13245 SW KINGSTON PLACE i
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13245 SW Kingston Plane:
ACITY OF TIGARD — MASTER PERMIT
A' DEVELOPMENT SERV!CES DATEEIS ISSUED: 3/6 U3 U2 00074
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171
SITE ADDRESS: 13245 SW KINGSTON PL PARCEL: 28104DA-19900
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: (125 JURISDICTION: I'I(i
REMARKS: SF rowhouse,Unit#25,8Idg 3,13S plan with deck
e'JILUING
REISSUE: STORIES i FLOOR AREAS REQUIRED SETBACKS REQUIRED _
CLASS OF WORK: NFW HEIGHT. FIRST. sf BASEMENT. sf LEFT: SMOKE DETECTORS: '
TYPE OF USE: SFA FLOOR LOAD: `,o SECOND: ':I,, sf GARAGE '.I r sf FRONT: PARKING SPACES:
1 YPE OF CONST: `N DWELLING UNITS: I THRD 731, of RIGHT,
: ' r.
OCCUPANCY GRP: H"1 BDRM: 2 BATH: TOTAL. I,1;a; VALUE115 sl BEAR:
PLUMBING _
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDR`;TRAYS: RAIN DRAIN. TRAPS:
Lt JATORIES: DISHWASHERS: 1 rLOOR DRAINS: SE•NER LINES: SF RAIN DRAINS: CATCH BASINS:
UB/SHOWEr.S: 2 GARBAGE DISP: 1 WATER HEATERS: I WA I'ER LINES: BCKFLW PREVNIR: GREASE TRAPS:
MECHANICAL OTHER FIXTURES:
_
FUEL TYPES FURN c 100K. BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER: i
1116 F'jRN>000K: UNIT HEATSRS HOODS: I OTHER UNITS.
MAX INP'. btu FLOUR FURNANCES. VENTS. i WOODSTOVES GAS OUTLETS: I
ELtI:TRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCFEEDERS BRANCH CIRCUITS M19CELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS. 1 0 - 200 amp, 1 0 200 amP--•` W/SVC OR FOR PUMPIIRRIGATION: PER INSPEC110N.
EA ADD'L 500SF. 1 201 400 amp-. 201 - 400 amp: tat W/O SVC/FOR SIGNIOUT LIN LT PER HOUR.
LIMITED ENERGY: 401 - 600 angc 401 600 amp. EAADDL BR CIR SIGNAL/PANEL IN PLANT.
MANU HMISVCIFDR 601 1000 anl0 SO•amps-1000v MINOR LABEL:
1000♦amplvoll
PLAN REVIEW SECTION
Reconnect only:
—4 RES UNITS SVCIFUR>=225 A.: >600 V NOMINAL. CLS AHEA/SPC OCC
ELECTRICAL•RESIRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL _
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO&STEREO,. FIRE ALARM INTERCOM/PAGING: OUTDOOR I-NUSC LT.
BURGLAR ALARM. OTH: BOILER: HVAC I.ANDSCAPEIRRIG� PROTECTIVE SIGNL.
GARAGE OPENER: CLOCK: INSTRUMENTATION, MEDICAL. OTHR:
HVAC. DAIA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS
Owner: Contractor: TOTAL FEES: $ 5,500.08
BROWNSTONE(QUAIL HOLLOW LLC BROWNSTONE HOMES, LI_C This permit 1s subject to the regulations contained in the
12670 SW 68TH PKWY STE 200 12670 SW 68TH PKWY Tigard Municipal Code, State CR Specialty Codes and
PORTLAND,OR 97223 PORTLAND.OR 97223 all other applicable laws All woo rk will be done it
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 the
Phone: 503-598-7565 Phone: 503-598-7565 Oregon Utility Notification Center Those riles are set
r" forth in OAR 952-001-0010 through 952-001-0080 You
Rap M: LI( 124627 may obtain copies of these rules or direct questions to
OUNC by calling(503)246.1987
REQUIRED INSPECTIONS
Sewer Inspection Electrical Service Gas Line Insp Gyp Board Insp Mechanical Final
Footing Insp Electrical Rough-in nsulation Insp Water Line Insp Building Final
Foundation Insp Mechanical Insp Soear lhsll Insp Smoke Detector Final inspection
Slab Insp Plumbing Top Out Extorior Sheathing Insl Electrical Final
Plm/undslb Insp Framing Insp Firewall Insp Plumb Final
Issued By : ---- Permittee Signature : _ 1
Call (503) 639-4175 by 7:C0 p.m. for an inspection needed the next business day
SEWER CONNECTION PERMIT
CITY OF TIGARD
DEVELOPMENT SERVICES PERMIT#: SWR2002-00050
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/6/03
SITE ADDRESS; 13245 SW KINGSTON Pl.
