11385 SW ERSTE PLACE i
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11385 SW ERSTE PL
MASTrRPERMIT
\► PERMIT # M /22/03 00457
CITY OF TIGARD
DEVELOPMENT SERVICES DATE ISSUEC: 10/22/03
13125 SW Hall Blvd., Tigard, Ok "7223 (503)639-4171
SITE ADE.?FSS: 11-135 S''" ERS1 E PL PARCEL: 2S103DB-09600
SUIIDIVISION: GFNF_S S NO 3 ZONING: R-4.5
BLOCK: LOT: 079 JURISDICTION: TIG
REMARKS: Addition IIt )83 sf l3u10p-0ut main level and upstairs.
BUILDING
REISSUE: CUSIFM sIOHILS FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADO nI-lWil FIRST 54 of BASEMENT: of LEFT: 5 yi SMOKE DETECTORS: Y
TYPE OF USE: SF I 1 00 L OAU mI SECOND, 229 of GARAGE: at FRONT: 20 PARKING SPACES:
TYPE OF CONST: 5N DWI I I INC,uwI S 1 iwrq sf RIGHT: 5
20 149.
OCCUPANCY GRP. R3 BDfiM PATHTOTA'.: 263 at VALUE: 26. REAR 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MAL O' LAUNDRY TRAYS RAIN DRAIN: TRAPS:
LAVATORIES. DISHWASHERS: FLOOR BRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS.
TUBISHOWERS: GARBAGE DISP: WATER HEATCRS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTI ORES:
MECHANICAL _
_ FUEL TYPES FUVN c 100K: BO,L/CMP<3HP: VENT FANS: CLO FHES DRYER:
FURN-T::-,: L NIT HEATERS HOODS: OTHER UNITS:
MAX INP: btu FLOOR.FURNANCE.: VENTS: WOODSTOVESGAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT_ SERVICE FEEDER TEMP SRVCIFEEDER.S BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 200 amp 0 200 ampWISVC OR FDR: PUMPORRIGATION: PCR INSPECTInN*
EA ADWL 500SF: 201 400 amp: 201 - 400 aml 1 at WKl SVCIF OR IN) SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp EAADDL FOR CIR: 100 SIGNALIPANEL: IN PLANT.
MANU HMISVCIFDR: 801 1000 amp: 801-ainpr100nv: MINOR LABEL:
1000♦amplvolt:
PLAN REVIEW SECTION
Reconnect only: -
>•4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREA/SPC OCC.
ELECTRICAL•RESTRICTED ENERGY
_ A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO R STEREO: FIRE ALARM: INTEFCOM/PAGING: (.t..DOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEfIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDIr.AL: OTHR:
HVAC: DATATELE COMM: NURSE CALLS: TOTAL M SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 628.20
CULBERTSON,JON C JOHN DOCTOR INC Thi., permit is subject to the regulations Contained In the
11385 SW ERSTE PL 1163 NE 3RD AVENUE Tigard Wnicipal Code,State of OR. Specialty Codes and
11385 S OR 97223 1163 N ORO,OR NUE 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:
Oregon law requires you to follow rules adopted by'he
Ph0"•: 503-681-9338 Phone: 503-681-2079 Oregon Utility Notitication Center. Those rules are set
forth In OAR 952-001-00,C through 952-001-0080. You
Reg 0: LIC: i)3563 may obtain copies of these rules or direct quest!ons to
OUNC by calling(503)246.1987.
REQUIRED INSPECTIONS
S:du il;cp Insulation Insp
Electrical Rough In Rain drain Insp
Framing Insp Electrical Final
Shear Wall Insp Final Inspection
Exterior sl
Iss1 L13y : /\ _ Permittee Signatures' _
Call (50 ,,J4175 by 7:00 p.m. for an inspection needed the--,,Wt business day �"
Building Permit Application Received Building
Date/By: 7-`1��'� Permit No.:1%r 3 -cvIY5-7
City of Tigard- RECEIVED Planning Approval other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 SEP O 4 2003
Post-RevDate/By:: A U U o3 Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Date/By: Laird uae
Date/By: Case No.
Internet: www.ci.tigaTCk.WW OF TIGARD Contact 1 s..I See Page 2 for
24-hour Inspection ReRp1 4�1 14 t llf��l Name/Method: //�� Supplemental Information
construction _ Demolition i9;A
Addition/alteration/replacement Other:
Mpg- ( i` Note: Pemiit fees•are based on the total value of the work.performed. Indicate
��11 &Vamily dwelling (�onitnercial/Industrial the value(rounded to the nearest dollar)of all equipment materials,labor,
- - — overhead and profit for the work indicated on this application.
