM THE E;, "I TO ACD DISPOSAL POINT APPROVED BY THE BUILDING c IU U DEPARTMENT. 5. PROVIDE ANIS MA NTAIN POSITIVE DRAINAGE AWAY 3 FROM BUILDING ON ALL SIDES. \ ca 6. THE BOUNDARY ANI;- TOPOGRAPHY INFORI IATIOA �� rn 10 -0 HAS BEEN PROVIDED TO POLLARD - H05MAR WIDE PRIVATE N S.D.E. FOR THE BENEFIT ✓ESIC N>=RS, INC. Bl TI--IE CONTRACTOR, OWNER O>< 4'-0' WIDE LONG. OF LOT IS ENG'NEERING CON5LULTANT. POLLARD - HOSMAR WALK: t STAIRS 'I DE5IC11NER5, INC. WILL NOT BE HELD LIAB1_E FOR THE ' C./7 rD (82 SQ. FT.) 420 B 4i0 400 o Ln ACCURACY OF TH15 INFORMATION. IT IS THE SOLE I / 1 ' ; ' 0 ,` / S. 89'�3'481' E. RE5PON51BIL,TY OF Tr4E CONTRACTOF' TO VERIFY �__—__— ' ` —__. �_—__ ' __ w x ALL SITE CONDI TION INCLUDING ANT FIL_ PL. �__-__ I ON THE SITE. Tc-1E ::�ONTRAGTOI? MUST INFORM TN1�5 n - ;` ; �-_1 -_ __ __ I .��\ i 1/ 1 % i I 1 1 I , OFFICE OF ANY POTENTIAL FIELD MODIFI.-ATIc N-S , , , , , 1 I I I 1 / NOT SPECIFIED ON THE PLANS. y ' ' 49'-II*` '.� ► z r t13 -� ' f 39,E `n 20 -0 _ MAI LR: v �'' 1 , 1 �T- — , Q � 4200' -1. NON-STABILIZED FILL MUST NOT EXCE=ED 2:I SLOPE N S. EXCAVATION MATERIAL REf�!AINiNG ON 51TE. .S TO i Dill -ilk BE CONTnINED BY AN APPR,0VED SEDIMENT F-,ARRIER. ' ' ' / i uiI / f 1 I ! 1 / / I i 1 I C� Ln (FILTER PABRIG TEN5!LE, 5TRAW BALE SEDIMENT BARRIER �.'; f /�` \w / l /' i , / i 1 ,� _ Ili 1 , , / ' / '/ OR EROSION BLANKET WITH ANCHORS) THE CONTRACTOR E 42m � _ i i 21-�51 w ,�Y�� _-, / i l /' /' ,�� ) - I • MUST VERIFY LCCAT'iON 11JITH APPRCPRIATE BUILC)ING D � ---r I I t ,�; / I / / / ; ; / � � / � � Q N OFFICIAL. LOIGEI� FLRf m // Dp,E STOCK ml!-E5 FROM OCTOBER iat THRU '� T i � 9. PROTECT ACD PRIL 30th PER THE EF-'05ION CONTROL HANDBOOK. ��i . t I ` ' C� .. I _ 10. NO CUTTING OFA'. FfL.i.INC; SHALL TAKE PLACE WITHIN 'r � \`� /' '' �� a' � THE DRIP LINE OF AN EXISTING TREE UNLESS THE S. /' . t` "' % !• � �, , �, / // i ,' //' ,/ ,/� Q f= E=XCEPTION 15 APF'RC',VED BY THE BUILDING DEPT. , lsAR1.1CsE 11, AFTER COMPLETION CSF CONSTRUCTION, THE CONTRACTOR _ - -- -- — ""`"` ""-'�- -" — ` -- -- — i'— — — —.�- —'— -- y` i'— .� — — —�— CD MUST EITHER LANDSCAPE THE SOILS MULCH THE 501L OR ' SEED THE EXPOSED SOILS- / / ' / / / / ! / / I W t10- // 11' wr-3'-1w W.4' ABS SANITARY SEWER 400 / AIRL CONNECT TO CITY 18'-0' WID.: x 390 20'-0' WIDE PUBLIC SDE., APPROVED SEWER 4' THICK S.S.E. AND PUBLIC UTILITY ICONC. DF:IVE EASEMENT vi WATER METER (432 50. FT.) °O N 1' PVC WATER LINE CCESS EASEMENT r` 3' ABS STORML INE - oil DISPOSE • BLK-our CURB � � T E L 1- 20'-0- LOT 20 CITY OF TIGARD OREGON CONTRACTOR &� C, - <E L 1 \E 5- 1 DN C F'H21-027 3 --7 ' fE GZ 4/II MUUA 60 7, .. . ... ._ s �� r' �/ • ISS NOTICE: IF 'THE PRINT OR TYPE ON ANY TI ►� � r rIII111 IIIII ! I I � III � I III � i � I , Ij1Tqr[-T-[ Ij-r .�.�.r(�� _ �� j � i i .1 �1. i.� r�-�. � i .i � � r�r � i � � Ili iIi � ! i � Ii 1Ii rrr�.riIi ! iIi fji 1.�1 IfIC1 �1 flf. .irl 1]711 �1 III III ililili 1 1 f IMAGE ISN C I I I 1 2 3 4 6 7 g NOT AS CLEAR AS THIS NOTICE, _ 9 10 _ 11 12 IT IS DUE TO .'HE QUALITY OF THE - _-- - _ __ _ 1---- _ -- ------- --- No.36 -� :•.�=":... r ORIGINAL DOCUMENT � E 6Z 8Z LZ 8Z 5Z fiZ EZ ZZ TZ OZ 6T 8t l�r VIII IIII IIII IIII IIII IIII IIII IIII Illi llllulLl 1111111ll1_m. Ill lllolll1111,1111 lll IIII IIII IIII III! Ilii II!I III! IIII IIII IIII IIII IIII I�!I IIII IIII IIII II!! llll l � I 1 � ll1l IIII llll lll<<�Illlllll L1.11 Ill Illllfll _,Www,..W.,.,.,.,.�........,..,.�..........�....�.............�,....._..__.._,.�,...w,,.,.....w..�.....,.».....•. :..�,W.�,.�,....,....�........._......_.� ,....,....,�.�...�».,,,.,�.,_..,.,.,... w N O 00 Cc C W 1 O d CL 3 0 O m U 0 13208 SW Broadmoor Place 44, wy.. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 14-Hour Inspection Line: 639- 5 Business Line: 639-417 BUP _Date Requested_/Z AM _PM BLD Location Z �2� __—� — Suite r �' MEC _ Contact Person — Pf l �7,7 PLM Contractor r Ph SWR — – `— BUILDING Tenant/Owner ELC — — Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN -- ---- — Crawl Drain Inspection Notes: _ ---- ----- Slab - -__---- , 0 SIT Post& Beam PF — ----- L=xt Sheath/Shear _ Int Sheath/Shear -- Framing _ Insulation+ Drywall Nailing - Firewall Fire Sprinkler - Fire Alarm __---- ---- - - - - --- Susp'd Ceiling -_—�-- Roof Misc: --- --- Final PASS PART FAIL PLUMBING ' Post 8 Beam --- ` Under Slab 'Fop Out -__-------- Water Service 7 ,/ Sanitary Sewer �+� Rain Drains -- �� Final - --- \ �� - PASS PART FAIL MECHANICAL Post& Beam ---------.--- Rough In Gas Line --------- ----- - Smoke Dampers Final - -- ----- PASS PART FAIL ELECTRICAL ---� -- Service i .a- eGPAR _- ------------------- ------IT- ME -- Backfill/Grad'ig ---�-— - _ -_ Sanitary Sewer ^!jam Drain [ [Reinspection fee of$- _required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RF._ -_ — [ ]Unable to inspect-no access ADA ApproachtSidewalk other -__ Date � _�Q-U1. Inspector _ �`" Ext _ Final ,7�� PASS PART _ FAII. DO NOT REMOVE this inspection record from the Jab site. CITY OF TIGARD BUILnING INSPE;:TION DIVISION MST "Z-) 02 8r 24-Hour Inspection Line: 639-•. 