PARCEL: 2 S 104 DA-19900
SUBDIVISION: (fl :111 I 1()l I.UW-SUI'I I I ZONING: R-4.5
BLOCK: LOT: 02� JURISDICTION: TIG
TF DANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LFPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF rowhouse.
Owner: I ---
- _ FEES
BROWNSTONE QUAIL HOLLOW LLC Description Date Amount
12670 SW 68TH PKWY STE 200 _
PORTLAND, OR 97223 1SWUSAJ S%vt Connect 3/5/031 $2,300.00
1 SWUSA] Swr Connect 3/5/03 $0.00
Phone: 503-598-7565 1S11'INSI'l Swr Inspect 3/5/03 $35.00
ISWINSI'1 S%\r Inspect 3/5/03 $0.00
Contractor: --
-- -- --- — Total $2,335.00
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 forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699.
Issued by: —� ,� — Permittee Signature:
--- 4 " _ c
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
t Building Permit Application
"Ds%.tcmctiv"ed: / Oi Ile rmitnoJ `if Y -GZ
City of Tigard � Pruject/appl.no.: Pxpirtzdate:
Address: 13125 SW Hall B N 2 F'
Phone; (503) 639-4171 Date issued: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
L'tnd use approval: E:l it Y U 1 AjAI. 1&2 family:simple Complex:
OF PERMIT
U 1 &2 family dwelling or accessory LICommercial/industrial U Milli family ❑New construction O Demolition
0 Addition/alteration/replacement U Tenant improvement Ll Fire sprinkler/alarm 0 Other: —
JOB SITE.INFOlkMATION
lob address: ti. •, ( ,_ c_ _- Bldg.no.: _u Suite no
< ' Ta ma /tax lodacct ant no.:
Lot: Block: Subdivision: tll I / t l c r!� �
Project name:
Description and location of work on premises/special conditions: --
OWNER FOR SPECIAL INFORMATION, USE CJIECKLIS*11�
(Floodplain,septic capseltv,solar,etc.) -
Name: '
'fQW hltn4st
Mailing address: n - 1 &2 family duelling;
City o �r CA. State:OR ZIP: �72� Valuation of work........................................ $
Phone - ,y Fax: p E-rnail: No.of bedrooms/baths................................. ---
Owner's representative: y _ Total number of floors.................................
Phone: B f ax.L li mail: New dwelling area(sq.11.) _ —
Garage/carport area(sq, ft.)................I........
Name: C Q c, Covered porch area(sq.ft.) ...... ..I...... .......
Mailing address: "� SW �`::::
Deck area(sq, ft.)........................................
StateOfher stricture area(s .ft.).........................City: cc Stal,,x: Commercial/industrial/multi-family:
1 1 � Valuation of work........................................
G Existing bldg.area(sq.ft.) .......................... _-
Business name: r6 W ,. New bldg.area(sq.ft.)