L-1 AccessoryBuildinpI Multi-Family -Z L, ISO =
[] Master Builder T Other: Valuation......................................................... --
Jrf` C C_a No.of bedrooms: No.of baths:
Job site address 13r Tota]number of floors.....................................
- New dwelling area(sq.ft.)............................. ---
Suite#: Bldg./Apt.#. Garage/carport area(sq.ft.).........................
Project Name: OA,I k4,,r u Covered porch area(sq.ft.)............................. — —
Cross streetMirections to job site: Deck area(sq.ft.)............................................
Other structure area(sq.ft.)............................ - --
Subdivision:— _ _ Lot#:
Tax ma / arcel #: Note: Permit fees*are based on the total value of the work performed. h,dicate
the value(rounded to the nearest dollar)of all equipment,materials,labor,
overhead and profit for the work indicated on this application.
SMSA 1 I�v ry1(� my M�l y� 11.
Valuation......................................................... $
Existing building area(sq.ft.)......................... _
-- --- New building area(sq,ft.)..............................
Number of stories...... ..................................... - —
l "( ] Type of construction....................................... i
Name:_ r f:�I �. c�.,� �— Occupancy group(s): Existing:
- --�- New:
Address: 3 g S v.1 E►- �-t PI. _ -
City/State/Zi
Phon (:ogl FSX: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Who W
i" provisions of ORS 701 and may be required to be licensed in the
Business Name: L-A Lj,,. -. �, — . jurisdiction where work is being performed. If the applicant is exempt
Contact Name: � ,� �,. t r from licensing,the following reason applies:
Address:_ zz -+"
City/State/Zip: l 1 fq
Phone: ►_ l Fax: — low&
E-mail tIt u,i,I vc:i�rR�It i r.I E.s�
r. �• to fct schednic.
Business Name: _ Fees due upon application..............................
Address:_
City/State/Zip: Amount received........-........ .. . ..................... S__-----
Phone: Fax: Date received:
CCB Lic. ---
Authortz Notice: This permit application expires If a permit is not obtained within
Signature: �' _ Date:_ 10.0 days after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
(Please print name)
i:\Dsts\Penrrit Fonns�BldgPermitApp.doc 01/03
Plan Submittal Requirement Matrix
Comniercial & Moulti-Family
Cit), of Tikard New, Additions or Alterations
Vol
°F SUB'MIYTAL 'n? PIS r
i w C �� f
Ii'N N . ,, dditiot s or/Aercltigns) Re, uired.at
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1*
FirEI Protection System 3**
Mechanical 2
Plum►)ing - Bui!ding Fixtures 2
Electrical 2
I
Plan review is dependent upon submittal of a completed application and plans.
/After plan review approval, the Plans Examinei will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
*For over-the-counter commercial tenant improvements, submit 2 sets of plans.
'New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
I:\Buliding\Forms\PlanSubMatrix.doc 04/03
Electric-Al Permit Application Received Electrical
Date/By: Permit No.: tbrwv-w
City of TigardC�1E'��,� Planning Approval -- Sign
: Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other --
Tigard,Oregon 97223 rr r� �) �1�0� Date/By: Permit No.:
Phone; 503-639-4171 l�ki�563 9 -1960 Post-Review Land Use
Internet: www.ci.tigard.onus "" Contac Case No.: _
Rp Contact Jutis.: See Page 2 for
24-hour Inspection RequeS 0510A���Kptl Name/Method: _� Supplemental Information_ J
— -
x _
New construction ❑ Oenol!tion Service over 225 amps- Health-care facility
Addition/alteration/re lacementd _ Other:,-- commercial [I Hazardous location
❑Service over 320 amps-rating of ❑Building over 10,000 square fee„
-gl_t I1' ":_ it 1&2 family dwellings four or more residential units in
1 &2-Family, dwellin ❑Commercial/Industrial ❑System over 600 volts nominal one structure
❑Building over three stories ❑Feeders,400 amps or more
Accessory Building Multi-Family ❑Occupant load over 99 persu. ❑Manufactured structs=or RV park
Master Builder Other: ❑Egress lighting plan ❑Other:
Submit—sets of plans with any of the above.
The above are not apolicable to tem ora) construction sery ce.
Job site address: ? "^!.: .
Suite#: Bld ./A t.#: Number of Ins sections per pern'ilt allowed
Project Name: Descrl P,on Qty Fee(ex.) 'rout
Cross street/Directions to Ob site: Nei,residential-single or multi-fanilly per
I dwelling unit.Includes attached garage.
Service Included:
1000 sq.ft.or less _ 145.15 __ 4
Each additional 500 sq.ft.or portion thereof 33.40 I
Subdivision: Lot#: Limite4 energy,residential 75.00 2
___ -------- - - Lunited ener ,non residential /5.00 2
Tax ma /parcel #; Each manufactured home or modular dwelling
'�- 54 T tVIJ service and/or feeder 90.90 2
Services or feeders-Installation,
alteration or relocation:
200 amps or less 80.30 2
- -- - -.- ---- 201 amps to 400 amps 106.85 1 2
401 ams to 600!M s _ 160.60 2
;. 601 ams to 1000 ar ps 240.60 2
Over 1000 ams or Bolts 454.65 2
Name:
Jun/ ('L4 Apl Tl-u.V Reconnect only 66.85 2
Address: lljp5 7-e /c t Temporary services or feeders-installation,
alteratlou,o:relocation:
City/State/Zip: 7- .Q d 1 J' 100 amps or less 61.85 1
Phone ��� �3 FaX:fr> /�G 201 amps to 400 amps 11`0.30 ].
401 to 600 ams 133.75 2
Branch circuits-new,alteration,or
Name: T,� ', /Ss� rsa.v _ extension per panel:
�. A.Fee for branch circuits with purchase of
Address: �/?�'S rL J L rS It ���c e service or feeder fee,each branch circuit 6.65 _ 2
City/State/Zip: 1 B.Fee for branch circuits without purchase of
service or feeder fee fust branch circuit 46.85 _ 2
Phone: -J- Fax:Sy 1 &,e/_ 9 7 Each additional branch circuit 6,65 2
E-mail: Ts_,v e l-. Cv Misc.(Service or feeder not included):
Each pump or irrigation circla _53.40 2
Each sign or outline lighting 53.40 2
Job NO: Signal circuit(s)or a limited energy panel,
Business Nae: -� alteration,or extension _ ^_ _ Page 2 2
_.._ Description:
Address:
City/State/Zip:/State/Zl Each additional inspection over the allowable in any of the above:
Per inspection pet hour min. l hour r>2�o
Phone: Fax: Investigation fee: - W
CCB Lic. #: Lic. #: Other
Supervising electrici _ _ Subtotal S _
si ature re uired: Pian Review(25%of Perrnit Fee) S
Print Name: .A- Lic.#: _ State Surcharge(8%of Permit Fee) S
_ TOTAL PERMIT F'p's' $
Authorized // Q Notice: This perm' )plication expires if a permit is net obtained within
Signature re.r/? _ Datp/d 21 f�.l 180 drvs after It he ten accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
(Please print name) - --- ----
i:\Dsts\Pemut Fors\ElcPermitApp.doc 01/01
Electrical Permit Application - City of Tigard
Page 2 - pupplemental Information
LE IITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems............................................................ $75.00
Check Type of Work Involved:
7 Audio and Stereo Systems*
Burglar Alarm
LJ Crarage Door Opener*
Heating,Ventilation and Air Conditioning System*
F1Vacuiun Systems*
71 Other
COMMERCIAL WORK ONLY:
Feefor each system.......................................................... $75.00
(SEE OAR 915-260-260)
Check Type of Work►rrvalved:
Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
U Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
Nurse Calls
0 Ot-tdoor Landscape Lighting*
f7 Protective Signaling
❑ Other ----. ---—
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i\Dsts\Permit Forma\E!cPermitAppPg2.doc 01/03
I;leetr[cal Permit Application Received Electrical
Electrical
Date/By: t No
. T v 3 ea 57
City of Tigard RECFrVED Planning Approval Std
-
Date/B : Permit No.:
3125 SW Hall Blvd. ,� Plan Review Other —
Tigard,Oregon 97223 SEP 0 4 2003 Date/By: Permit No.:
Phone: 503-639-4171 Fax, 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard,or.us-ITY OF TIQAAD Date/By: Case No.:
Contact Juris.: See Page 2 for
24-hour Inspection Request:KU3.1b8l1► ODMISI Name/Method: Supplemental Information.
•Tew construction _ Demolition Service over 225 amps- Health care facility
commercial ❑Hazanlous location
�ddition/alteration/r laCemenl Other: ❑Service over 320 snips-mting of ❑Building over 10,000 square feet,
yt 1 dt:2 family dwellings four or more residential units in
&2-Family dwelling Cornme'AaDIndustrial ❑System over 600 volts nominal one structure
- ; 8 Building over three stories ❑Feeders,400 amps or more
Access- Building Multi-.amily _ __ Occupant load over 99
p persons ❑Manufactured structures or RV park
Master£wilder �� Other: ❑Egress/lightingplan ❑Other
R rI INPORMATI®,:q0f ,;' , Submit_sets of plans with any of the above.
- — ""— The above are nota ([cable to tem orar construction servitt.
Job site address:
IF i
Suite#: Bldg./Apt.#: _ Humber of wsuections per errnit allowed
Project Name: Q"P)� r rJy\- v` Description Qty Fet(ea.) Total
New residential-single or meld-tamity per
Cross Street0irections to Job Site: dwelling unit.Includes attached garage.
J I Scrvlce included:
/ 1000 sq.ft.or less 145.15 4
Each additional 500 sq.ft,or portion thereof 33.40 1
Subdivision: Limited energy,residential 75,00 2
subdivision: �u �` ?,
—T—Lot#: Limited energy,non residential 75.00 2
Tax ma / arcel#: (}4 Cc' Each manufactured home or modular dwelling
:tet and/or feeder 90.90 2
Services or feeders-Installation,
��:•? 't'�� e C r C-1 s alteration or rebcation:
200 amps or less 80.30 2
201 ams to 400 amps _ 106.85 2
__ 401 amps to 600 amps 160.60_ 2
ROPE'RW,j C 1K' TF.�2 ; 601 amps to I000 amps 240.60 2
Name._- - -- - Over 1000�s or volts --- 454.65 2
� 1 >< f' �% Reconnect only _ 66.85 2
Address: $ j sy4 jgr�_1-- Temporary services or feeders-installation,
City/State/Zip:_ � �Y 7'2 alteration,or relocation:
1 L -,I Z�2 200 amps or less 66.85 l
201 amps to 400 ams
Phone: Fax: -- - -- �---__ 100,30 2--
- --- - 401 to 600 ams 133.75 2
441: T PERSON
z -y -- ----- 74—
Branch circuits-new,aitcration or
Name: " �,,,._ p LVut- extension per panel:
Address: 1 J A.Fee for branch circuits with purchase of
service or feeder fee,each branch circuit 6.65 2
Cit /State/Zip: ;Ile, 0 V__ A-711,14 B.Fee for branch circuits without pu'chase of
Phone: t o¢l,1- 2 or7 Fax: service or feeder fee,fust branch circuit _ 46.85 2
_� ipySZ!�t�a�s_ _ Each additional branch circuit 665 2
E-mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 ;
Fach siEn or outline lighting 53.40 2
Job No: Signal circuit(s)or a limited energy panel,
Business Name: rlterstion,or extension Pa e 2 _ 2
to% 9) 0A Description:
Address: \
City/State/Zip: Each additional j.nsecdon over the allowable In anyo_f_the above:
Per inspection per hour min. I hour 62.50
Phone: Fax: Investigation fee:
CCB Lic.#: Lic.#: Iother: -y-
Supervising electrician Subtotal $ _
Si�riature required: Plan Review 25%of Perntit Fee $ i
Print Name: Lic. #: State Surcharge(8%of Petmit Fee) S
TOTAL PERMIT FEE S
Authorized Notice: This permit application expires if a permit is not obtalned wltldn
Signature' _ _ Date: 180 days after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
- (Please print name)
i^,Dsts\PermitForrrs\ElcPerrnitApp.doc 01/03
Electrical Permit Application -City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ $75.00
Check Type of Work Involved:
ElAudio and Stereo Systems*
Burglar Alarm
Garage Door Open,'`
0 Fieating,Ventilation an i Air Conditioning System*
ElVacuum Systems*
0 Other.-----_ -- —
COMMERCIAL WORK ONLY:
Feefor each system.......................................................... $75.00
?C'E OAR 918-260-260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock"Systems
Data 1'elecommunication Installation
n Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Mr;li�:l
Nurse Calls
CJ Outdoor Landscape Lighting*
A
Protective Signaling
Other ----_----�
Number of Systems
* No licenses are required. Licenses are required for all
other Installations
i ,Dsts\Permit Fcrm TlcPermitAppPg2.doc 01103
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tutdald.t'IflltlloT.Stdluttnl.Eatw' EDMION_C�MiRDL PLAN NOTES
• The Pit er fabric shall be pprrocina"d In a continuous holt cul to the length of Anprovry of doo Moa "dnheraata MWIA IESCI pun does rx's conN u a„
the ban ier to..,,Ad ,e of lolnla. N/Inec joints are aaeceuary,filter cloth th of 8M."M rermsnem road or nrrmoo –m N.O.tore arsd locnxm s,^atm noes
be spliced together tMly At a wppmt pmt,with a mhdnwm b-Inch overlap, reso"spa•Manners.r«arwim `uta.u1sAKe~c.l
and both ends eMco,ely fastened to the poN. The•MNemerxalo of thase ESC mans Mod too consn,xno,,. me xrnarn n
d e Nomos"ent. and upgrst*V d ah"e E5C !Stem w am rmspnso hay of she
• The filter fabric fence shad be Installed to follow the contours where epphcwwcorx,actor ural a•wrsunrtla+u-Mm"d
feasible. The fence posts shall M spaced■ma*Imam of ti feel apart and
driven senif Oy into the ground a minimum of Jit inches. The bo,iudanN of the clo r g tomato shit W M plan at W re cfeeny]upped
n ane Mkt prix to ccxmruclia+, Ouvmp the conskuc'.ke,perbd,M dlsaxbanu beyo„o
• A ttrnrh shall be exce%sted,roughly 6 inches wide by II Inches deep, dmr MgQed dearrny h*xts mall h permlted. II,a ssppnp ones ere memrxansn test tens.
upslope Sort adjacent to the wood post to allow the filler fabric to I–tutted. 4111;11�fco'h_• ��x..Allem W hmtr--w".
When standard strength(lifer fabric b used,•wire n,ppnrl furca Shell Urr The ESC fatslsrs.town rtn am pa+must h ccxmrmeracm h CcrrKrx=un h r,,as
listened standar In the strength
filter
aide nl she posh ire ssing hes -cut tre claw"end prada,p aedwrtes.and N uCi a moexher as to mate.that vm%r ,t ted-,
Y she rarer dose nor enter ehM rfanapM""or violate sopkabre water standards
stMries at hast I Inch look{,tie wire or hop rings. The wire s all emend In10
the,.ench a rnlnimum of ll Inches and shall not extend more than 36 inches IM ESC faciliea shnaal on MH pW�arethe rran+maarn ncexrMwxs lis arhlrcpateA
above the origins]ground surface. sae wMsrons O,rrkV th cahsoucnon,m rod.tfh"e FSC IefAtlee ones h,moWalcmd
N rwwd for hawnlecled memo a-moo and"naadad 4 r"m.kMdn oni on sse.
• the standard strength filter fabric shall he stapled r wiled to the lencq u,d
20 Inches of the(Mbric shall be rxlr„ded into the Irenrh. The fabric shall not V- F.SC facisnts stall be SwoeeM chest by Rm sppac_erafcnna•arcv &,e.
extend more than 36 In hes crow tw nrlglnal ground wr/ace. Tiller(4NIr entoraa"wl es FWsasary so Moth"Ow aperatad asmdbreng.
Strait not Ix si.,pl#d to existing Items.
The FSC la Mw.m rum—eaN slut M kmus"erl and nterxakhwd a murk rat
' When extra-strenSth Rllrr fabric and crooer proof apsring are us.,i,the wire d now a rrDelo or.xrr,ase M hours sono en;f a norm^aver%.
mesh support(encs may be ellm]naled. In suer•case,the(111rr fahhtr Is prnr to p&mV a
N rho nm soM mea ttran m bot dse6hoon h asoxood to acanasna reewh
standar or wired directlyto the purls with MII other pnvlsiuns of the slave ■corn baton. N catch basin and or%MymX*totes crus be CIO~standard nolo!w standard Strength filter fabric applying. The corer"opatata•„sty a Mone"Wee,saner hoer on 0„emwvsam eysrem
Sediment fences shall be removed when they have twved their useful StatsatnlCOrooh,NCOM OnVentame coat he emww•m a"fmgWoxr,q of comrur.7rm
Vurprne,but not hfom the upsinpr arms hot Men permanently nabilleed. arxl marxerwd for me du"en of Soo r cqa t Arrtawr„I rmasurN may h,aou,eM ro
rratxe that as pavM are"are k"M Men,k:,d,a,aerel,m d am nro"'T.
• Sediment Imrn shall be Ice('�''�d by eppNnnt/mnOartnc immediately
after each rainfall and at leas) ad ily during prolonged reln(all. Any required Stood so orllurbed(`,^neer at cxocsmx r,d pacvnp See Nrheboak ix Seed rvl
repairs shall be made Immediately. Fertilize;PA. Moll Acpaca non Mus
• RamWOfa('XmM banms n RC1Y AnMh,ti,„aa s warxsm c
SEE cP015k)N CONTRCL PWS TE='14ACA SMANCF PANC8000C PREPAnEJ
By CITY OF PORTLAND. BUREAU OF ENMONMENTAL SERVICES. AND
NASNMKiTON COI11eTY OEAT, OF LAID !ISE A MANSPORTATIpN. DATE-3
N(T/15MBEP 1909 FOR RECOWMENDE'7 CCskiTlll.CM14 SITE EROSION CONTROL
4117ASl IRCI
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is'i+sess ateasrer lime rsaeeM Ataysl CasW+aruon yexraexe--- }MMINs.wlh �",,,,;,� •
a� MilrRiwl aM,:
CITY OF TIGARD- SITE PLAN RE ' 'w RECEIVEDy
BUILDING; PER NC).:Vl�t��vU3•� �
PLANNING DIVISION: V ¢ .5 -SE �) 1QU
Required Setbacks: Approved ❑ Not Appru�rd
Side: _ZS_ street Side: I� � CITY OF TIGARI3
07o hear: .., I31JILDING DIVISION
Front. -A o. Garage: u
Visual Clearance: )1)A ❑ Approved ❑ Not Approved
`
Maximum Building Neigltt• Lo feet No
CWS Service Provider Letter Required: a Received
F:NI;INE: IN " Dfa'A MENT:
Bio A ruv�d ❑ %4ok Approved
Actual slope: Approved ❑ N ►t A roved
Site PI Dp / Dut�•� f
fJ
Nolcs.
CITY OF TIGARD 24-Hour 1
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (50? ---
) 639-4171 - - - - ---
Blip
Received _ — Date Requested -3 - -3 AN1 — PM ____— -_ Blip
Location _ f 3 �,S c �- Suite _ MEC
Contact Person __ C �_ Ph PLM
Contractor _ _ _ — Ph(—) -- SWR -
BUILDING Tenant/Owner i _. ELC
Footing
Fount !on Access: ELC _----_-__-- -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors - -- -- ---
Ext Shaath/Shear
Int iheath/Shear ---`
Framing _ -- -- - =>- ----
Insulation
i Drywall Nailing
Firewall (��v�, c �► N_ L, -
Fire Sprinkler
f,.a Alarm
Susp'd Ceiling - --- - -- --
Roof �n P
C
Other; �.-._....- —
Final _ �� �J 1 U - _L-•
_PASS PART FAIL y
FZIJMBING
Frost&Beam - --- -- � --
Under Slab
Rough-In
Water Service ----.-------_ __—
Sanitary Sewer
Rain Drains --- - - - - - -- —
Catch Basin/Manhole
Storm Drain --- --- --------- ---
Shower Pan
Other: —
Final
PASS PARI FAIL
�MECfiANICAL
Post&Beam — - � � -------- - -
Rough-In — --_---- -- -- - -- - -
Gas Line
Smoke Dampers -
Final
PASS PART FA L - - ---
_ELECTRICAL. —
Service --
Rough-In
UG/Slab
Low Voltage
I Fire Alarm i
AS _ PART FAIL Reinspection fee of$ __.required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE F� Please call for reinspection RE:-.. E] Unable to inspect-no access
Fire Supply Line —�
ADA 1Le
Approach/Sidewalk Dab rt �A Inspector
niher _
Final DO NOT REMOVE this Inspection re Ord from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING
Inspection Line: (503)639-4175
ST
IN DIVISION Business Line: (503)639-4171 cm:�Y__
BUP
4
Received Date Re uestcd AM_—--- PM 8UP
Location MEC
Contact Person
PLM
SWR
BUILDING Tenant/Owner ELC
Footing ELC
FoundationAccess: ELR
Ftg Drain
Crawl Drain SIT
Slab Inspection Notes:
Post.& Beam
Shear Anrhors
Ext Sheath/Shear ------- -
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final
PAPT FAIL
4'LAHMMG
Post
K_ffea_
rW
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 Reinspoction fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
Please call for reinspection
no access
E: Unable to inspect
q
Fire Supply Line Ext
ADA
Approach/Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL