12210 SW KELLY LANE N
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12210 SIM KELLY LN
CITY O F T i GA R D v MASTER PERMIT
PERMIT#: MST2003-00540
DEVELOPMENT SERVICES DATE ISSUED: 1/15/04
13125 SW Hall Blvd., Tigard, OF, 9'1223 (503) 639-4171
SITE ADDRE',S: 122.10 SW KELLY LI`: PARCEL: 2S103CC-08600
SUBDIVISION: WHISTLER'S WAIX ZONING: R-1.�
BLOCK: LOT: 033 JURISCICTION: 116
REMARKS, Ncvv SF detached, Path 1.
BUILCING
REISSUF• DM170QA2 STORIES _ FLCJR AREAS REQUIRED SETBACKS REQUINED
CLAq'-.-..vl<ru NEW HEIGHT: FIRST: 1 57) 0 BASEMENT: sl LEFT: SM "E uc LECTORS, Y
TYPE OF USE: SF FLOOR LOAD: a0 SECOND: 1.':- >f GARAGE: 105 of FRONT: 20 PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: 1N1RD of RIGHT: S
.
OCCUPANCY GRP: R3 BDRM H 15 BATTOTAL: I'-��� ..r VALUE308,013 70 REAR: 15
PLJMb'NG
SINKS: 1 WATER 7LOSETS: 3 WASHING MACI L 1 .AUNDRY 1 RAYS: RAIN DRAIN: 100 TRAPS.
LAVATORIES: 4 DISHWASHERS: I FLOOR DRAIN' SEWER LINES. 10 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS. GARBI GE DISP: 1 WATER HEAIERS WATER LINES: I'll, BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL _
_ FUEL-TYPES___. FURN<100K: Boll'CMP<3HP: VENT FANS: CLOTHES DRYER: 1
r URN 1=10OW 1 UNI I H?ATLRS. H07DS: OTHER UNITS: 1
MAX INP. MIT FLOOR FURNANIIES VENTS. I W(1'OUSrOVES GAS OUTLETS: 4
_ELECI RICAL
_ RE^IDENTIAL.UNIT_ SERVIJE FEEDER TEMP SRVC/FFEDER3 BRANCH CIRJUITS 'AISCELLANFOUS ADU'L INSPECTIONS
10U,'SF OR LESS: 1 0 - 200 amp 0 200 amp WISVt..IR FUR: PJMPIIRRIGATION. PER INSPECI.ON:
EA A1)D'L 500SF: 5 201 - 400 amp. 201 - 400 amp: let W/O SVCIFDR: SIGNIOUT LIN LT PER HOUR:
LIMITI.D ENERGY: 40 600 amp. 4PI 600 amp: EAADDL SR CIR: SIGHALIPANEL IN PLANT.
MANLI IMISVCIFDR: 601 1000 amp. 601+amps-1000v: MINOR LABEL.
10004 amplvnit
PLM RL%!EW SECTION _
Raconnocl only:
>-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
ELECIRICAL•HE;IRICTED ENERGY
A.SF RESIDENTIAL B,COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM. AUDIO R STEREO. PIRE ALARM: INTERCOM/PA 'NG: OUTDOOR LNOSC LT.
BURGLAR ALARM DTH: BOILER: HVAC: LANUSCAPEIIRPIG: PROTECTIVE SIGNL:
GARAGE OPENER CLOCK. INS.3UMENTATION: MCnICAL: OTHR:
HVAC: DP-A/TIA.E COMM: NURSE CALLS. 1 OI-L 0 SYSTEMS:
Owner: Contractor: TOT;,L FEES: $ 5,621.47
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This pernllt is Subject to the regulations contained III the
4230 GALEWOOD ST 4230 GALE WOOD ST,STE 10U Tigard r apr'iaal Code,State of OR. Specially Codes and
STE 100 LAKE OSWEGO,OR 97035 all other ce with
bie laws. All worans. will be done it
LAKE OSWEGO,OR 9%035 accordance with approved plans. This permit will Rxrare H
ork is not started within 180 days,f Issuance,or if the
work Is sum.ended for more than 180 Jevs. ATTENTION:
Oregon law requires you to follow r des adopted by the
Prions: 503-387-7538 Phone. Oregon Utility Notification Center. Thu%A)rules are set
forth in OAR 952-001-0010 through 952.001-0080. You
R.0�, �Q 38737 ! may obtain c,)pies of these rules or direct questions to
OUNC by calllnp(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control 681-44 Post/Beam Structural Mechanical Insp She; Wall Insp Insulation Insp Water Service Insp
Grading Inspection Post/Beam Mecha1nica Plumb Top Out Exterior Sheathing insf Gyp Board In<;, Appr/Sdwlk Insp
Sewer Inspectlon Underfloor insulation Electrical Service Low Voltage Rato drain Insp Electrical Final
Footing Insp Crawl Drain/Backwater Electrical Rough Ir Gas Line Insp Sterni drain Insp Mechanical Final
Foundation Insp PI-M,'Underfloor Framing Insp Gas Fireplace I.A.'a:er Line Insn PIUmb Final
^ �a
Issued By : ' • �.` -- �2 _-- Permitteit Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S`NR2003 00398
13125 SW Nall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/15/04
SITE ADDRESS; 1221(1 SW KELLY LN PARCEL: 2S103CC-0860C
SUBDIVISION: WIIISTL,ER'S WALK ZONING: It-4.5
BLOCK: LOT: 033 JURISDICTION: i Il
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USF.: SF NO. OF BUILDINGS:
INSTALL TYPE: L TPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF.
Owner: -
_ FEES
DON MORISSETTE HOMES Description Date — Amount
4230 GALEWOOD ST _
STE 1,,0 1SWIJSA I Swr Connect 1/15/04 $2,400.00
LAKE OSWEGO, OR 9703.5 ISWUSAI Swr Connect 1/15/04 $0 00
Phone: 503-387-7538 1SWINSI11 Swr Inslwct 1/15/04 $35.00
ISWINSI'l S��r Inslieet 1/15/04 $0.00
Contractor: — ---
Total $2,435.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeit,-d 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, th,� installe shall purchase a "Tap and Side Sewe" Perm
f
Issued by: f 1�'1L .�< c�'— Permittee S',gnature: � —
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
A. ' Building Permit Application
—
oDatereceived: t'10--i
City of Tigard
Address: 13125 SW Nall t�1r �97223 Projecdappl.no.: Expire date: }
(uvnj'T'i and Date issued: I}yt ' Receipt no.: r J
Fax: (503) 599- ) �� ase file no.: Payment type:
Lind use: al)provalU• � � -� 1 1&2 family:Simple Complex: �
U I &2 family dwelling or access .ommercial/industrial U Multi-family &New construction U Demolition r.
U Additiotitalteration/replacement U Tenant improvement �7 Fire sprinkler/alarm G 'thee:
JOR SITE t '
Job address: 0-7-- 7 1 — Bldg.na.: Suite no.:
Lot: Block: _ Subdivision. Q 3'ax mup/s lot/account no.: �..
Project name:
r
Description and location of work on premises/special conditions: ��--
Name: septic t
illar,etc.)
Mailinr ,,'dress: �L' 7 I &2 family dwelling:
City_ , I St ZIP:"LIP: ', Valuation of work..................................... .. $_
Pitons - Fax: 7 mail: No.of bedrooms/baths.................................
Owner's representative: i�17 rf vim __ Total number of floors............................ ...
Phone: Fas: ��t;'T New dwelling area(sq.ft.) ..........................
(',rag,/carport area(sq. ft.
Name: Covered porch area(sq.ft.) ...I................... . _
Mailing address: �)('t _�I. 'S, Deck area(sq.ft.) ........................................
City: State: 7.IP: Other structure area(sq. ft.l............ ..... ......
y— !--.-mail: --'"— CummerclaUlndustrial/multi-family:
Phone. Fax:
jli,,.,r._^of work........ ....... $ --
( �
r�xisting bldg.area(sq.ft.) ..........................
Business name: 1
' �! `"` -- New bldg.area(sq. ft.) ................................ _.
Address'( i_ Number of stories
State: Z.IP: ^— ....
City:
Type of construction....................................
Phone: Fax: — E-mail: _ Occupancy group(s): Existing: _
CCB no.: _ New:
City/mew lic.no.: Notice-All contrvtors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: a Y provisions of ORS 701 and may he required to be licensed in the
Address: jurisdiction where work is being p<xfotmcd. If the appli.artt is
State: ZIP: exempt from licensing,the fallowing reason applies: —
Cit ----.—._
Contact person: Plan no.: _
Phone: Fax:
Nsrne: (Contact person: Fees due upon application ......... ................. $
Address. Date received:
City: State: ZIP:_ Amount received ....................... .......... ....
Phone: ^` Fax: E-mail: — — Please refer to fee schedule.
hereby certify I have read and examined this application and the Na all jurisdictiau rap credit cods.pte.we call jurisdiction for more infottnntion.
attached checklist. )rovisions of I ws and o dinances governing this ❑Visa 0 MAstetCard
work willhe comrl�,,t ,whether. 'In �erelnt r t. //1/ /1 Credit card nae.,ber: __ — —Lpres
Authorized si natu, / [ V ; of crnNoidet u shnwn on credit cad —
L s
Print name: Crtrdbolder si6natme — Amouni
Notice:This permit explication expires if a permit is not obtained within 180 days ager',I+s;been accepted as complete. 4104613(dotvcOM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
City ofTigard " _ Associated permits:
City of Tigard . O Electrical o Plumbing J Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 ' •-�? t, ^.
Phone: (503) 639-4171 Yther.
Fax: (503) 598-1960
I Land use actions completed.See iur.sdiction criteria for concurrent reviews. _
2 Zoning.Floodplain,solar balance points,seismic soils designation,historic district,etc.
3 Verilicat!.n ofspproved plat/lot. _ s
4 r1re district_ approval required. —"-
5 Seprit,system permit or authorization for remodel.Existing,system capacity -
Se-mer permit. --
Water district approval. -- --
n Soils report.Must carry original applicable stamp raid signature on file or w:th application.
9 Erosion control 0 plan ❑permit requited.Include drainage-way prctection,silt fence uesign and location of _
catch-basin pr,.tection,etc.
10 3 Complete sets of legible plats.Must be drawn to scale,showing conformance inapplicable local and state
bui ding codes.Lateral design details and connections must be incorporates into the p!ans or on a separate full-size
sheat attached to the plans with cross references between plan location and details. Plan review cannot be completed
if i o yright violations exist. _
1 I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a O4 elevation differential,plan must show contour lines at 24 intervals);locat'un of easements and
driveway;footprint of structure(incl,ding decks);location of wells/septic systems;utility locations;direction indicator lot
area;building coverage area;pet centa',!of covet-age;impervious area;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,plumbing fixtures,balconies and decks 30 inches above grade,etc. _
14 Cross section(s)and details.Show all framing-member sizes and spaci-ig such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one gross section may to required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slupe,ceiling height,siding material,footings and foundation,stairs, u
fireplace construction, thermal insulation,etc. _
I S Elevation views.Provide elevations for new construction;rrammum of two eievat,ons for addi'.ions and remodels.
Exterior elevations must reflect the actual grade if the char4c in grade is greater than four foot it building envelope.
Full-size sheet addendums showing foundation elevation-,N,ith cross references are ac;eptable._
16 Wall bracing(prescriptive pa(h)and/or lateral analysis plans.Must indicate detailc and locations;for
non-prescriptive path analysis provide specifications and calculations co engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and dettils showing p!acement of rebar.For engineered
s•.stems,see item 22,"Engineer'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 beam/joist carrying a non-uniform load.
20 Manufactured fie_ 'roof truss design details. _ —
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required
_ for four or more appliances. _
22 Engineer's calculations. When required or provided,(i.e..shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be shown tc ti, ai,hlicaHe to the project under review.
JURISDIC'I'li!)�A1,SPECIFICS
23 Five(5)site plans a e required for Item 1 I above. Site plans must he H 1/2" x I I' ,r I I" x 17".
24 Two(2)sets each are required for Items 16. 19,20&22 above,
25 Buiiding plans shall not contain red lines or tape-ons.
26 Ne rolled,reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black 4,1K.
Red ink is reserved for department use only. 4404614(&MCOM)
Mechanical Permit Application
Date received: Permit no.:f(gr .�t p-c:X-)yt
City of Tigard pcij��v�D Nojcct/appl.no.: i Expire date:
City,of Tigard Addces�: 13125 SW Nall BI d.
Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1560 v 2003 Case file no.: Payment type:
Land use approval: ____C XTY QE1lGARD_____ Building permit no.:
TYPE OF,PERMIT
;Job
I &2 family dwelling art iccr,ssoiy 0 CommerciaUindusuial r Multi-family 0 Tenant improvement
few construction 0 Addition/alteration/replacement %J Other:
t ; ar t COMMERCIAL1 1
address: I �y� I L Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite r value of all mechanical materials,equipment,labor,overhead,
Tax ntap/tax lo'laccount no.: profit.Value$
Lot: 5 Block: FS u bd i v i s i o n IcD -See checklist for important application information and
Project name: jun-is
un diction's fee schedule for residential permit fee.
City/county: _ ZIP: t1011111
Description and Iccation of work on premise t t x' 1111ZICIFORDL11 ' t
_
Fre(m) Total
Est.date of completion/inspection: r Desr*;odon Qty. Re3.only Res.ouly
Tenant improvement or change of use: an
Is existingace heated or conditioned?0 Yes U No Air handling unit r
space Air.onditioning(site p an require, �
Is existing space insulated?0 Yes O No '.lit.ratio�n o existing HVACsystct,I
Boiledcompressors
State boiler permit no.:
Business name: t IllHP Tuns BTUIH
Address (' Fu.Nsmoke dampers/duct smoke detectors
City: State: LIP: eat pump(s!te p an required)
Phone: Fax: E-mail: nsta rep ace rnec urnt:r__ -,BTU/;I
Including ductwork/vent liner 0 Yes 0 No
CCB no_��u7(' — TnsLalIIrepTcdrc ovate heater s-su— s— pendia.
City/metro lic. no.: N/A � wall,or floor mounted
Name(please print): NC:.:L-C___ entor aLplianceo er an urn ace
Refrig.-ratiou:
Absorption units 6TU/H
Name Chillers
Compressors.— UP
Address: L �� , T—
rfronmental exleauct and ventUation:
City: State: zlpP Appliance vent
Phone: Fax: E-mail: I Dryerexhaust
Dods,Type U Wres. tchen/hazmat
NE' hood fire suppression system
Name: — g 1' Exhaust fan with single duct(bath fans)
Mailing address: ; �' musts stem apart rom heat
or AC
City: '(7,
��, State, ue 'ping an distribution(up to 4 out eV)
Type: _._LPG NG Oil
Phone: -�- Fax^ E-mail: Fuel pipWjeach dditional over 4 outlets _
Process piping(schematic required)
Name Number of outlets
Or er listed appliance or equipment:
Address: _ Decorative fireplace
City f state: Lll' nsert-type
WoodPhone: - FS` -mail: stovelpe eistove
Applicant's signatut,, Date .) Ut er.
Name(print)— — '
Not all Jurisdictions a.cM credit cards,please can jutltdkUon fa Mr"irttma
atlat. Permit fee.. ........... ......$ _
Notice:This permit application Minimum fee........... ....E _
O Visa 13 MasterCard expires if s permit is rot obtained
Credit card number Ji Expires within Igo days after it has been Plan review(at — %)
State surcharge(84'0) ....
NamS _
Naof cardholder a Showa aaccepted,credit cud – P as complete.
Cardholder siralum e Amount 4ksa6ll(WOCOM)
Plumbing Permit Applie-Vion
Date received: Pe'mitno.:(Y"i1 •ejf�,r ,
City of Tigard �� �
Sewer petTrut Inc.... Building permit no..
Address: 13125 SW Hall�� g ----__
CiryojTigarQ Phone: (503) 639-41 1 Pro)ect/appl.no.. Expire dat
Fax: (503) 598-1960 ��C 1 1(Itl1 Date issued. By: •iptno.:
1, UVJ
Land use approval: MY Case file no Payment type:
C 1 •4t 2 farrul,,dwe ling or accessory ❑Commercial/industm-d O Multi-family O Tenar," .Provement
tion co-strucuor. U Addiuon/alterrabortireplacemert 0 Food service 00
1 : 1 1 71 1 t+ r
Job address: ( \ Descripdoo . Fee(en.) Total
Bldg.no.: Suite no. — New I-and 2-family dwellings only:
(includes 100 ft.for etch utility connection)
Tax map/tax lot/account no.: )FIR(1)bath _
C�t Black: Subdivision: "4 _M72)bath
Project name: SFR(3)bath-- -
C;t-V/counrr I ZIP: Each additional bathulatchen
Descnption and location of work on premises: Siteutilities:
Catch basin/area drain
Est_date of compleucini-inspection: Dry%veilsileach line/trench drain
Footing drain(no. lin. ft.)
' ' 1r Manufactured home utilities
Business name: Manholes —
Address: Rain drain connector
CityState* ZIP. Sanitary sewer(no. lin. ft.) _
Phone: "' `. 1 Fax: _ Email Stony sewer(no.lin. ft.) _ _
CCB no.: (C—'j L(� plumb. bus. reg. no ,
Watet ;er%ice(no. lin. f't.) I
FLrture or item:
Ciryimetro lie. no.: N A Absorption valve
"�_'ontrzctoesresentative signature� BackClowreventer}�c%—"� I f� Backwater valve
gleaftism"R,to th- I
Basinsrlavatory — __
Clothes washer
Name: P, K 1�1 tJ�
Address: � � Dishwasher
i'•�`0 V = --- Donlan¢ fountain(s) _
City _ State: ZIP: Ejector sump
Phone TF E-mail: _ Expansion tatuk _
IlUXIONFixture/se.ve;cap
Floor drains/fbor sittks/hub I
Name (priori �_ t� l`-, .Fl"� �`� (tubage disposal
Mailing address:�C, _1~�`T Hose bibb _
City '1 State ZIP: — Ice maker —
Phone _ ;Fac: ',�-7(�i Email: Interceptor/grease trap
Owner lnsrallatfoniresidendal maintenance only: ne actual installation Pnmerts)
will be made bi, me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the propem• I own as per ORS Chapter 447. Slnhist, basin(s). lays(s) _
n«ner's signature: Date: Sump
Tubs'shower/shower pan
Unnal
Name:
Water zloset
Address _ Water heater
Cit% _State: ZIP: Uttler.