Address: S' r - e Number of stories ........................................ `
City: -� State 7_I Type of construction.................................... —_
Phone- - �' Fax:6Ao • -mail-:, Occupancy group(s); Existing:
CCB no.: L46 aNew:
City/metro lie.no.: Notice:All contractors and subcontractors arc required to be
t licensed with the Oregon Construction Contractors Board under
Name: �� fs � provisions of ORS 701 and may ae required to be licensed in the
30 I _ jurisdiction where work is being performed.If the applicant is
/ L exempt from licensing,the following reason applies-
Cit - State 7..1P:
Contact persue: H ) Plan no.: ,_ — ,-----
l a� --FI nutil
Nwne: w. �' mart Ixrsun: :) Fess due upon application .................. $
Address: tt ) �c�- Date received: _
City: late.. ?.IP: 3 Amount received ......................................... $
�,�.c --
Aione: Fax: E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Na Wt jwiu kaatu accept credit ca- a,please call jurisdiction for min infanuaua
attached checklist.All provisions of laws and ordinances governing this a Ansa (]MasterCard
work will be complied ,wheth > ed herein or not. Credit card number:
1p
Authorized si ture: _ Naxafcv&wlduu shown on credit card $
Print name: r__ _ r --- der a ttaature Amomt
Notice:'ibis permit application expires ifs permit is not obtained within 180 days after it has been accepted as complete. 44044617 MAXIM
a•v
Plumbing Peri,iit Application
Datereceived: Permitno.:
Al� City of
f i T bard Sewer permit no.: Building pet�rtit no
Address: 13125 SW Hall Blvd,Tigard,OR 97223 — _
CiryoJTigard Phone: (503) 639-4171 Project/apri r,o.: Expire date:
Fax: (.503)598-1900 Date issued Hy: Receipt no:
Land use zpproval: _^--- _ _--^_ _ case roe no Payment type: —
❑ 1 &2 family dwelling or accessory U Cominemalfindumnal Ll Multi-family U Tenant improvement
O New constntetion U A.ddition/alteration/rcplacxment U Food service U Otlter:
JOBSITIE INFORMATIONSCHEDULE
Job address:v✓ 5 S UJ ���.- I)Mscriplion (jt I-c, (ca.) '!oral i
^ —� a c ti P�a<< J_-, Nen 1-and 2-famll)dwellings only:
TaBldx
no.: tn Swte no.: (Includes 100 ft.for each utWtyconnection)
Tax mep/tax lot/account no.: SM(I)bath J` [31ock: Subdivision:v` SFR(2)bath -
Project name: =1
SFR(3)bath -- --
-City/county- — �Z1P: — Each additional hadYkitchen � -
Description and location of worst on premises: SiteutlliUes:
Catch basin/area drain
Est.date of completion/inspection. Drywells/leach line/trench drain
ICOOR Footing drain(no. lin.ft.)—
Manufactwcd home utilities
Manholes _ -
�Vulc Ott I'Itnnhing Rain drain c:onne.;tor
PO Box 2007 ---- —
Sanitary sewer(uo. lin. ft.)
Gresham OR 97030-0594 Storm sewer(no.lin. ft.) -
503-007-1781 Water service(no. lin. ft.) ----
C'C'13:23847 I'I %I 20-208111 nxture or item: ^-
Abso on valve
Contractor's representative signature:
-._
Print name: — nate: sack flow reventcr
Backwater valve _
1Liu I W X two Basins/lavatory
Name: Clothes washer
Address: -- - — - Dishwasher —�
City: State:
Drinking fountain(s)
—te-: -7Z—[P: -- --
E'cctors/sump
Phone: Faplaiiiiion tank �-
1 F ixtute/sewer cap----
Name ----
,print):
ap __Name :print): Floor drains/floor sinks/hub _
Mailing address: Hose bibb
---- — - Garbage disposal__ -
City_ �——�Stwe:� ZIP: lex maker
Phone: I E-mail: _ Interceptor/grease tra
Owner installationdrrsidential maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my rrgular Roof drain(commercial)
employee on the propetty 1 own as per ORS Chapter 447. Sink(s),Tasin(s),lays(s)
Owner's signature:—_ Date: _--_ Sum
7Ubs/shower/shower
Name: Urinal -
-____ — —. Water closet —
Address: W iter heater —
City:y -- Starr— ZIP:- Other._
Phone__ 1 Fa t-: F-mail: Total -
Nd as�rridktioa amgit uedi�cards�i+e carr�ladiction ra arxe idiaram�tlar l Minimum fex................