5 Business Line: 639-417 BUP _ Date Requested �iy---AM PM BLD Location Z_C)S' - -,�_��y, Suite �� _ MEC Contact Person 4611 Ph / 5� 1'7 PLM Contractor _ Ph SWR BUILDING Tenant/Owner _ ELC _ Retaining Wall ELR — Footing — ----- ----- Foundation ACCESS: j J FPS Ftg Drain Crawl Drain Inspection Noies: SGN Slab Post A Beam SIT Ext Sheath/Shear Int Sheath/Shear - Framing —------- ---- Insulation Drywall Nailing Firewall Fire Sprinkler -----------___--_ -----_-- -- — _ Fire Alarm Susp'd Ceiling --- --- ----- Roof - -- ------- _ Mise: --------._... - Final 'I-RASit--&a RT FAIL ----.._— -- --- ---- --� -- ---------- -- (, U G __._... --------- .....--- --f -----------Post -- eam Under Slab Top Out ---- -- ------- -- ---- Water Service Sanitary Sewer Rain Drains ASS PART FAIL _ ANICAL Post& Bean, -- - - -- --- —t Rough In / Gas Line Smoke Dampers / Final - ---- PASS PART FAIL ELECTRICAL Service Rough In - - --- a UG/Slab Low Voltage , -- - Fire Alarm PASS PART FAIL - - --- --- ---- ---- -----SITE _ - --- Backfill/Grading Sanitary Sewer Storm Drain ( ] Reinspection fee of$_—! required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line I I Please call tc: re.nspection RE [ ]Unable to inspect-no access ADA _ e Approach/Sidewalk Other _ Date Inspector _-z_ Ext Final -- _.-�_ _ .—. - __ PAS5 PART FAIL DO NOT REMOVE this inspection record frnrrti the job site. CIT` OF TIGARD ELECTRICAL - ENER RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT M ELR2001-00228 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/1,1/01 PARCEL: 2S104DB-02000 SITE ADDRESS: 13208 SW BROADMOOR Pl. SUBDIVISION: AMESBURY HEIGHTS ZONING: R-4.5 BLOCK: LOT: 020 JURISDICTION: TIG Prosect Description: Inst;illation of all encompassing limited energy for new single family residence. A. R-ESIDENTIAL. __ B.COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA[TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL#OF SYSTEMS_. Owner: —- Contractor: ORENT BiCKEL EVANS ELECTRIC INC REN BI MENLOR LN 10150 SW NIMBUS AVE E-6 TIGARD, OR 9722.3 TIGARD, OR 97223 Phone: 503-590-5331 Phone: 503-639-5572 Reg #: LIC 104896 SUP 42255 ELE 34-405C FEES Required Inspections _ Type�By Dake ! — Amount Receipt Low Voltage Inspection Elect'] Final PRMT CTR 9/14/01 S7.5.00 2720010000 5PCT CTR 9/14/01 $6.00 2720010000 Total $91.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This pert-nit will expire if work is not started within 180 da;s of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires vat follow7utes adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 1-00'10 through OA 952-0 1-0080. You may obtain copies of these Hales or direct questions to OUNC at (503) 246 1987. _ K 1 { Issu by Pernrittee Signature /� _ OWNER INSTALL XNON ONLY The installation Is being made on property i own which is not intended for sale. lease, or rent. OWNER'S SIGNATURE: DATE:.--,------ CONTRACTOR ATE:_- -^-, _CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. E'-EC'N: _ _ ___—____— _ DATE:_______ ICENSE NO: Call 639-4175 by 7:00 P.M.for an inspection needed the next business day A Electrical Permit Application — "Datemceived rmtt no: /_40111;.9 City of Tigard proJect/appl.no.: Expire date t.y uj•figard Address: 13125 SW Hal'Blvd,Tigard OR 97223 Date issued: By: Receipt no. Phone: (503)639-4171 Case file no.: Payment type: Fax: (503)598-1960 Land use approval: J I &2 family dwelling or accessory U CommetcitUindustnal UMulti-faintly U Tenant Improvement )&New construction U Additiorlalteration/replacement U Other: 0 Partial � r Jab add-mss: St Bldg.no._ Suite no.: ax map/tax lot/awount no.: Lot Bicwk: Subdivision; Ftolect name: Descnpt on and I action of work on premises: i i�c cJ �+r�e.r.�;r k.slnnated date of completion/inspection: Fee Mas Job 00: Descri tion ea) Tool no.Ins business name' / ,`Ll.:.�i reswenwi-atoRrarnuut-tonallyper A tiress: 1l l i C? �c /•� ,' �L_� dwelWstuaM•IncYrderrtlachedRarsoae. ' State: 7 ( ZI?: r' 9ervicelnclydad (pity'. i'2� � � C / i v _ I000 W (t or lessPhone:C5 1J Fax:rj: ;/ E-mail: Each additional 700 s fl.or rtion thereat/ yy� lace.bus.ilc.nix s� I 1—��__ l.imikd enat�y_teildeMtal r j i 1 -' I Lirnitedenera ,rain-residential _ - City/metro lie.n -- Each manufactured home or modulo dwelling C t1 - _ Service NrUor[cedar_ 5i nmol sec sin uiciN(required) _halt _ — se ti Sup elect name( rind �:� l CL 1-1'3 Llcentano:yG}S^ S dlefalleaorrelocatbn: 200 amps or less 201 am s toEEE _Na_me(print): c, -- 401 ams to Mailing address: _ 6ot amps to IOOo amps _ -- $IatE: L1N_`__ _ over 1000 amps or volts ('try: -- - -- - — _ Reeonnertonly Phone' —��Fax: _ E-mail: _._,�... 't'emponr)xrvicea or leaders Owner installation:The installation is being made on property I own in,tallattnn alterntloa orrelrrunon: which is not intended for sale,lease,rent,or exchange according to nam ecce is or less _ 2 )RS 447,455,479,670,701. 201 amps to 400 amps 2 Ownces si nature: Wit ,: 101 to 600ams 2 _1111ranch circuits-sew,Wmuon, 'We,tension per paael: i dame: A Fee for branch eimulti with purchase of service or feeder fee,each branch dreuu Adams: ___ __ - State: ZIP; B. Fee Porbranch dtcutu withoutpu-hsae Cily: _ —___ — of service or feeder fee,first branch circuit -:T: I'llone: h,s E-mA'L Eschadditional branch circurt Misc.(service or feeder not Included): Each um or un aeon circle 2 C]Service over 223 amps-curnmucial J Hrdth•cuefacdity Eachslgnotoudoneh hung U Service over 320 Amps raring of I&2 J Hatudouslocation Eachsgnor(u)inalimiin energy Panel. fano ly dwellings U Building over 10.010 square feet(out or 2 U System ovei6t10voluenom,nal murcrcsidenualunits inone structure dterauon.ofextension• _FT_ J Building over three stone% O I•eedera,400 amps ur more •Descn it _- -- -- :J Ckcupent load over 49 Per+one U MNufacturcd atruc urea a RV Part Fact additlunal inspecrbn over the allowable to any of the above: J 6grtsidlighWtgplan U Other _----- — Perntspccnun — Submit—sets of plans wktb say of the a The abore we not appUable to temporary eonatirdellon service. Otho _ Permit tee Nd all JarnsdicYron%ateyi actin cads,please rat jurisdiction for more infort,adoo 1 expNotire:This permit application Plan review(at — %) $ Zi Visa 'J MasterCard expires iCa permit is not obtained --7 r within 180 days after it loss been State surcharge(8%).. S _—5�- cradii card camber a0in� TOTAL. . .. S accepted ucomplete. - Kjme al _cardnotdrr u shown on ends cud S 4AUJryiS c«a'i I'Nl I ZUUI�J S31111011 ?I.)!?IlNt 1. ML 599 L'U; ,itd Ld til L!S Uv to I I "ir; 7� IL:i b-W. HALL, bLVU. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE J & R PLUMBING 3430B SW 209TH AVE ALOHA, OR 97007 Plumbing Signature Form Permit #: MST2001-00288 Date Issued: 6/8/01 Parcel: 2 S 104D B-02000 Site Address: 13208 SW BROADMOOR PL Subdivision: AMESBURY HEIGHTS Block: I_ot: 020 Jurisdiction: TIG Zoning: R-4,5 Remarks: Construction of new single family detached residence. 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 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 OWNF-R. PL.UMBING CONTRACTOR: BRENT BICKEL J & R PLUMBING 13251 SW MENLOR LN 3430B SW 209TH AVE TIGARD, OR 97223 ALOHA, OR 97007 Phone #: 503-590-5331 Phone #: 642-7776 Reg #: I Ir 72680 P1 M 34-214PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signatur�fAujri zed F'lunber �� If you have any questions, please call (503) 639-4171, ext. # 310 I E-- - - - 0- - CITY OF TIGARD IGARD MASTER PERMIT DEVELOPMENT SERVICESPERMIT#: MST200,1-00288 13125 SW Hal! Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/8101 SITE ADDRESS: 13208 SW BROADMOOR PL PARCEL: 2S104DB-02000 SUBDIVISION: AMESBURY HEIGHTS ZONING: R-4.5 BLOCK: LOT:020 JURISDICTION: TIG REMARKS: Construction of new single family detached residence. Path 1 BUILDING REISSUE STORIES: 3 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 30 FIRST: 1,539 of BASEMENT: 978,00 of LEFT: 4 SMOKE DETECTOR Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,657 of GARAGE: 707 If FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 21 OCCUPANCY GRP: R3 DORM: 4 BATH: 4 TOTAL: 3,196.00 of VALUE: 5351,901.00 REAR: 58 PLUMBING SINKS: 2 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 6 D1814WASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: t CATCH BASINS: TUBISHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PRE:'NTR: 1 GREASE TRAPS: MECHANICAL OTHEP FIXTURES: FUEL TYPES FURN<100K: BOIUCMP C 3HP: VENT FANS: 6 CLOTHES DRYER: t GAS FURN),-IDG : 1 UN17 HF-A1 FRS: HOODS: t OTHER UNITS: 3 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC:�EEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 •200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION; PFR INSPECTION: FA AOn'1.5rOSF: 8 201 400 amp: 201 40C amp: 1st W/O SVC/FDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 500 amp: 401 600 amp: EA ADDL SR CIR: SIGNAL/PANEL: IN PLANT: MANU HM1SVC1FDR: $01 • 1000 amp: 601+ampn1000v: MINOR LABEL: 1000+amprvolt: Reconnect only: PLAN REVIEW SECTION �--4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAL: CLS AREAISPC 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: LANDSCAPEtIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,363.96 BRENT BICKEL DALTON CONSTRUCTION INC This permit is subject to the regulations contained in the 13251 SW MENLOR LN 8465 SW HEMLOCK ST Tigard Municipal Code,State of OR. Specialty Codes and TIGARD,OR 97223 SUITE A all other applicable laws. All work will be done in TIGARD,OR 97223 accordance with approved plans This permit will expire N 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 followrules adopted by the Oregon Utility Notification Center. Those rules are set Rego: LIC 67798 forth in OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to REQUIRED INSPECTIONS OUNC by calling(503)246-1987. Erosion Control Insp 8& WIT Proofing Bsm't We Footing/Foundation Dr. Mechanical Insp Shear Wall Insp Insulation Insp Grading Inspection Post/Beam Structural Pim/undslab Insp Plumb Top Out Exterior Sheathing Ins; Rain drain Insp Sewer Inspecbo, Poat/Beam Mechanica PLM/Underfloor Electrical Service Low Voltage Water Line Insp Footing Insp Underfloor Insulation PLM/Underfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Foundation Insp Crawl Drain/Backwater Ftng Drain Bsm't Walls Framing Insp Gas Fireplace P Eler..trical Final Issued By: . Permittee Signature Call(303)639.4173 by 7:00 p.m.for an Inspection needed the next business day CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2001-00161 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/8/01 SITE ADDRESS; 13208 SW BROADMOOR PL PARCEL: 2S104DB-02000 SUBDIVISION: AMESBURY HEIGHTS ZONING: R-4.5 BLOCK: _ LOT: 020 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: Sewer connection permit for new single family detached residence. Owner: _ -- BRENT BICKEL FEES ----- 13251 SW MENLOR LN Type By Date Amount Receipt TIGARD, OR 97223 PRMT CTR 6/8/01 $2,300.00 27200100000 Phone: 503-550-5331 INSP CTR 6/8/01 $35.00 2.7200100000 — ---- Total $2,335.00 Contractor: ^i 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 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 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. ATI-ENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those 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. Issriaci b l Y Permittee Signature: ' Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Permit Application "Dateceived: 5 9�:^ Permit no.: S f�i City of Tigard -- Address: 13125 SW Nall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date: City ojTigard Phone: (503)639-4171 Date issued: By: Kec eipt no.: Fax: (503) 598-1960 Case file no.: Payment type: - Land use approval: _J 1&2 family:Simple Complex: ,�Zf1 &2 family dwelling or accessory U Commercial/industrial U Multi-family ,�A New construction U Demolition U Addition/alicration/replacenlent U Tenant improvement U Fire sprinkler/alarm U Other: _ Job address: 13 2 a i3�a n rK� Bldg.no.: Suite no.: L.tx: 2 O Block: Subdivision: y>r � a }jst �-�TTax map/tax lit daccount no.: Sip •OsZt� Project name: 11L1 Ile 7-// k-IKr Description and location of work on premises/special conditions: Name: _ 1G I`s L Mailing address: 7 Y2 2,S (,�) . MC I &2 family dwelling: 13 Wo C—ity.-174 Ax 7 State: ZIP: 7 2 7- Valu tion of work........................................ $ Phone: 563 a-5331 Fax: D ffz E-mail: B er-g le,cet ao.of bedrooms/baths................................. Owner's representative: M P to TY W c&_ 6AM"n''~ otal number of doors................................. 3 a f f77 Fax:-2L•Fsyil E-mail ICVJeIL 11• IV, dwelling area(sq.ft.) .......................... L Oaragc/canport area(sq.ft.)......................... �— Name: Ic Jle Covered porch area(sq.ft.)......................... _ Deck area(sq.ft.) Mailing address: 1 32 5 1 S-W. mLM ........................................ . City: j .*p State: ZIP: Other structure arca(s .ft.)......................... phone:5 o-53,3 r Fax:S O- ,?ZZ E-mail: Commercial industrial/multi-family: Valuation of work........................................ $ _ Existing bldg.area(sq.ft.) ............ ............ Addreesas:name:&4(_!L _ S. ) C�[7DF! ,r r r !r -New bldg.area(sq. ft.)........... ............... Number of stories Citty:—�/ State:Jmrl ZIP: IFOccupancy group(s): Ex :........ — y - Type of construction. Phone: 0 G Fax: y / Gmail:G�1�� • is g: CCB no.: 477!FS , , ,`7t _ - i ,,., Ne City/metro lic.no.: I'I N,r.r 1 rr r ns n- "of t t r r, n Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: I lt'_ t-er_t7 14p 5 M P rL provisions of ORS 701 and may be required to be licensed in the Address:V 7/2 - ry r. - ab jurisdiction where work is being performed.If the applicant is city: State: f 7.IP: ZZ exempt from licensing,the following reason applies: Contact person: Plan no.: t e/Lt Phone: ZS/ Fax: 7 •5YE-mail: - Name: Contact person: _ Fees due up)n application ...........................$-- - - Address: _�1 (�• Date received: _ -_ City: I State: d#,Z.IP: 7 ZD Amount received ......................................... $ Phone: Z Fax: 2Z - 7 E-mail: Please refer to fee schedule. I hereby certify 1 have read and examined this application and the Not dl juriadktiau accent cnxBt cards,plere can ludubcaon for•.,ae inrarm iat. attached checklist.All provisions of laws and ortgnances governing this U Visa U Mastercard work will be complied with, spe ' herein or not. C"I card number --- e.r.i res Authorized signature: Date: `/ d C Nate or c /der r shown oo credit card Print name:_ Aat�l7N _ crlmder sip atre $ Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440461.3 tar MWDM) 1— One-and Two-family Dwelling Building Permit Application Checklist Reference no.: CityafT'gard City of Tigard Associated permits: Address: 13125 SW Hall Blvd,Tigard,OR 972.23 U Electrical U Plumbing ❑Mechanical Phone: (503) 6.39.4171 U other: Fax: (501) 5'8..1960 -- I land use actions completed.See jurisdiction criteria for concurrent reviews. 2L.oning.Flood plain,solar balance points_,seismic soils designation,historic district,etc. 3 Verification of approved plaUlot. 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 originai applicable stamp and signature on file or with application. -- 9 EAWIon control U plan U hermit required.Include drainage-way protection,silt fence design and location of hasin protection,etc. 10 3 Complete sets of legible plans. Must he drawn to scale,showing conformance to applicable local and athte -- ing codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size sheet attached to the plans,,pith cross references between plan location and details. Plan review cannot be completed if co ynght violations exist. 11 .SYi te/plot plan drawn to scale.The plan must slxow lot and tojilding setback dimensions;property corner elevations(if — J,tltere is more Ulan a 4-0.elevation diflcrrmial,plan must show contour lines at 2-ft.intervals);location of easements and _ driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;perventage of coverage;impervious arra;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, r-dumbing 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 const uciion, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and.or lateral analysis plans.Must indicate details and locations;for non pTs nj tive 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 I(wations.Show attic ventilation. _ 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,see item 22,"Fngineer'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 heam)joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details, - 21 Energy Code compliance.Identify the prescr'ptive path or provide calculations.A gas-piping schematic is required for four or more_a appliances. _ 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or Rrehiteci licensed in Oregon and shall he.;hewn to be applicable to the project under review. 2 Fis_e(5)trite plans are required for Item I 1 above. Site plans must be 8-1/2"x I I"or 11"x 17". L27 lfiwo(2)sets each are rcquired for.Items 16, 19,20&22 above. Building plans shall not contain red lines or tape-ons — �No •olled,reversed or mirrored building plans will he accepted. 28 Checklist must be completed before plan review start date. Minor changes or notes on submitted plans n.qy be in blue or black ink. Red ink is reserved for department use only. 140-4614(6000T_oM) Mechanical Permit Application Date received: Permit no.: City of Tigard Project/appl.no.: Expire date: C'iryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 — Phone: (503)639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1%0 Case file no.: Payment type: Land use approval: _ - Building permit no.: ,all &2 family dwelling or accessory U Comrnercialhodustrial U Multi-family U Tenant improvement Ntw construction U Acldition/alteration/replac,meat U Other: Job address: M00& _ Indicate equipment quantities in boxes below.Indicate the dollar Bldg.no.: _ Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit. Value$ Lot: — Block: Sutxlivision: Abj"8&g,y �1€ 'Scechecklist for important application information and Project name: 1'1-pA� U IIgj O-gr4 F-t-' _ jurisc'tction's fee schedule for residential permit fee. City/county: ZIP: U Z 2 3 - rkscription and location of work on premises:_- - - ' Fee(ea.) Total Est.date of completion/inspection: - i)escri ton Qt Res.anl 1144.only Tenant improvement or change of use: Is existing space heated or conditioned?U Yes U No An handling unit CFM All conditioning(site plan required) Is existinj;spac^insulated?❑Yes U No Alteration of existing HVAC system Lf/replacc essors Sermit no.: Business name: _�g�(/�G PP --Tons__,BTU/H Address: Y', o . 6.� ak_ 7_33 Famper uct smoke detectors City: ISs 2M StateCMt ZIP: C ite p an requPhone: Z Fax: y E-mail: urnar, urne: - Including ductwork/vent liner U Yes U No CCB no.: _ -, nsta 1/rep ace/re oca(e healers-suspended. City/metro lic.no.: wall,or floor mounted _ Name(please print): V Ent foga ince o er t an furnace 911101 Kid 11111 W a Milo e eratan: Absorption units_._ BTU/H Name. Chillers_ _ HP Address: ------- --- Com resaors 111' - - n rontsenU exhaust an ventilation: City: _ _ _ -_ State: ZIP: _ Appliance vent _ Phone: Fax: E-mail: rverex aunt nods,Type I res. itchen/hazmat h(led fire suppression system Name: _ Exhaust fan with single duct(hath fans) Mailing address: x amt systema art rom I� e ting or AC City: _ _ tatr: ZIP: - n'' �SP p ng and distribution(up to 4 outlets) Type: 1_110 NG Oil _ Phone: Fax: E-mail: i ve i iT n eac�i al3ditional over 4 outlets rocs piping(sc ematic requtre ) _ Name: Number of outlets Other Wilted appliance or eq—uTpmenh Address: Decorative fireplace City: _ __ State: ZIP: nsert type Fa - - - Phone: x - E-mail: stov pe lei tstove (h lie r: signature: Da c: Name(print): _ A Na all judadictinns accept mclit cares,Meme can jurisdiction for more infer adon. Notice:'Phis permit application Permit fee.....................$ U Visa U MasterCard expires if Minimum fee................$ a permit is not obtained Credit card number:____ _L /_ Plan review(at _ %) $ Eapims within ISO days after it has been State surcharge(8%)....$ - -Minn of rarihotder a:ahnwnon—�care - � accepted as complete. TOTAL .......................$ -- S - Car defderaisnalum--- AmorM - 4144617(6RlOVCOMI MECHANICAL PERMIT FEES COMMERCIAL. FFE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: ---- ---- - -- -- ---- Price Total TOT_AL_VALUATION:_ FEE_: Description: $5,000.00 _ Minimum fee 572.50 Table 1A Mbchanical f ode - qty (Fa) Amt $5,001.00 to$10,000.00 $72.50 for the first 35,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents _- - 14 00 fraction thereof,to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts&vents 17.40 _ $10,001.00 to 325,000.00 $148 50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or including vent __ _ 14.00 --_ fraction thereof,to and including 4) Suspend3d healer,wall heater __ _ _ $25,000.00. or floor mounted heater __- 14.00 $25,OO , to 350,000.00 $379..50 for the first$25,000.00 and 5) Vent not included In appliance permit $1.45 for each additional$100.00 or __ - -- _--- 6.80 fraction thereof,to and inciuding 6) Repair units __ ____ $50,000.00. 12.15 - 350,001.Ot;'Ind uo $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat A r $1.20 for each addi;lonal$100.00 or For items 7-11,see or Pump Cond fraction thereof. footnotes below. --- --- - - - `-- 7)<3HP;absorb unit - - ---- -- to'I OOK BTU 14.00 ASSUMED VALUATIONS PER_APPLIANCE: 8)3-15 HP;absorb - Value Total- unit 100k to 500k BTU 25.60 Descry ory Qt Ea Amount 9)15-30 HP;absorb Furnace to 100,000 BTU,including 955 unit.5-1 mil BTU _- 35.00 -- ducts&vents __- 10)30-50 HP;absorb Furnace> 100,000 BTU including 1,170 unit 1-1.75 mil BTU _ _ 52.20 ducts&v3nts 11)>50HP:absorb Floor furnace Including vent - 955 unit 11.75 mil BTU - _ 87.20 Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM floor mounted heater 10.00 _ Vent not Included in applicance 445 13)Air handling unit 10,000 CFM+ permit ..---- --- - ---- -- 17.20 Repair units 805 14)Non-portable evaporate cooler <3 hp:absorb.un:l,_ - 955 10.00 to 100k BTU 15)Vent fan connected to a single duct 3-15 hp;absorb.unit, - - 1,700 - _ 680- 101k 101k to_5OOk BTU --- 16)Ventilation system not included In 15-30 hp;absorb.unit,501k to 1 2,310 appliance permit 110.00--__ mil.BTU --- -- 17)Hood served by mechanical exhaust - 30-50 hp;abso-b.unit, 3,400 10.00 1-1.75 mihBTU - - 18)Domestic incinerators >50 hp;absorb.unit, 5,725 17 40 >1.75 mil.BTU ----- 19)Commerclal or industrial type incinerator _ Air handling unit to 10,000 cfrn, _65669.95_ Air handling unit 110,000 cfm 1,170 20)Other units,including wood stoves _Non-pogzrlje evaporate cooler _ 656 --__ 10.00 Vent fan coenected to a single duct _ 446_ _ 71)Gas piping one to four outlets Vent system not Included In 656 40j___ a (lance permit _ _PP__ _ - - 22)More than 4-per outlet(each) Hoodsery j Ib 'apical exhaust 656 - 1 00 Domestic incinerator 1,170 Minimum Permit Fee$72.50 SUBTOTAL: $ Commercial or industrial Incinerator 4,590 _- Other unit,including wood stoves, 656 -- - 8%Stale Surcharge $ Inserts,etc. GasI ip p ng 1-4 outlets -__- 360 25%Plast Review Fee(of subtotal) $ Each additlonai outlat i _63 - Required for ALL commercial permits only TOTAL COMMERCIAL - $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION_ -_ _ _-_ _-- E7-- h r InsiDections and Fees: 1 Inspections outside of normal b:ainess hours(mininium charge-two;onus) $72 50 per hors 2 Inspect�ons for which no fee is specifically irdicated (minimum charge half tour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-one-half hour)$72 50 per hour Stale Contractnr Boller Certification required for units>200k BTU. '"Residential A/C raquiras site plan showing placement of unit. OdsWilimmsVirtech-fees.doc 10/11/00 Plumbing Permit Application City of Ti�— gard I)atereceiva!: Pcrrlitno.: i,700/'Oric.1,P Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: -- CityojTigard Phone: (51)3) 639-4171 Project/appl.no.: --- Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no. Land use approval: _ Case file no.: Payment type: ❑ 1 &2 family dwclluog accessory U Commrrciallindustrial L)Multi-familyU Tenant improvement ❑New construction U Addilion/alteration/repl icement U Food service U Other: _ Job address: I c,g S• W sa _ Description Qty.I Fee(ea.) Total Bldg.no.: Suite no.: New 1-and 2-family dwellings only: Tax map/tax lot/account no.: - (Includes 100 fi.for each utility connection) SFR(1)bath Lot: ZD Block_- 1Subdivisiotr 1 M1F'5ygctE? SFR(2)bath - _--- ----- Project name: utL ��j 3 - SFR(3)bath --- --- -_— - -- City/county: Zi P: 3 Each additional bath/kitchen Description and location of work on premises: Sheutilities: _ Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trcnch drain iiiiiiiiiiiiiiif Footing drain(no.lin.ft.) — Manufactured home utilities Busines.,name: ?(_(.f M 131 N�� Manholes Address: -3 (5 0- Rain drain connector City: 14 ars State: IP J 7 Sanitary sewer(no.lin.ft.) L.L ---v y_ L_ Storm sewer(nn. lin. ft.) Phone: 7- 777 Fax: Lail: _ CCB no.:7Z 444 =Plumb.bus.reg.no: _?/�Pd aler service(no. lin. ft.) City/metro bic.no.: 6 ; - Fixture or items 4,y Contractor's representative signature: Absorption valve - s Back flow preventer Print name: Date - Backwbter valve Basins/lavatory Name: Clothes washer Address: Dishwasher --- - _ Drinking fountain(s) City: State: LIP: Ejcctors/sump� Phone: Fax: E-mail: Expansion tank Fixturelsewcr cap _ Name(print): Flown drains/floor sinks/hub Mailing address: - -- - Garbage disposal - - Hose Bibb City: _ State. 7..1P_ Ice maker - - Phone: Fax 1 mail: Inter:eritor/grease trap Owner installationrresidential 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),ba,,in(s),lay.(s) _ Owner's signature: Date: -_ Sump - Tub-/shower/shower pan _ Name: Urinal J- ----- -- - Water closet Address: Water heater City: _ Stater_ ZIP: Other: Phone: �I, E-mail: 'notal NM all jurisdictims accept credit catde,please call juridiction Im m,xe inrorrmtion Minimum fee................$ U Visa U MasterCard Notice:this expires if a pertnnn application isnot obtained Plan review(at -_ T) Credit cud number: —_ -- - - within 180 days after it has been State surcharge(8%) ....$ — r•.%pire. TOTAL ..................... .�+ --- Nrrtr of r a�toloe:u rhown on credit card _— accepted as complete. - -- ('rrdhelrrer eltpnlure - -- -----Amount- - 440 4616(61 YCnx1) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dings only: G IXTURES (IndlviduaQ _ QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL well Sink - 16.60 the dwe:ling and the first'00 ft. QTY (ea) AMOUNT for each utility connection Lavatory --_ 16.60 - One(1)bath _ $249.20_ Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 i 16 -- - .60 Three 3 bath $399.00 ihower Only _-- Water Closet - 16.60 - - v SUBTOTAL _ Urinal 16.60 - _ 85:STATE SURCHARGE Oishw2sher - 16.60 PLAr4 REVIEW 25'/•OF_SUB TOTAL _ - TOTAL Garbage Disposal 16.60 ------------- - --- _I Laundry Tray 16.60 Washing Machine 16.60 f'!oorDrainlFloorSink -7- 16.60_ 1660 PLEASE COMPLETE: 3" 16.60 4" -- 16.60 Water Healer O conversion O like kind 1660 Quantit b Work Performed Gas pipinq requires a separate mechanical Fixture Type: New Moved Replaced RemoveCapped/ permit. _--- -- -- MFG Horne New Water Ser./Ice 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory _ - Tub or Tub/Shower Hose Bibs 16.6j Combination _- <oof Drains - 16.60 Shower Only Drinking Fountain 16.60 Water Closet _- ------ 16.6U �-- Urinal _ Other Fixtures(Specify) __ Dishwasher Garbage Disposal__ -- -- - LaundRoom Tray --- --- - ---- Washin Machiiie ,- Floor Orain/S nk: 2" Sewer-1st 100' 55.00 3^- SAwer-each addllion3 100' 46.40 4" - Water Se^fico-1st 100' _ - 55.00 Water Heater ___ -4640-- Other Fixtures Weser Service-each additional 200 - (Specify) Storm 8 Rain Drain-1st 100' 55.00 Storm 8 IT.in Drain-each additional 100' 46.40 --- Commercial Back Flow Prevention Device 46.40 - - -` Residential Backflow Prevention Dovico' 27.55 -- - Catch Basin 16.60 Inspoction of Existing I lumbing or Specially 72.50 R-n uq estsd Inspections _ --Per/lir COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps Traps 16.60 - -- --- - -- QUANTITY TOTAL Isometric or riam diagram Is requh d 11 _-_Quant. Total Is�9 "SUBTOTAL -- -- - - - 8%STATE SURCHARGE - ---- ---- - ---- "PL.AN REVIEW 25%OF SUBTOTAL Required only If fixture qty total Is_9 --_ TOTAL s *Minimum permit fee Is$72 so.8%state surcharge,except Residential 9aCK11ew prevention Device,which Is S38 25+8%slate surcharge "All New commercial A dtdings require plans with Isometric or riser diagram and pian mvlew i:\dstslformslplm-fees.doc 10/10/00 Electric-id Permit Application -'R --- ----- Datereceived Permtl no: City of Tigard Project/appl.no Expire date, Address: 13125 SW Hall Blvd,Tigard OR 97223 Date issued: By: Recetptm Phone: (503)639-4171 Fax: (503) 598-1960 Case file no.. Payment type Land use approval J I & 2 family dwelling or uccessory C,1 Comn, icialJindustnal U Multi-family J Tenant improvement YNew construction U Addition/alteranort/replac•ement U Other�: J Partial )ab address: ZO W. fL,at�DLtiltsa+'` Bldg.no.: Suite nn.: Tax map/tax Iot/accounl no.: ,& Block: 11 U _(4 a Frolect name Rtay Description and location of work on premises. tstimatea date of coo letion/insrain: MMKIMPIGLILIIAIJ MUM Job no: Fee t►t.. business name, iptiutt _ atilt Tout no.Ire Address: r .r / , �� Includes or AK-d ant per '� �t; /, 'r' �i_ -,_.�C-�---.----- dwelYagWdl.lncladtsattrciK•Jeruyge. City: j r , / State:(7 ( Z1 P: 2 c/ Servicrincladed: �\ Phone: ', i fjj Fax! 1000 w•fl.or less A (.'B no.: I Mec.bus.lic.no: z r i✓F L Eaeh additional SW s d.or portion thereof Citylmetro lie,no.: / r Limitedener�y,residenual - _— _ Limited ener ,non•resid_•nual �1 _ •_1.- C"6 F•uch manuteout d home err modular dwelling laic c Service and/or feeder • Si tuwre of ser •r aim uictan(required) f4 _ 2 Sup elect nomequino 6L q�t.•3 Liceveno,yL J.)- S Seriiorfeeden-installation, alteration or relocation: 1 200 amps or less 2 Name(print): 2r;amps to achy amps - - 401 oms to 600 amps 2 Marling address; _ _ 42+S to 1000 amps City: State: ZIP: ihverl0o0am sorvolts F'hunc rax: E.mail: ___- --- -- Reconnect only Owner installation:The installation is being made on property I own 'temporary services orfeederm• which is not intended fot sale,lease,rent,or exchange according to Molallation,alteration,fir relocation ORS 447,455,479,670,701. dW atnps or less 2 201 amps to 400 amps I Owner's Si nature. Datc; 401 to 6W ams _ ? Stanch c4colts-Now,altentloa, dame: or extension per pial: __— _. A Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: $laic: ZIP: _ 9 Fee for branch circum without pwchue — — _ of service or feeder fee,first branch circuit 2 111one: I'-r t mail' Each additional branch circuit t Mise.(Service or feeder not Incladed): Cl Servica over 2I1 amps: v:,mrtri a1 I lit.1011 ar-tor(-. , Each pump or irrigation circle 2 C.`!•rv, .,.er 320 imps sung of I&? J Huardous locarroo Lich signor outline lighting � I fsnuly dwellings U Building over 10,00 square feiv four In Signal circuit(s)or a limit cl energy panel, •A System over 600 volts nominal more remdenual units in one stnicture itheration,orestension• D Budding Liver avec stones U I•ceden,400 ompa t i more •Descnpuon _ .)Occupant load ova 9n;ei ions U Manufactured%true ares or RV puk Fseh additional inspection over the allowable In any of the abore .)6g:eselhghungplu, O Othrr _ --- [let mspccmun Submlt_.—self of pons witb am of rive a Tote. InvesliNation fee -- 11te above are not appUcable to temporary cumtruclion Service. Other - ___ Permit fee "' Kd all iattrikuons acept ciedi cud.*ere call junadicuon.r err more info tauac Notice-This perrnil application '� ----- --- G Visa J Mureresrd expires ifs permit is not obtained Plan review(a( _ %) b craetr cue Dumber _-_ _eip4n within 180 days after it has been State surcharge(896)... _.-__-.----^ -----_._n-ervdi+a—card-_ accepted as complete. TOTATOTAL Name of cvdholdrr u rfimvn o — t'ardlwader Ngaarre --- 9 Arrswn LutJAi trnxvr'rAt ZUU(rl SeIWUN NJ121lNYL S9LL 07.9 1'00 Xk:l LD l'l 1%-% 00 to I t , rv' SEE 35iVIM ROLL # 20 FOR OVERSIZED DdCUMENT :6 ti r d .ryn I N � 0 a a o �,�, G �0 w r, Y►� � � U n vV r0 s i I � o � Ln cz o on . . .... :� �fiYri53�aktc+... CITY OF TIGARD BUILDING INSPECTION DIVISIONMST ez 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP _ _Date Requested_ AM PM --LL— BLD Location 1 c C � 1�°z y rLa -� �I Suite _ MEC ---- - Contact Pei son fes`" Ph r `l�l %� PLM Contractor _ Ph _ _ _ SWR BUILDING Tenant/Owner ELC Retaining Wall i ELR Footing Access -� ►I Foundation �� . j �l / ,- FPS --_ _- Ftg Drain - SGN Crawl Drain Inspection Notes: --- - --- Slab - ---- - - SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing ------- - ----- ---- —_�-- - - ---- Insulation Drywall Nailing Firewall -- -J--------- Fire Sprinkler _- rire Alarm Susp'd Ceiling -- - - - -- --- ----------- -- _. Roof Misc: -- - -- - - - S,15ART FAIL -- ---- - -AWRIBING 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 ELECTRICAL _.--- -- -- ---- 'service Rough In UG/Slap Low Voltage Fire Alarm Final PASS PART FAIL SITE -_ Backfill/Grading -- — Sanitary Sewer Storm Drain [ !Reinsp ion fee of$_ __ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd `Catch Basin (Fire Supply Line [ J Please call for reinspectlonjtE: [ J Unable to inspect no access ADA Approach/Sidewalk pate -/ G ( Inspector Ext Other - Final - --- PASS PART FAIL. DO NOT REMOVE this inspection record from the job site.