Phone: Far: -�E mull: _ Total I
Na�I iunedtcutxu aecep credit rods,plesu tilt juniWtcuan fn more mfarmuron Notice:This pl pp Minimum fee................S _.
mit i application Plan inview(at °b) S
C visa d M.uterC.ud expires if a permit is not obtained
C edit:yn number / within ISO days after it has been State surcharge(81a) ....S
t apirer TOTAL . S
accepted as cam lets, .... ...... . .... ..
vyrte�t:.ar::twlder v No+n oa ctedtt card p
_ S
C2tCotder Amount 440-J616AJOCOMu
Electrical Permit Application
—' hate received: Permit no.:
City of I Pro)cct/appl. Expire date:
CiryojTigard Address: 13125 1,Tigard.OR 97:23 Date issued_-_" i By: Receiptro._
Phone: (503) 639-4171 1 NOFax: (503) 598-1960��k,(, Case file no.: Payment type:
Lan-: use appro allYQf_TI(aAFD ----,
t
7&JUI 2 family dwelling or accessory 0 Commerrial/industrial O Multi-family 0 Tenant improvement
w construction O AdditiotJ.ilterition/rr:placernent ❑Other. U Partial
JOB SITE INFORMATION
Job address: ( ) ( n 13idg. no.. Suite no.: Tar map/true lodaccount no.:
t.ot: j Block:
Project name: Description and location of work on premises:_
Estimated date of completionlins ction:
t
"Jobno:qr- Fee Max
Description Qty. (.a) To#Al no.trap
Busiress name: `-��, -1 —
_ � Ne*residential-singk or mrthi-family per _
Address: 1?1 Cl CMO _ dwelling unit.includes anactseri g2nge.
City:
Service included:
3 tats: 7_I P:
Phone: 1j - I Fax: E-mail:
1000 sq,ft.or less 4
�' -T- Each additional 500 sq.ft.or portion thereof
CCE no.: a�- _— Elec. bus. lic, no: 1O Lirnitedenergy,residential 2
— -- —
C' 7 _ Limited energy,non residenual 2
- Each manufactured home or modular dwelling
- f_-- — Service and/or feeder
ware ujsuprnrrrnK lerrricirur rrr _.--- Date quired) -- -- ----
Servicesor feeders llation,
SuP elect name(print) Licenseno alteration or relocation:
200 amps or las 2
201 amps to 400 amp, 2
Name(print): ` _ 401 amps to 600 amps - -- _ 2
601 amps to IW ams 2
Mailing address: �j '�I p, p —� _.—
City: c , Slate LIP: :�, Over 1000 amps or volts _ _2_
_Phone:-'±e7- _-mail: Reconnectonl l
C caner lnsfollatlon:The installation is being made on property l own Temporary services or feeder-
which is not intended for sale, lease,rent,or exchange according to Installation,alteration,orreloaUon. 2
200&nips or less
ORS 447. 155, 179,670,701. 201 amps to 400 amps 2
Owner's si nature: _ Dat,_: 401 to 600 ams _ 2
Branch circuits-new,siterarlon,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit _ 2
City: $tate: ZIP: B. Fen.for branch circuits without purchase
__-- -- :7=E of service or feeder fix.first branch circuit: 2 _
Phone: I ,tx Email: Each additional branch circuit:
Misc.(Service or feeder not Included):
O Service over 225 amps-cornmcrc al r]Health-car!facility Each pump or irrigation circle _ _ 2
O Service over 320 amps-ruing of 1&2 O Hazardous location Each sign or outline lighting — 2_
familydwellings 0 Building over 10,000 square fee!four or Signal circuit(s)or a limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration,or extension* _
❑Building over three stories U Feeders,400 amps or more *Description: —_.-
O Occupant load over 99 persons U Manufactured structures or RV part Each additional Inspection over the allowable It,any of the above—: -T
r]Egress/lighungplan O Other. -- Perin_pecuon _
Submit_sets of plans with any of the above. Investigation fee
The above are not applicable to temporary con0ruction service. Other
Not all Jurisdictions accept credit cards,please call jurisdiction la mare informatinn Notice:This permit application Pernrt fee.................96))
O Visa O MasterCard expires if a permit is not obLincd Plan review(at __ S -.—
Credit card number _ __1_L� within 180 days after it has been Suite surcharge(13%) ....S
8rtpircs accepted as complete. TOTAL .......................$
Now of cardholder u shown on credit cid
4r0 1615(6AOCOM)
Cardholder signature s Amount
— — OBE : 2803
l ON • MORISSEWE
s 11-M28 1 It C 1) A P 0 X A T I b LOT= 93
4230 GALS W 0 C D 8TPi2T DATE: 11/25/03
LAts 08Tsao. 0itx40N 97035
(503) 317 - 7538 FAZ (853) 357 - 7815 PROPERTY: WM9rLS-'AALK
OTTY: TIGARD
SCALE: 1-=20-
PLAN
~=2Q-PLAN No.: 170
OPTION 2 ELEVATION
I
12210 0-111 KELL r LANE
3rdwa Ik : -
—� '�m.�m'`` . Approach
6 3�1
33 ' ` ' ——1.9' LANDSCAPE
NGl1J� O O EABEIMQN=
+1 i
I I I I
I •• 1 ---�---..339 '.3�A _ ��
FwU,E, in
I
I »° eb
I I I 405 sq. rt.
2 car gar. F.
mmE �ueuI I FFE. 340'
PEDESTRIAN E,4EMENT , I I I
_33s -r-r I I
.fir
I I I 3,1W sq. rt.
4 bdrm.
rue�'c zmmm sv--�-JJ op I I 21/1 bath 61
•ND 98 EASEMENT I ( F!°.E. 341,95' —
_
I I I I 3+ ° 9
KONG'• G 34.1 /,
I I I PATIO I
I I I
� I
(
6
-
� c t 1) 2003
LEGEND _ LOT COVERACsE CITY OF'rIGARU !�
LOT AREA: 6.A02 sa. BUILOING GL\\&
rAb
c� ) ---1' ACEQ RUCR'.- BUILDING AREA: 2,600 `a. =T. 6,402 sq. rt.
`�� /// 'RED MAPLE' PERCENTAGE: 32.5%
CITY OF TIG. ,
ARD -SITE PLA � RF:Vfb:W
BUILDING PERMIT NO,: �'a• Oa LI lbj
PLANNING; DIVISION: y,5
Required Setback, ErApproved ❑ NA Ahprr,�rd
Sheet Side: 15
GO rage: -SR-0 Rear:
Visual Cle"ll-Ince: 0A>armed ❑ Not Apprined
!�-aximulr I'luildillp! Ilelghi•9D feet
Service Mer Letlt•r Iteyuirc ,: ❑ Ycs No
/� ❑ Receivect
JO .,
Not Approved
t: I'I;trt./ / flhllrr,ved ❑ uI pproved
�� PCtI�mP/1 ?tic r-rrAc�jrr,ern��'
UWAVIT 10 YTO
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CITYOF T I GA R D PLUMBING PERMIT —_
n DEVELOPMENT SERVICES PERMIT#: PLM2004-00144
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/5/2004
SITE ADDRESS: 12210 SW KELLY LN PARCEL: 2S103CC-08600
SUBDIVISION: WHIS i LER'S WALK ZONING: R-4.5
BLOCK: — LOT: 033 — _--_ JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOP"E SPACES:
TYPE CF USE: SF WASHING MACH: BACKFL01'V PREVNTRS: 1
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
DISHWASHERS: RAIN GRAIN: ft
Remarks: 13m.ktlow preventer.
—.------_
Owner: FEES ----
- -- _ _
Description Date Amount
DON MORISSETTE HOMES -
4230 GALEWOOD ST I I'LUMBI 11crmit Fcc 4/5/2004 $36.25
STE 100 ITAX1 x";,Statc tiur.hm: 4/5/2004 $2.90
LAKE OSWEGO, OR 57035 Total $39.15
Phone : 503-387-i538
Contractor:
LANDSCAPE OREGON, INC.
122u0 SW MYSLONY RD.
TUALATIN, OR 97062
REQUIRED INSPECTIONS
Phone : 5(0-692-5945 RP/Backflow Preventer
Final Inspection
Reg #: 1 I( 7804
This permit is issued subject to the regulations contained i-, the Tigard Municipal Code, Stale of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance w .h approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspei,'ded
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
952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246-66,99.
Issued By:
C
Permittee Si 'r7 L �( ,��•
Gc.
rnature:
9 v
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Flpr- 02 04 09: 22a dan edmands 503-69i -07138 V. 1
PlumNi_ng Permit Application FOR OFFICF,
US ._
City of Tigard Planning Appm al Sewer
Permit No.:
13125 SW Hall BN6. Plan Review Other
'Tigard,Oregon 97223 Datd� _ Pemnt No.:
Phone: 503-639-4171 Fax: 503-5i
%o- "fO Post-Review Land Use
Datc�B
Internet: ww w.ci.tigard onCase No.:
us r Contact ---- Jud,; See Pace 2 for
74-hour Inspection Rcqucst: 503-6394175 - See
Supplemental Information. .)
----_.-__ -- TYPE OF WORK FEE''SCHEDULE(roars e:kid Information use checklist
New canstructiotr __ Demolition _ Description
_ ��QtTFee(ea.) Total
-.LAddition/alterahorl/r lacerrient Other. - New t-&2^fairttly.dwelllogs
_ CATEGORY OF CONSTRUCTION. Sind 'des 100 R_.for cacti ut7it ccoanecdon _
I & 2-Familydwelling
- _ Cornmercial/lndus_teal SFR I bath - 249.20
---' -- SFR 2 bath _ 350.00
[ Accessary Buildi�_� Multi-Family- SFS (3)bato 399.00
Master Builder _ Other. _ _ Each additional bath/kitchen _45.00
-JOB SITE INFORMATION and LOCATION Fi.- tinklcr- -ft: T PMS2
2
Joh,site address: Site-UNlitles
Suite#: Bldg./Apt. Catch basin/area drain- 16.60
-Pro ect Name• i ��- C ` - -- ell/leach linthrench drain 16,60 -
-1_ l.L h r___( r �,L�� LCI` 3 Footing drain(nw.linL R�- �, page 2
Cross street/Directions to job site: Ma-:nfactuttd home utilities age2
Manho:es 16.60
Rain dmu-connector �____ 110.00 16.60
_ _ _ Sanity sever no.linear_[l.) _ Pae 2
Subdivision: UU tI l Sf laS L(2' 0.4 Lot#: 3 3iurrn -wen ono.linear fLl � e 2
���
Tax ma p/parcel#: ` C- /3 Water servi�no.linter R) -- Pa e 2
DESCRIPTION OF Fc[ture 01 tem _
Abso tion valve
-� -- �_- - 16.60 -
LLu w.S C e- ClG�Du) C�C6}L ?J -._�
------ � Backflow prcventa-_ Page 2
Backwater valve��-_-_ - 16.60 _
_Clothes washer _16.60
Dishwasher _ 16.60
T PR QP Y OWI11rR TENANT Drinking fountain �- 16_60 ---
E cctor�rsump 16.60
Name: Expansion tank 16.60 Addrt:ss q�30 SLt3 ��t-G:c�uoo Cit Fixturr./sewercar - 16.60
Ctt /State/Zi L LS'1Lt OSS uc b C17( � I Floor drain/floor sink/ht:b 16.60
-- -- -- - - C;arhage dts-�_-__- 16.60Phone: Fax: hose bib 16.60
PPLICAN7' LCONTACT PERSON_ Ice maks -- - 16.60 -�
Name:ELI L" 04r-mo ---4 Incl ive tor/ rrt_trap _ 16.60
Address:/�_D 0 S W )"yl(,ts,l�y t j Medical s-value: I _ Page 2
City/Scare/Zip:"1LCCLk4-^tltL�_�O-f2 �70fv d� P=te- -_16.60
Roof drain(Cormtercini) 16.60
Phone_,R) (e yti -Sri ILS Fax 9N3 Iola.- o76,V Sink/basin/lavatog l 16.60 -
E-mail: - - Tub(dwwrx/showerLmn _ - 16.60 -"-
_� CUNTRAt�'I'OR� - Urinal 1660
Business Name Water closer-
A)�d.S U f�t`1 Q1 'T-1-1 -+ 16.60 --
Address: (aa(30 , k-/ Water heater 16.60
Othm _
C.ISt3te�Zlp:�i'1A QOr� l2 - 1Q U(n�"___ Other. ---- ----�
Phone.>ta3 ! - S9kj5 Fax Y33 (pqd - pr7L_ _~Plumbiug Permit Fees• _��5'
� -
CCB Lic. #: -7,kt) Plumb. Lic.#: -- - Ski total S --
Authorized Minimum Pemtit Fee S72-50 $
_�- - L residential Backflow Miniamm Fee 536.25
Signatutc;,/�-L�-LJ�_ LL-�t�t l�:v Datrl a � � Plan Review�?SX of Permit Fee S
�1/cr1 Slaar nr 'Cl state Sua re°ti of Permit Fee S �-
(Pleasc print name) _T,'1TAL.PERMIT FEE S ,
Matic-: "14 pmn--.
permit ann `lvn expir._s If*permit is not obtained within AJI new commtreial buildingr regdte 2 sNs of plans w so
I Litt days alter it has Ixnr creep•d as complete. metric or
r+arr diagram fsr Plan review.
•Fee methewle1e0 set by Tri County Ruilding Industry Service Board.
CITY OF TIGA RD ':4-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST --
/� BLIP _---._
Received ---Date Requested AM —_ PM — BLIP ----
Location � __Suite.— �1L �� MEC — --
Contact PersonPh (
Gontrac!,*,r �.GP G � _ Ph ( ___) _--_ SWR
BUILDING Tenant/Owner __-- -_ _ ELC ---__. —
Footing -i
Foundation ELC
Access:
Fig Drain ELF!
Crawl Drain _—
Slab Inspection Notes: SIT
Post& Beam -
Shear Anchors - -- - --
Ext Sheath/Shear _
Int Sheath/Shear -
Framinc
Insulation
Drywall Nailing
Firev all
Fire.sprinkler -- --- -- ------
Fireae
Susp'( C
: eili,Ig - -- --� -
Roof
Other:- --- -- / -- - -_--
Final V /!
PASS PART FAIL �— ---PLUMBING
Post
Post& Beam— --� -
Under Slab -
Roi.igh-In
Water Service -----_------ --------.._ __ , -_—
Sanitary Sewer
Rain Drains _ ___-- ----------------r-__-._ _ — --- -
Catch Basin/Manhole
Storm Drain ------------ --___._- ------.-a
Shower P n
Other.; ------- - -- - ----e-�
--
_ tv S5 FART FAIL -------- --- ----------------------- ---_--_ _A_ __- _..
HANICAL
- --------- ---------------
Post& Beam
riougr,-In -.--- - ----- -
Gas Line _-s-. ---- _ ----_ -. ---- -
Smoke Dampers - - - ---- --- --- -. --
Final
_PASS PART FAIL __- - --- ---
ELECTRICAL _
-Service I -
Rough-In `-- ---- - ---- ---- -----
UG/Slab
Low Voltage
_.._._.._...--------------
Fire Alarm - - - -
Final Reinspection fee of S-- requireo before ^4x1 inspection. Pay at City Hall, 13125 SW Hall Blvd
PASS PART FAIL.
SITE _ W [� Please call for reinspection RE: - _-_ _ --_ - �� Unable to inspect-no access
Fire Supply Line
AD
Approach/Sidewalk Data - -.- Inspector _- __- ----__. -_-- Ext
Other. --_-_ -
Final 00 NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST-3
INSPECTION DIVISION Bus'ness Line: (503)639-4171
l/ BUP - ---
Received _.__ — Date Requested-Z�-3 AM___PM--- BUP _-
Location 1.2 ?-Ito - _ Suite_ MEC _
Contact Person Ph PLM
Contractor __�_ - �d/l� -- Ph (.-_--) --_-- --. SWR
_ UILDI ' Tenant/Owner _ -_- _— -_ -_ ELC
Foo ELC
Foundation Access:
Ftg Drain ELR �-
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear ---- -
Int Sheath/Shear
Framing __-_ - -- ----- _---_--- --_-
Insulation
Drywall Nailing ---- - -------- ----- -____ --- --
Firewall
Fire Sprinkler --------- ---- - --- -------- -
Fire Alarm
Susp'd Ceiling --_------ -- ..----- ----- ---- --__ ----- _..-
Roof
47alPART FAIL
ar -
UnderSlab ---- --- ------ - ----- ---- ---_----- --- --- - -
Rough-In
Water Se.vicf --- -__ ----- --- ---------- - _ _---- - ---
Sanitary Sewer
Rain Drains --__ - ---- .-- -- --------------- -_._---.------__.___.. �.------_
Catch Basin/Manhole
SturmDrain --- ---- - ---- ------------------ -------__--------- ---
Shower Pan
�1SS PART FAIL
Post 1 gam
Rough-in --
Gas Line
Dampers -- ----- - - - -- - -- -- -------- ---- -----
�inal
- PRT FAI!.
ervice
Rough-In
UG/Slab
Low Voltage - - -- - -- ----- --- ----- -- - ---- -- -
tF
m rm
inal Reinspection fee of$ --._ _. required before next inspection. Pay et City Hall, 13125 SW Hall Blvd.
ART FAIL Unable to ins ect--no access
--- L] Please call for reinspection RE: ----- - p
F re Supply Line
ADA Az Ext---s---
ApproachiSidewalk Date -- Inspector r5z --
Other-
Final iD1 NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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CITY Of TIOARD
Residential Certificate gf' Qccupancy
Permit No.: 0(.) y(j— Address: _ -2 z
Owner/Contractor: �' ' � 5 17--cc.,
Date of Final Inspection: c f// 7/�c/ Inspector:
This structure has heen found to he in substmitial compliance with the provisions of the,Sime of Oregon One& Two Family Dwelling
Specialty Code and is hereh approved for uccupanc