I IJotice:This permit application
nvua r1Mutercatd Plan review(at _ _ %) S
e.rpire,if a permit is not obtained -----
nv&card'a1°� —- —'-1 ev,thin 180 days after it has been State surcharge(896)....$ _
—
Nrmed acoct;tz+as onnipiete TOTAL .......................S
arAaldn u rborra t.tredN card
S
C antbotdc atp+a4rAc —� AMIN 4404616(6050)M)
Mechanical Permit Application
rDatereceived: Permitno.:
City of Tigardl.no.:Address: 13125 SW Nall Blvd,TiBard,OR 9'1223 Expire date:
�-I ry Of fl�pr// }, '--
Phone: (503) 639-4171 late issued: B) Receipt no.:
Fax: (503) 598-1960 Case file no.: `---- Paymerii type. -
L.and use approval: Building permit i --
1
U I &2 farni!y dwelling or accessory U Commercial/industrial U Multi-fancily U Tenant improvement
U New construction CJ A(ldit on/alteration/rcplacerncnt U Other:
Job address: ,) ,S Indicate equipment quatuitics in boxes below. Indicate Lie dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax IoUaccountno.: �- profit. Value`D
Lot: j ;— Block: Subdrvrsion: 'See checklist for important apolication information and
Project name: jurisdiction's fee schedule for residential permit fee
City/county: ZIP: I I
Description and locauon of work on premises:_ _ I r I t a I
--------
Fee(ea.) Total
Est.date of completion/inspection: Descritifion Qty. Rrs.only Res.only
Tenant;tnprovement or change of use: (:
Is existing space heated or conditioned?U Yes U No Air handling una -_ __CFM
Is existing P s c(c insulated?U Yes U No Air conditioning(stpean required) —
Alteration of existing HVACsystem
1 1 oils cr,'compressorx
o•.M..----- State boiler permit no.:
Four Seasons I lealing& A/C Service Inc _ NP Tons BTU/H
PO Box 66409 ire/snio ce ampers/ uct smoke etectors
ea�3-•t pump(ci(e p an requir ) -" -
Portland OR 97290-6409 nsta I/rep ace furna urner T — —
503-775-5919 Including ductwork/vent liner U Yes U No
C(Al •482fO ItsT-lalVreT[a relocate eaters-suspende ,
wall,or floor mcxcnted
Name(pieasc print): eV tit ioi a iana o rcr thanJurnacc
-7—
CONTACT PERSONe era
Absorption units- BTWII
?Tante: - Chillers_____ � HP
Address: Compressors
_^
City: � -- slate._ ZIP: '� roomette a tat an yen ton:
-- - Appliance vent
Phone: Fax �ryerexheust -
0 i s, ype res. tc c azmat � ---
F.od fire suppression system
Nance: - _ Exhaust fan with single duct(bath fans)
Mailing address: — '--- hausr ay�;rm span fiiim actin or AC
City: State ?.IP: pjP'jnR-s �vt on(up to out els)
Type 11'C; NC Oil
Photic: - Fax 1{ mail I'Piping eacha iticna over o-� uticis -
p p nS(sc iematicrequi )
Name: Number of outlets
Address: --- -- APP aI-ace'or egtr�l►menl:— --
_ Lecorauvefireplace
City: _ — te: ZIPS nsen-type — —
Plcone: Fax: E-mail: — tovjr-letstove -- — — --
Applicant's signature: Dale: ( er -- -
Name (print): O
NU dt � ---- --J-
1 cumn r'i'p—fif card&,pieta tail
►miduum rpt rt�te la/annarion Pemlll fee.....................$
Notice ibis app --..-
OYw ❑Mastert'trd patron IrudiO° Minimum E file................$
rye&card mpahm. v �- expires if a permit is not c„•ainal , --
- kap; ,h within ISO days after it ha!been Ian review(a; — �) $
��a ti�>aJa tl on aee»card - accepted as complete. State surcharge(8%)....$
----— --- $ -- TOTAL .......................$ —
--- Cardtwtdu�Rnar,tc A,�� -----
__ 4#)�M 17(60()MM)
a>•..
Electrical Permit Application
Date received Permit no.:
City of Tigard Project/appl.no.: Expire date:
CirygfTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Da;e issued: By: Rtxeipt no.:
Phone: (503) 6394171
Fax: (503) 598-1960 Case rite no.: Payment type:
Land use approval:
O 1 &2 family dwelling or accessory O Commercial/industrial U Multi-family U Tenant improvement
Q New constniction U Addition/alteration/replacement U Other: U Partial
lob address: Bldg. no.: Suitt no.: jTax map/tax lot/account no.:
Lot: Block: 5u ivision:
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
Job no: Fee I►tan
-- Description Qty. (ea) total no.ins
JEROME ELECTRIC NeNreaidrntist! Wngleormulti familvper
PO BOX 751 dwelling .I°`iudrsWatched garrse.
Srr.ier Witrded:
HILLSBORO OR 97123 10(x)sq it otless 4
503-648-5144 Each additional 500 sq ft.or portion thereof
Limited energy,residential 2
CCR: 36051 F.LC: 34-1190 SUP: 2877S "Limitedener _ _
energy,non-residential 2
,Factured home or modular dwelling
Si nature of su rvisin electrician(required) Dale or feeder 2
Sup.elect.name(print). License no feeden-kni allation,
r relocallon:
less 2
Name(punt): 201 amps to 400 amps 2
Mailing address: 401 amp-to 600 amps 2
601 amps to 1000 amps 2
City: Slate:�1P: Over 1000 amps or volts 2
Phone: Fax: E-mail: Reconnect only_ l
Owner installation:The installation is being made on property I own Temporaryv fwfeeders-
which is not intended for sale,lease,rent,or exchange according to Yulallatlo%alleralikin,orretncation:
ORS 447,455,479,670,701. 200 amps or less 2
201 amps to 400 an,ps 7
Owner's signature: Date: 401 to 600 amps 2
lan 10 it 01 Branch etrcalts-sew,alteration,
w extension per pool:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
- of serviceor feeder fee,firs(branch circuit. 2
Phone:
FaX: E-mail: Eachsddttioruilbranch circuit: _
Mise.(Servlee or feeder aot Included):
•Service over 225 amps-commeirial U Health-care facility Each pump or irrigation circle 2
U Service over 320 amps-rating of 1&1 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,0W square feet four or Signal circuit(s)or a limited energy panel,
U System over 600 volts nominal more residential units in onr structure alterauon,ot extension• 2
U Building over three stories U Feeder,4W amps or more .tri tion;
U Occupant load over 99 persons U Manufactured structures or RV park Each additli aat Inspectlon oxer the allowable in any of the pbove:
O EgtrssAightingplan O Other per inspection _
Subtnll—sets of plans with any of the above. Investigatinnfee
The above are not applicable to temporary cominwtlon service. Other
Not all jurisdictions accts credit cods.plesse call)unsdicuon for ince information' Notice:This permit application — Permit fee.....................S
O visa U MasterCard expires if a permit is not obtained Plan review(at — %) $
Credit card number within 180 days after it has been State surcharge(8%)....$
xn'et S
Name d otifrr u shown on c 't er�iird accepted as complete. TOTAL-
S
Cardh'lder aipaiure —� Aioouat
440.4615{6a0RbM)
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
APORTANT PERMIT NOTICE
DAVID JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2002-00074
Date Issued: 3/6/03
Parcel: 2S104DA-19900
Site Address: 13245 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
131ock: Lot: 025
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse,Unit #25,Bldg 3,13S plan witn deck
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER ELECTRICAL CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LLC DAVID JEROME ELECTRIC
12670 SW 68TH PKWY STE 200 PO BOX 751
PORTLAND, OR 97223 HILLSBORO. OR 97123
Phone 1/: 503••598 7565 Phone #. 648-5144
Req #: 1( 16051
S1 1' 28775
rr 1: 34-111)(
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Superv' rn, ectrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
T° ,ARD, OR 9722:3
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST200 a-00074
Date Issued: 3/6/03
Parcel: 2S1 ne aA-19900
Site Address: 13245 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot. 025
Jurisdiction: TIG
Zoning: R-4.5
Remarks SF rowhouse,Unit #25,Bldg 3,13S plan with deck
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 retarn
this Plumbing Signature Form prior to the start of the work to the address above, ATTN Building Division.
No plumbing inspections will be authorized until this completed form is received
OWN[-.R. PLUMBING CONTRACTOR.
BROWNSTONE QUAIL HOLLOW LL-C WOLCOTT PLUMBING CONTRACTOR!
12670 SW 68TH PKWY STE 200 PO BOX 2007
PORTLAND, OR 97223 GRESHAM, OR 97030
Phone fl 503-598-7565 Phone #. 667-1781
Rocl0 LIC 23847
PLM 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
i
X _ -..Ae --
P�
Signdtur Aut ized Plumber
If you have any questions, please call 503.718.2433.
ELECTRICAL PERMIT-
CITY OF TI(;A
RD
DEVELOPMENT SERVICES - RESTRICTED ENERGY
13125 SW Hall Blvd., Tigard, OR 97223 (5(13) 639-4171 PErMIT#: ELR2003-00170
UED: 6/17/03
SITE ADDRESS: 13245 SW KINGS-1ONPL DATEPARCELL: 2S O4DA-19900
SUBDIVISION: QUAIL HOLLOW- SOUTH
BLOCK: LOT: 1)25 ZONING: R-4.5
Proiect Description:All encompassing low voltage. JURISDICTION: TIG
rj� SIDENTIALB.COMMERCIALAUDIO & STEREO: X AUDIO & STEREO —URGLAR ALARM: X INTERCOM & PAGINGARAGE OPENER: X BOILER: LANDSCAPE/IRRIGAT:
HVAC: X CLOCK: MEDICAL:
VACUUM SYSTEM: X DATA/TELE COMM:
NURSE CALLS:
OTHER: ALL. ENCOMP : X FIRE ALARM OUTDOOR LANDSC LITE:
HVAC: PROTECTIVE SIGNAL:
INS rRUMENTATION: OTHER:
Owner: _ ---- TOTAL #OF SYSTEMS:
FIRUWNSTONE QUAIL HOLLOW LLC 2670
_----
12670 SW 68TH PKWY STE 200 AZIMUTH COMMUNICATIONS INC
PORTLAND, OR 97223 P.O. BOX 508
WILSONVILLE, OR 97070
Phone: 503-59K-7565
Phone: 503-639-01 10
Reg #: III{ 36-94CLE
2312LFA
FEES IIr 14828
_ Required Inspections
F
ption Date —�
Amount Low Voltage Inspection
1TJ lil"It Pr6/1 /7 03 $75.00 Elect'I Final
".4.Statc Tax 6/17/03 $6.00
Total $81.00
This Permit is Issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty Codes and
all other applicable laws, All work will be done in accordance with approved plans. This
started within 180 days of Issuance, or if work is suspended for more than 180 dayspermit will expire work is not
You to follow rules adopted by the Oregon Utility Notification Center. Those rules are et forth in C c.Oregon law requires
R 952-001-0010 throuc
Issued by
Permittee Signature
r
INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, leave, or rent.
OWNER'S SIGNATURE..:
-------- - DATE
-� --"— ----"-----_---- _e. CO_._NTR/1CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N —_ — -- ----�
LICENSE NO DATE:
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day V —
I
Electrical Permit Application
Date rcceive4-1 ?-p r Permit nu`� p�j�, 0171)
City of Tigard I'roject/appl.no.: _ Expire date. _-
Ciivo/Ti,grrrd Address: 13125 SW Hall Blvd,Tigard,OR 97223 Dale Issued, B-:{4 Receipt no.:
Phone: (503) 639-4171
Case(503) 598-1960 ase file no: payment type:
Land use approval: _
U I &2 family dwelling or accessory U Commercial/industrial J Multi-family U Tenant impto�cmeta
At New construction U Addition/alteration/replac orient O Other;_ U Partial
JOB SITE INFORMA'I ION
Job address: I Bldg. no.: 17 Suite no.: fTax map/tax lot/account no.:
Lot: Sc,..TH
Project name: Utk t_ c: a�n-f Description and location of work on premises; t, L)ie I 0p ))1,L,
Estimated date of con lotion/ins ecuon: '
SUIEDULE
Job no: Fee Man
Description _i Otv', (ea.) l utas no.lost,
Business flame: 1 )1� New residential-singleormulli-fatnlly per
Address: jLflcjs S',LO, _ e r ' 460 dwellhlgunit.Includessiltachedgarage.
City: ix • State ) Z. ZIP: C Service Included:
1000sq ft or less 4
y � —1
Phone: ' 'r FAX;C 65cj-Cil l S Email: Bach additional SUO sy ft ur portion thereof _,-
CCB no.: I Elec.bus. Ilc.no: (1 I.inutedenergy.residenual 2
City/metro lic.no.: 000 06 1_-9 Ltmuedenergy,non•residential
L _ Service and/or feeder 6 l 1 u If u 3 Each mnnufuctwed home or modular dwelling
Signature or supervising electric hln lred)
egn �� Date -----� �,
Su .eleet,none( nal) Licrnseno 2311 Services orfeeders-Installalion,
.t � L allerat Ion or relocation:
PROPERTY OWNER 1 200 an, s or less
Name(print): �1L<J�;ai Lt. 2o11a„ s1o4U0amps
-- 401 amps to 600 amps
Mailing address: 601 amps lo 1000 amps
City Slate: ZIP, (leer 1000 amps or volts
Phone: _ ('ilx: I.mail: Krc'onttect onl
(Ak ler installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to Installs(lon,olterotion,urreloc•a0mt:
200 amps til Icss
ORS 447,455,479,670,701, 20 I amps to 400 amps
Owner's si mature: Date; -401 to 600 amps
Branch circuits•new,alteration,
or exlension per panel
Name: A For for branch circuits with purchase of
Addl-M service or feeder fee,each branch circuit
I lay: - State: ZIP: Fee for branch circuits vithout purchase
of service or feeder fr. first brunch circuit R
Pllone: Fax: 1 E-Mail: Mach additional branch e wil.
Misc.(Service or feeder not Included):
Each um or Ira anon circle '
U Service oser225nnys•conu,Icrnnl J Health earcl-aelhn �.-p C`�
LI Service os cr 120 amps-rating of IC U azardous location Each sign at oullinc hghtiag ? 1
family dwellings U Huddingover 10,0(10 square feet fouror Signal circuit(s)or u limited eneigs panel,
0 System over 600 volts nominal more residential units in one structure alteration,or extension* I I 2____
•Building user three stories U Feeders,4W amps or more c Description
U occupant load over 99 persons U Manufactured structures or KV park Tach Idltlonol Inspection wee the allureablc in an)of the alwpe:
U Egress/lighlingplan ❑Other —_ prrinsprcyu,❑
Submit__-_,sets of plan+with any of the above. _Tr wrsugatr.n fee
The above are not applicable to temporary construction sery Ice. Other
Permit fee,
Not all lurtMlactions accept credit cards,picric call jurisdiction lot mote mformauon. Notice: 1-his permit application
O Visa t7 MasterCard expires if o permit is not obtained Plan review(at __ `✓ 1
Credit cud number: . _ within 190 days after it has been State surcharge(8%) ....
.spires
_ accepted as complete TOTAL .......................
risme of cardholder u shown on ere at cud
_ S
Cudhnlder sl nature i Amount 446 4615 IMAht'C)M
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST a
INSPECTION DIVISION Business Line: (503)639-4171 ---F—
n BUP
Received �_ _ ___ ,—/ Date Requested b Z� .AM_ PM BUP
Location � f1 a 7 j -_ ..._/�/-���c1� nn-� Suite _ MEC
Contact Person _ __ --__ ____-_- Ph( ) 3-57FL6 PLM
Contractor _ _ Ph(--) _-__ SWR
BUILDING Tenant/Owner _ _ ELC
Footing
._._ ELC —
Foundation Access:
Ftg Dtain ELR
Crawl Drain _
Slab Inspection Notes SIT
Post& Beam - ------ -- -
Sh,aar Anchors ---
Ext Sheath/Shear
Int Sheath/Shear
Framing
nsulation --- -- - - - -
Drywall Nailing —_- --- - ---
Firewai, �Q: -�
Fire Sprinkler - - - - -
Fire Alarm '
Susp d Ceiling ---
Roof
Other: ...------ -- ._
_ .
r.ASS/ PART FAIL
-----_ --
Post S Beam -
Under Slab
Rough-In
Water Service ------ ---
Sanitary Sewer
Rain Drains --
Catch Basin/Manhole
Storm Drain - - - --
Shower Pan
Other. -- -_
Final
ASS PART FAIL
MECHANICAL-
_ --
Post& Beam
Rough-In — -_
Gas Line
Smoke Dampers -- - —-- --
M-kICAL
PART FAIL -- -- ---
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final u Reinspection fee of$ - _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE:_ _ Unable to inspect_ no access
Fire Supply Line
Approach/SldeWalk Dtato - /t Inspector -- Ext
---
Other:
Final T DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BLIP ----_�___---
Received Date Requested_g' O3 __ AM__ _ PM .._. _--___ BLIP
Location 32y S w �� NAS otJ L,_Suite_ MEC
Contact Person -- __-___, Ph( ) -- _-_ PLM
Contractor ._ — — -- - Ph( ) - ---- -- -- SWR
BUILDING Tenant/Owner _—_�___ ELC
Footing E
tX
Foundation ---------_ ---- -.--
Ar..cess:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �I� - --- ---- ----.
Post&Beam -
Shear Anchors ---_---- ,--- - _--
Ext Sheath/Shear
Int Sheath/Shear -- _- -
Framing - - - - - -
!nsialation
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 Line -
Smoke Dampers —
Final
PASS PART FAIL
ELECTRICAL
Service —'--- ------ - —_. _ ___.---
Rough-In
ILIG/StallZ
Low Volta e T L ,�`� �� Qui�x- 1-70
�-
Fite Aiarfn
FJ -
PASS PART FAIL �-} Reinspection fee of$ required before next inspection. ay at City Hall, 13125 SW Hall Blvd.
SITE n Please all for reinspection RE: _. i Unable to inspect-no access
Fire Supply Line
ADA 3
Approach/Sidewalk Dates ? inspector Cj1 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST 2• nd�� 7 5/.
INSPECTION DIVISION Business Line: (G03)639-4171 BLIP --
Received . _ —__-___ Date Requested F��j=- - -- ��/►--- -- P�"_—__-- -- BUP Location -___J `� _ S(.v K;tiA.r fa N, Suite _— MEC
Contact Person CI,..-I r, — Ph(—) 4 u PLM - - --_- ----
Contractor- _- --- Ph(—) SWR ------
BUILDING Tenant/Owner R ELC __"--- --
ELC
Footing
Foundation Access:
Fin Drain ELF! --
Grawl Drain SIT -_
Sian Inspection. Notos: --
Past& Ream
Shear Anchors
Ext Sheath/Shear -- _
Int Sheath/Shear �—
f-'remind t—r�-w c�✓ ►'u c, v.It - _ __.__.
Insulation _
Drywall,Nailing ------I-----------__._ T_
Firewall raw
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P_A_ PART_ FAIL — k� �
PLUMBIN C P✓G Pill,' Wa-It✓ /�z�.k✓ I�ay ��'rc�w3cJ-JC1 S I
m �1 Tb U i c c"r .Sµ..Li a i_"( o `T tN t tSw. 1C,%-
Under
c,%-Under Slab -'
Hough-Int�
Water Service Q t` j'► 6 i,.� 1•t'�Y w$ S d L �a.41..� CG ��t2 ,�v.�+►blat�Iv S7'ec..el...-.�r i'J5 PS�,
Sanitary Sewer -tr...` -� ' ✓ Lj^AL._ tP�., K) S hti t 1 Qt h1 j ,w.�,.r-L -----
Rain Drains — _ (
Catch Basin/Manhole b 1-QwL�� y May` w.r.�.. 2 1 c�T A bow c c1vn.J►t\ C'V, 1-1"Storm Drain
Drain —'-
Shower Pan
In ..
( PART X!J
_ NICAL ---- — —_ --
Post& Beam
Rough-In
Gas Line
Smoke Dampers -- _
Final
PASS PART FAIL
ELECTRICAL -
Service
Rough-In -- -- --
UG/Slab —
Low Voltage
Fire Alarm
Final Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd,
PASS PART FAIL
SITS E] Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA Date. St J 2 t2 d?----- Inspector J' Ext ------
Approach/Sidewalk
Other:-
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL