11130 SW GREENBURG ROAD I
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Octc oer 4, 1999
Rebecca Ambrose
11130 SW Greenburg Rd.
Tigard, OR 97220
RE: Address
Dear Ms. Ambrose:
1 apologize for the delay in answering this concern. I was contacted by Jeanne Temple
questioning the address of the shelter. She was told by yourself that the address of the Shelter is
11130 SW Greenburg Rd. Some of the City records showed the address to be 1100 SW
Greenburg Rd., while others show the 11130 address.
There prr viously was a structure (11070 SW Greenburg Road), which was demolished. The
problem arose when that address was never 'retired'. I have retired the 11070 address, so there
should no longer be any confusion for laity personnel.
I would suggest that if your mailbox shows the 11070 aduress that you change it to the 11130
address to further reduce confusion.
Thank you for your cooperation. if you have any questions please contact me by calling
503/639-4171 x377.
Sincerely,
Catherine 'Kit' Church
Engineering Technician
L+NG N ITerhlre—%helrer 10041A
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 E usiness Line-. 639-4171
.Date Requested AN AM PM
Location K )26141-C;
suite MEC
Contact Person Ph PLM
Contractor A:le 6, 7D_V Ph SWR
BUILDING TenaritiOwner '//14 ELC
Retaining Wall ELR
Footing
Foundation NOT REQUESTED FPS
Ftg Drain FOUND DURING RESEARLH SGN
Crawl Drain
Slab NO INSPECTION(S) IN FILE SIT
Post&Beam -—------
Ext Sheath/Shear
Int Sheath/Shear
Framing
----
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Hoof
Misc:
Final
PASSTAPT FAIL
FQ,UMBIN%)
[lost& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
I lfio`I
ASS PART FAIL
MEIC14ANICAL
Post& Bearn
Rough In
Gas Line
Smoke Dampers
Final
I PASS PART FAIL
ELECTRICAL
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain I J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125'113W Hall Blvd
Catch Basin Please call for reinspection HE: i I J Unable to Inspect-no access
Fire Supply Line
ADA
Approac;i/Sldewalk
Other Date z Inspector Ext
Final
PASS PAR) FAIL DO NOT REMOVE .*his Inspection record from the job site.
U.\
David Scott
Building Official
M City of Tigard
13125 SW Nall Blvd.
Tigard, OR Vi 223
October 14, 1997
Dear Mr. Scott,
Mme~ I am writing to request an extension( to Building Permit #BUP97-0242, to
t,��• Demolish and Remove a house on 11130 SW Greenburg Rd.
Interfaith Outreach Services has purchased this property to build a new
pct facility to house homeless persons(RITE Center). NW Demolition has
agreed to demo the house as an in-kind contribution to the project. Due to
P their heavy volume of work, they have been unable to schedule the demo as
yet. We estimati, that the demo will take place so,netime in November
r 1997.
If you have auy questions or need additional information please feel free to
contact me. Thank you for your consideration of this request.
CCS r�
• Sincerely,
E"* TWO
ONE* ^l Kim Brown
. . Executive Director
M I
AWN
•
l 'roue 1he hopelessness 1 /f pore►rl.r• to Me Power of independence. "
1,
CITY OF TIGARD BUILDING PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : BUP97-0242.:
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 05/15/97
PARCEL: 1 S 135CA-02600
SITE ADDRESS. . . s 11130 SW GREENBURG RD
SUBDIVISION. . . . : ZONING:R-12
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : JURISDT.CTI.ON:TIG
REISSUE: FLOOR AREAS----------- EXTERIOR WALL CONCTRUC'tION--
C:LASS OF WORK. -.DEM FIRST. . . . : 0 sf N: S: E-. W:
T`r PE OF USF_. . . :SF SECOND. . . : 0 sf PROTECT OPEN I NGS?------------
f YpE OF CONST. .-5N . . . . 0 sf N: S.- E: W:
OCCUPANCY GRP. :R3 TOTAL------: 0 sf ROOF CONST: FIRE RET? :
OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEP. RATED:
STOR. : 0 HT: 0 ft GARAGE. . . : 0 sf OCCU SEP. RATED:
BSMT? : ME:Z Z? :. REOID SETBACKS-------------- REQUIRED---------------------
FLOOR
EQUIRED-------------.---_---
FLOOR LOAD. . . . : 0 ps f LEFT: 0 ft RGHT: 0 ft FIR SPKL: SMOK DET. . :
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP1 ACC:
BEDRMS: 0 BATHS: 0 IMF, SURFACE: 0 PRO CORR: PARKING: 0
VALUE. $ : 0
Remar-ks : Demolition permit of single family residence and garage at 11130 ;W
6reenburg Rd and a garage at 11070 SW 6reenburg Rd. Sewer must be capped and
inspected. All debris to be removed.
Owner: ---------------------------------------------------- FEES ------- --
INTERFAITH OUTREACH SERVICES type amaunt �jy date r'ecpt
9020 SW BLIRNHAM PRMT $ 25. 00 B 05/15/97 WAIVED
TIGARD OR 9722:3 SPCT $ 1. 25 B 05/15/97 WAIVED
EROS $ 26. 00 B 05/15/97 WAIVED
F'hone #: 598-0359 ERPC $ 8. 45 B 05/15/97 WAIVED
ERPC $ 8. 45 B 05/15/97 WAIVED
Contr-actor: ------------• _---------------
NCIRTHWEST DEMOLITION/DISMANTLI
BRIAN H SMITH
PO BC'X 390
WILSONVILLE OR 97070 ------------------------------------ �
F."hone #: 638-6900 $ 69. 15 TOTAL
Reg #. . : 000482
-- -- -- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other !ltf" t 1V1
applicable laws. All work will be done in accordance with 1n
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Fm1ermittee Si attire :
TT
Issued By
: �.: .____•—__.______.__._, _ �_._.
Call for inspection — 639-4175
CommerciaLB.uildingr= ADDIication
1 C,ty of flgarb 131:5 3w Hall Blvd. Tigard.oR 97:23
1503)839-4171
Jobslte Address: 1' tUrc� OFFICE USE ONLY
'enant:-_ _ Suite # Planck/Rec. #
Valuation:
Permit �� .
I Map &TL
owner:
Aagrovals Requirgd
Address:
Planning
Engineering
elephone: �'Iei-a L-
Other
:ontractor:
1'
_ Type of constr.
elephone: Occupancy Class:_
:ontractor's License > Sprinkler? Yes No
(attach copy of cur-ent Oregon license)
Sq. Ft. '7f Project: �r
ontact name & telephone: ;,
architect g Engineer: Story (1st, 2nd, etc.):
' � - ^_�- �—'
Proposed Use:
ddress: —
Previous use:
Note: Plumbing & mechanical plans must
elephone: _ '1'�. .(`?..�, jam) be submitted at time of building permit
application.
8 DESCRIFTi0N: �.
UC r
(Applicant Signature 3 Telephone Number) Y� f Wt'
I
,-eived by: I l _`_ Date Received:
tMIT Account Description Amount Amt Pd. Balance Due
Building Permit (BL ILD)
Plumbing Permit (PLUMQ)
Mechanical Permit (MEC: )
State Tax (TAX)
Bldg. _
Plumb.
Mech. �
Plan Check (PLANCK)
Bldg. _
Plumb.
Mech.
Sewer Connection (SWUSA)
Sewer Inspection (S`IVINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Masa Transit TIF (TIF-RAT)
Cor .iercial nF (TIF-f;)
Industrial TIF (TIF-1)
Institutional TIF (TIF4S)
Office TIF (TIF-0)
Water Quality (WQUAL}
Water Quanity (WQUANT)
Fire Life Safety (FLS)
b�
Erosion Cntrl Permit (ERPRMT) 6���
Erosion Planck/USA (ERPLAN) 75-
Erosion
Erosion Planck/COT (FROSN) y7
TOTALS:
I-Z:WT1 ;CC ,CST) IC/Se � � (. 1\� �� crw
1
CITY
�� O� �����D _ ELECTRICAL PERMIT
C
\ PERMIT#: ELC2002-00168
DEVELOPMENT SERVICES DATE ISSUED: 4/15/02
13125 SW Hall Blvd., Tigard, OR 9723 (503) 639-4171 PARCEL: 1S135CA-02600
SITE ADDRESS: 11130 SW GREENBURG RD
SUBDIVISION: ZONING: R-12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of(1) branch circuit for new dishwasher. Job No. 61103
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 800 amp: SIGNIOUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR: 601+amus - 1000 volts: MINOR LABEL (10):
_ SERVICE/FEEDER _ BRANCH CIRCUITS _ ADD'L INSPECTIONS
0 - 200 amp: W/SERVICF. OR FEEDER: PER INSPECTION:
201 - 4CO amp: 1st W/O SRVC OR FDR: 1 PER '-LOUR:
401 - 600 amu: EA ADD'I- BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION _ _J
1000+ arTiplvolt: >=4 RES UNITS: ��— > 600 VOLT NOMINAL:
—Reconnect only: SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC:_ _
Owner: Contractor:
WASHINGTON COUNIY FRAHLER ELECTRIC CO
111 SW FIRST STREET 11860 SW GREENBURG RD
HILLSBORO, OR 97123 TIGARD, OR 97223
Phone: 503-644-6775 Phone: 639-4627
Ren#: LIC 37410
SUP 18165
ELE 34-13C
FEES-.- _, Required Inspections
Type By Date Amount Receipt Rough-in
PRMT CTR 4/15/02 $46.85 2720020000( Elect] Final
5PCT CTR 4/15/02 $3.75 2720020000(
Total $50.60
This Permit is Issued subject to the regulations contained in the Tigard �1Unidpal Code,State of OR. Specialty Codes and 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
work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules aoopted by the Oregon Utility Notification
Center Those rules!ire set forth in OAR 952-001-0010 through OAR 952-001-0080, YPw-Mdy--6bWn copies of these rules or direct questions to
Permit Signature: r Iss ed By:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE- DATE:
CONTRACTOR INSTAL.LATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ _ DATE:_
LICENSE NO: --
Call 639-4175 by 7:OOpm for an inspection the next business day
Electrical Permit App icatinnINE
Dale received: 4 # 09
. i
City Of Tigard Project/appl.no.: Expire date: --
Cit t'of'!'igard Address: 13125 SW Hall Blvd,Tigard,OR 9.7,12 .� Date issued: By: Receipt no
Phone: (503) 639-4171 vi
Fax: (503) 598-1960 •� Case file no.: Payment type:
Land use approval:
7UNew2 family dwelling or accessory U Comm ' ' Nilidustrial U Multi family U Tenant improvement
consltvrlion 'J All,lition/a otalom/rrhlnrcmrnl U flier U t;tni:tl
NFORMATION
Job address: 11130 SW GREENBURG ROAD -_ lildp.
LAW Black: Subdivision:
Project name: GOOD NEIGHBOR CTR Description and location of work on premises: CONNECT' NEW DTSIJWASHFR
i
Estimated date of com letionh ection:
1 .
Job no: 61103 fee
_ Uescrlpliun Qty. ten.) 1o1al Via.hlsp
Business name FP AtTLP, Ej.In TC CQMPA(�7 ew rrsi11cr11iAI-si!I�k or[milli-family per
Address: 11860 SW GREENBURG ROAD li'IellillR lltlil.1111'hldes allA('ll('d f!AI tee
City: Slate: OR ZIP' `.rsiminelulhai:
Pilone: - 62 Fax: 639-4673 E-mail: 11""0-'`t I' 1` `
i.ach udd u„nal 5(Nl sq.ft.or portion thereof J
CCB no.: 37410 Elec.bus,lic.no: 34_;Zl_ i.imiledenergy,residential 2
City/metro lic.no• 198 7 Limited energy.non-residential 2
Vii, In/�_ Eech manufactured home or modular dwelling
S[Y/ �/ Sencce anlUor feeler Z
Si nature of supervising electrician(re uired) Date — -
Servlcesorfeeden-instAllA(ion.
sup.elect.name(print), R.W. FRAMER JlAcensenw 18 alteration or relocation:
200 amps or less 2
201 amps to 400 amps 2
Name(print): 401 amps to 600 amps 2
Mailing address: —_ GUI amps to it)C10amps '-
City: Stale: ZIP: Over tool amps or volts -'
Phone: Pax: E nlz<iL Reconnrctonly l
Temporary servlres or feeders-
Owner installation:The installation is being made on property I own Temporarysetention,orrelocAuon:
which is not intended for sale,lease,rent,or exchange according to In5falle21x1 amps or less
ORS 447,455.479.670,701. ?01 amps to 400 amps
Owner's signature: -- Date: 401 to G(x)nm - --
�3 lot"— Bencdh clrcus-new,alteration,
or eenslon per panel:
Name: --_ A Pee for branch circuits with purchase of
Address: T _ service or feeder fee.each branch circuit
Cit ---- State.. IIP: H. Fee for branch c'muitr without purchase
Y --_._1 �• of service Pr feeder fee,first branch circuit: 1 .85 2
Plume: I ax: I: until: Each additional bran_hcircuit:
M Isc.(Service or feeder not Included):
Each pump or irrigation circle 2
U Service over 225 amps-a,mnleninl U Hrnhh-carr fncihly Each sign or outline lighting '-
U Service over 320 amps-rating of 1.42 U Hazardous location Signal circ it(s)or a limited energy panel,
familydwellings U Building over 10AX)square feet fourot tt i
U system over 600 volts nominal more residential units in one structure alteration,( extension*
U Building over three stories U Feeders.400 amps or itu,re .I h scn,tion __ .
U(kcupant la=ud over 99 persons U Manufactured structures or RV park Foch additiond Inspection over the allo"ble In any of the above:
U Fgremnightingplan U Other Pe:inspection
Submit—sels of plan-with AVIV of the above. Investigation fee
71ir above are not applicable to temporary construction service. I other
Notice:This permit application Permit fee.....................$ 46 35
Not all jurisdictions Accept crcdil cods.pleax call jurindirUlm Ge axxe infnrmnlino Plan review(at %) $
U Visa U MasterCard expires if a permit is Vint obtained —
Credit card number __ _—_L�._ within 189 days after it has been State surcharge(8%)....$ j7 5
Cxplte accepted as complete. TOTAL .......................$ 50.60
Name of carldholder r::bown�n c it c —� s --
CArdholder dplalure Amourn_` 4401615 I6RIOV('Itn1
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT F E-&
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: — - —. - � -
Restricted Energy Fee...................................................... 575.00
Number of Inspection.i ger Rerrnit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq It or less $145.15 _._ I ❑ Audio and Stereo Systems'
Each additional 500 sq It or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy _ $75.00
Each Manul'd Home or Modular ❑ Garage Door Opener'
Dwelling Service or Feeder $90.90
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 11201 amps to 400 amps $106.85_ 2 V�cuurn Systems'
401 amps to 600 amps $160.60 2 ��
601 amps to 1000 amps $240.60 _ 2 Other_
Over 1000 amps or volts i $454.65_ 2
Reconnect only _ $66.652
Temporary Services or Feeders _ TYPE OF WORK INVOLVED CUMPJIERC'AL ONLY
Installation,alteration,or relocation Fee for each system................................................... ...... $75.00
200 amps or less $66.85 2 (SEE OAR 918-k60-260)
:01 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see"b"above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit _ $6.65 2 ❑ Data Telecommunication Installation
b)The lee for bunch circuits
without purchase of servrce ❑ Fire Alarm Installation
or feeder fee
First branch circuit $46.85
Each additional branch circuit $6.65 _ ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or foede not included)
Eech pump or in igation circle _ $53.40 ❑ Intercom and Paging Systeme
Each 3Ign or outloo lighting __ $53.40 _
Signal circuit(s)or a limited energy
panel,alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels(10) $125.00
Medical
Each additional Inspection over ❑
the allowable in any of the above ❑ Nurse Calls
Per inspection _ $62.50
Per hour _ S62 50
In Plant _ $73 75 _ ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Fnte.total of above fees $ n Other --
s%State Surcharge $ _ Number of Systems
25%Plan Review Fee
See"I jinn Review"semi of on, $ ' No licenses are required Licenses are required for all olhe installations
front of f1pplicItion —
Fees:
Total Balance Dot? $
Enter total of above fees $.r
❑ Trust Account# 8%State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
iAdsts\forms\elc-fees.doc 08/30/01
CITYOF TIGARD ___ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00119
13125 SW Hall Blvd., 'Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/12/02
PARCEL: 1 S135CA-02600
:,ITE ADDRESS: 1 1130 SW GREENBURG RD
SUBDIVISION: ZONING: R-12
BLOCK: LOT: _ JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: I
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS-
STORIES: WATER HEATERS: CATCH BASINS:
_
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
CISHW.ASHERS: 1 RAIN DRAIN: ft
Remarks: Replacing existing dishwasher. No change in EDU's _
FEES
Owner:
Type By ^ Date Amount Receipt
WASHINGTON COUNTY 5PCT CTR 4/12/02 $5 80 27200200000
111 SW FIRST CTREET PRMT CTR 4/12/02 $72.50 27200200000
HILI_SBORO,OR 97123 —
Total $78.30
Phone 1: 503-644-6775
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 PEQUIRED INSPECTIONS
Phone 1: 503-659-5296 Rough-in InspFinal Inspection
Reg #: LIC 2439
PLM 34-29PB
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 permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
/J�,� �_
Issued By: --- Permittee Signature:��-L=
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
�Date received: 'y /P O� Permit no.: /t/,Izj�/ /
City Of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no,: Buildmgperntitno.:
-
r ')''q/'K"ld Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
J I & 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
J New construction U Addition/uheration/replacernenl U Food service U Other: -^ _
Joh address#1,52 Desert tion Qty.IPct(ea.) 1Total
Bldg no.: Suite no,: New 1-and 2-family dwellings only:
(Includes 100 fl.for each utility connection)
Tax roup/tux lot/account no.: SFR (1)bath
Lot: Block: � Subdivision: SFR(2)bath
Project name: SFR(3)bath
City/county: / I ZIP: 77,W Each additional batlt/kitchen
Dcsc iptio t and Iocation of w9f k ciA premises:_� ' Siteutilities:
j-r eAc' Catch basin/area drain
lineltrench drain
Est.date of completion/inspection: Drywalls/leach
iiiii Footin drain(no. lin. ft.)
Manufactured home utilities
Business name: Manho es
Address: 0,4 Rain drain connector
Stale ZIP: - ,, Sanitary sewer(no.lin.ft.)
Ctty. ? !� r Storm sewer(no. lin. ft.)
Phone• ?9 1'a p/ E-mail: -
CCB no.: .?� Plumb.bus. reg.no: �/ 9 / Water service no. in. t,
City/metro lie,no.: Q�' Fixture or hem:
- -7Absorption valve _
Contractor's representative signature: Back flow preventer
Print name: ,f fate: Co L Backwater valve PERSON -
Basins/lavatory -
Name: Clot es ter
-- is washerher
Address: Dunking fountains)
City: Stale: ZIP: E'ectors/sum
Phone: Fax: E-mail: Expansion tan
Fixture/sewer ca
Name(pant): 600 IN /M -e G ,e Ftoor drains floor sinks/hu
Garba a disposal
Mailing address: Hose bibb
City State: ZIP: Ice maker _
Phone: Fax: E-mail: nterce for/grease trap
()%►ner installation/residential maintenance only: The actual installation Primers)
will tx made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per URS Chapter 447, in (s),basin(s),lays(s)
Owner's signature: Date: Sum
ubs/shower/shower pan
Urinal
Name: _ - --_----_. Water closet
Address: _ --Water heater
City: State: ZIP Other. -
Phone: _^-- --- Fax: LTotal
Minimum fee................$
Nor all jurisdictions accept credit cartta,piease edl jurisdiction for more information Notice:This enrol application
U visa U MasterCard PPlan review(at ' ) $
/ expires if a permit isnot obtained State surcharge(8%,) ....$
Credit cud number -. Eapirn within 190 days after it has been -0
accepted as complete. TOTAL .......................$ , r
NanK of cardholder v shown on credit card $
Cardholder signature Amount V 440-4616(6rtx1/COM)
CITY OF TIGARD 24-Hour
BUILnING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 V—
BUP —
Received ---____—___._ Date Requested ' S AM PM_--_— 8UP
Location — dl,� �' Suite -_ nAEC
Contac!Person .�_ _�'Y Ph( t PLM
Contractor_ _ PFS( ) _ SWR _
BUILDING _ Tenant/Owner _ —_ — ELC 0 44;!oQ
Footing —
Foundation ELC
Fig Drain Access: ELR
Crawl Drain
Slab Inspection Notes: St!
Post&Beam
Shear Anchors i '-
Ext Sheath/Shear
Int Sheath/Shear
Framing -- -
Dry Insulation
Dry � L`
Drywall
Nailing
Firewall _—,�-
Fire Sprinkler - ------- --
Fire Alarm
Susp'd Ceiling ---- -- !-- �—
Roof
Other. -------- ----..._.------- - -
Final
PASS PART FAIL - -- --- --- - -- ---
PLUMBING -
Post&Beam
Under Slab
Rough-In
Water Service ---- --- ----
Sanitary Sewer
Rain Drains ---- -- - ---- -- -------
Catch Basin/Manhole
Storm Drain ---- - _ - — --
Shower Pan
Other: -
Final
PASS PART FAIL -
MECHANICAL
Post&Beam
'Rough-In ----
Gas Jne
Smoke Dampers ----
Final
PASS PART FAIL
ELE(tTRICAL
Rough-In
UG/Slab
Low Voltage ----- -- --_ _--- -- ---
Firt arm
AS `_'ART FAIL Reinspection fee of s- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE:--_ E] Unable to inspect-no access
Fire Supply Line _ __Z_
ADA pzZ �'``
'
Approach/Sidewalk Data Ilisp r _ _.Ext
Other: _
Final DO NOT REMOVE this Inspection record from the fob she.
PASS PART FAIL