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13255 SW Kingston Place
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST Z -66073
INSPECTION DIVISION Business Line: (503)639-4171 --�- —
Q� BLIP
-
Received _-__- . Date Requested.__ gr 2' " AM_. - - PM __ -_ BLIP
Locatc,n — f 3 4 ;� --- -�r�� Suite_ __ -_ _� MEC
Contact Pers,.n ---- Ph PLM - -
Contractor_ � �_ L`Cl_C_ Ph(- _) _____._� —_ SWR
BUILDING _ Tenant/Owner ___. —__ - --_____- ELC
Footing ELC
Foundation Access'.
Ftg Drain E L R ;2X3 0016
Crawl Drain
Slab Inspection Notes. SIT GocJ Lf?1*L
Post& Beam
Shear Anchors
Ext Sheath/Shear
In, Sheath/Shear
Fuming
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd CeilingRoof
—
Other:
Final
J
PASS PART FAIL r
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 _
UG/Slab T
Low Voltage __---
Fire Alarm
'�--�PART FAIL F-1Reinspe^tion tee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE - ❑ Please call for reinspection RE: _ LJ Unable to inspect--no accoss
Fire Supply Line
ADA A�tApproach/Sidewalk Date ' Inspector V � .. Ext
Other: _ _
Final DO NOT REMOVE this Inspection record from tho Jott afte.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639,4175 MST 2 G Lid Cl
INSPECTION DIVISION Business Line: (503)639-4171
BUP _
Received D to Requested, $_ _____ AM._ .._.. _ PM__ BUP
Location _... ___Suite _ MEC
Contact Person --_- Ph(— �) 3 S 7 �_ PLM __--
Contractor _ __ _ Ph(--___) SW -- --
BUILDING Tenant/Owner ELC __--
Footing ELC
Foundation Access:
Ftg Drain ELF!
Crawl Drain --
Slab Inspection Notes: SIT -- - _
Post&Beam ----- --
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing — -- -- - -
Insulation �/� ('
Drywall Nailing '`,��]nt r CJiI ren nr J .1t:., Ll� ��s Tub /Vlit✓1 t✓_�-+Tt
Firewall
Fire Sprinkler
Firr .Alarm
Susp'd Ceiling
Root
Other:
Final
PASS PART FAIL
PLUMBING �-
Post&Beam
Under Slab
Rough-In
Water Service - - --- -- - -----
Sanitary Sewer
Rain Drains ------�� — --
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Ina _
-fPASV PART
_MECHANICAL
Post& Beam
Rough-In --- -
Ras Line
Smoke Dampers -
Final
PASS PART FAIL -----�
ELECTRICAL_
Service � —
Rough-In _ _—
UG/Slab
Low Voltage —
Fire Alarm
Final Reinspection fee of$ ��required before next inspection. Pay at City Hall, 13125 SW Hall bivd
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA f'
Approach/Sidewalk Date- Y i ; -___ Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIT_
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST 1 -o as 73
INSPECTION DIVISION Business Line: (503)639-4171
G� p� BUP — _----
Received .. Date Requested — AM_ PM —__..__— BLIP _
Location tea SS Suite MEC
Contact Person __— _ —_-__ - —_ Ph72_37 I PLM --
Contractor — — _—_ Ph(� ) - SWR
BUILDING Tenant/Owner -_ ELC
_ --- — —
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain _
Slab Inspection Ncles: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall I
Fire Sprinkler Ae1�-- -
Fire Alarm L"
Susp'd Ceiling
Roof
Other: ,--r=-
—-- 1,
Other:
ASB PART FAIL ------ - —
PLUMBING _
Post&Beam e
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains ---- .- -- -�_-- _-.-
Catch Basin/Manhole
Storm Drain - --- - — -- -
Shower Pan
Other: --- — - ---- -..._—_
Final
PASS PART FAIL ---- --- ----- — -—
MECHANIC_AL
Post&Beam
Rough-In _.�--- - ---- ----
Gas Line
Omoke Dampers __�—_—__s _--- _—.------- -_-- --_.._—
Ptn ,
A,SS- PART FAIL
ELECTRICAL.
Service
Rough-In
UG/Slab ----- -- — -- — - -- ---
Low Voltage
Fire Alarm —— — -- -
Final 0 Reinspection fee of$— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE s Please call for reinspection RE:. Unable to inspect-no access
Fire Supply Line .--y
ADA
Approach/Sidewalk Date -_-_ Inspector --
Other:
Final — DO NOT REMGVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD _ MpSTERPERMIT
PERMIT#: MST2002-00073
DEVELOPMENT SERVICES DATE ISSUED: 3/6/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
SITE ADDRESS: 13255 SW KINGSTON PL PARCEL: 2S104DA-19800
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: 1Z-4.5
BLOCK: LOT: 024 JURISDICTION: TIG
REMARKS: SF rowhouse,Unit#24,13ldg 3,8S plan with a deck
BUILDING
REISSUE: STORIES: i FLOOR AREAS i REQUIRED SETBACKS REQUIRED__
CLASS OF WORK: NEW HEIGHT: FIRST: 112 %1 BASEMENT. st LEFT: SMOKE DETECTORS.
TYPE OF USE: SA FLOOR LOAD: SIS SECOND 735 at GARAGE: Sa% sr FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: TMRO 135 sl RIGHT:
19,•'.55;0
OCCUPANCY GRP: R3 EDHM: ? BATH: 2 TOTAL: 1,647 d VALUE REAR.
PLUMBING
SINKS: 1 WATER CLOSETS: 7 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN TRAPS.
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES SF RAIN DRAINS. CATCH BASINS.
TUB/SHOWERS: GARBAGE DISP: I WATER HEATERS: ' WATER LINES BCKFLW PREVNTW GREASE TRAPS.
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100W 'OIL/CMP<3HP: VENT FANS: 3 CLOTHES DRYER: I
I nc FURN>=1001<: UNIT HEATERS. HOODS: I OTHER UNITS
MAX INP. hfu FLOOR FURNANCES. VENT,— WOODSTOVES GAS OUTLETS- I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 1 0 200 amp. WISVC OR FOR. PUMP/IRRIGATION PER INSPECTION. Y
EA ADU'L SOOSF. A 201 400 amp 201 Anoamp Int WIO SVCIF OR SIGNIOUT LIN LT'. PER HOUR
LIMITED ENERGY. 401 - 600 amp 401 600 amp. EA ADDL SR CIR SIGNAL/PANEL: IN PLANT.
MANU HM/SVC/FOR: 601 1000 nmp; Sol+amps-1000v MINOR LABEL'
1000+amptvolt:
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS- SVCIFDR>=225 A.: 600 V NOMINAL. CLS AREAISPC OCC.
ELECTRICAL RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO A STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM- INTERCOMIPAGING OUTDOOR LNDSC LT.
BURGLAR ALARM OTH: BOILER: HVAC. LANDSCAPEIIRRIG PROTECTIVE SIGNL.
GARAGE OPENER: CLOCK, INSTRUMENTATION: MEDICAL: OTHR.
HVAC: DATA,`1 ELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,500.08
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES LLC This permit is subject to the regulations contained in the
12670 SW 68TH PKWY STE 200 12670 SW 68TH PKWY Tigard other
Muniapal Code, State o k Specialty Codes and
PORTLAND.OR 97223 PORTLAND.OR 97223 all other applicable laws All work 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,ou to follow rules adopted by the
Phone: 503-598-7565 Phooe: 503.598-7565 Oregon Utility Notitica.ior,Center Those rules are set
forth in OAR 952-001-0010 through 952-001-0080 You
Rao M LI(' 124(127 may obtain copies of thes,: rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Sewer Inspection Electrical Service Gas Line Insp Gyp Hoard Insp Plumb Final
Fooling Insp Electrical Rough-In Insulation Insp Rain Drain Insp Mechanical Final
Foundation Insp Mechanical Insp Shear Wall Insp Water Line Insp Building Final
Slab Insp Plumbing Top Out Exterior Sheathing Ins{ Smoke Detector Final inspection
P1m/undslb Insp Framing Insp Firewall Insp Electrical Final
Issued By : r _ Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business .fay
1 CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00048
13125 SW Hail Blvd , Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/6/03
SITE ADDRESS; 13255 SW KINGSTON PI_
PARCEL.: 2S104DA-19800
SUBDIVISION: 011AIL Ilt rl ! 1 11 ZONING: R45
BLOCK: LOT. '1 JURISDICTION: Ilr
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS. 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL. TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF rowhouse.
Owner: —
__ FEES _
BROWNSTONE QUAIL HOLLOW LLC Description Date Amount
12670 SW 68TH PKWY STE 200 _
PORTLAND, OR 97223 JSWt ISA I Sok r Connect 3/5/03 $2,300.00
JSWIISAJS%%r Connect 3/5/03 $0.00
Phone: 503-598-7565 1SWINS111 Stir Inspect 3/5/03 $35.00
Contractor.
1SWINS111 Skvi Inspect 3/5/03 $0.00
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: _
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
7Project/appl.
,�i ,er Permit
City of Tigard �. — --
Address: 13125 SW Hall Blvd,Tigard,OR 97223 o.: re date:
Phone: (503) 639-4171 Dateissu-d: Byif Receiptno.:
Fax: (503) 598-1960 Case file n),: Payment type:
Land use approval: --BILTIL.DiN('•DMSAON I&2 family:Simple Complex:
TYPE OMERMIT
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/alteration/replocentent LI T"nant nupmVemcnt U Fire sprinkler/alarm U Other:
O; SITE INFORMATION 7
Job address: "�
.ti ''��: -�� = Bldg. no.: Suitt no.:
Lov ISubdivislon: y.Ljp r C Sc-t t T11 ITax map/tax IoUaccount
Project name:
Description and location of work on premises/special conditions:
i 1
Name: ,f-o . iti& _
Mailing address: nr 1 &2 faudly dwelling:
City o,-4. "\_e Statc:0R ZIP; Valuation of work.................... ................... b
Phone —9SFax: E-mail: No.of bedrooms/baths................................. —
Owner's representative: ' Total number of floors....... ................. ......
1'honc: a I'ax: Email: New dwelling area(sq. ft.) ................. ........
Garage/carport area(sq. 1't.)................. .......
Name: Covered porch area(sq. ft.) .........................
Mailing address: SW ¢t —S,'
Deck area(sq. ft.) ........................................
City: ,_. 0 h State: Lll. 4 Other structure area(sq. ft.)................... .....
Phone: Fax: E-mail: Comtnerrial/industria l/multi-famfl�:
i Valuation of work........................................ $
Business name: re u,' „_5 �
Existing bldg.area(sq. ft.) ..........................
Address: .2 _fig New bldg.ares:(sq.ft.) ................................
Number of stories
SWCXD Zl Type of construction
Phone S' — Fax:4 o -e 3-mail — y g
Occupancy Existing:
CCB no.: �� z New:
City/metro tic.no.: —
Notice:All contractors and subcontractors dre required to be
licensed with the Oregon Construction Contractors Board under
Name: 6 Lo provisions of ORS 701 and may be required to be licensed in the
Address: 1,301 BE4Ave- —5L,,'4 b I jurisdiction where w,irk is being performed. If the applicant is
Cit : ,_ State ZIP: exempt from licensing,the following reason applies:
Contact person: V%'k.L W1, Plan no.:
Phone: If 111,10 -
w, Contact person: Ot&iyFees due upon application
Address: _t,, 44,--4-4 Date received: _
City: r sa. w tate: ZIP: 3LA Amount received
Phone: g,,;t _ Fax: E-mail Please refer to fee schedule.
1 hereby certify 1 have read and examined this application and the Not all)urisdictioru accept credit cards,pkase call jurisdiction for more infunm ioa.
attached checklist.All provisions of laws and ordinances governing this U Vita U Mastercard
work will be complied whethgU ' ed herein of not. credit care number
�y��.� Upfru
Authorized sl"ure: Name of cardbo der as shown on credit card
Print name: eni C-& -- $
der i1pature _ Am,roni
Notice:This permit application expires if a permit is not obtained widiin 180 days after it hes been accepted as complete. au»e 13 d60WUM
P' lumbing Permit.Application
City of Tigard
"')ax' raxived:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no
CiryojTigard Mone: (503) 639-4171 Projccyappl no.: Expiredate:
Fax: (503)598-1960 Date issued
-- ------ Hy: Receipt no.
Land use approval: _ `- _-�- Case file no.: Payment type:
1
❑ 1 &2 family dwelling or accessory U Commercialhndus'la. U Multi-family U Tenant improvement
U New construe ion U Add iIiordalteralion/repiaccmcnI U I-uxi wi-Vice U Oar,
Job address: ;J •)5 SW `t,y _ n1 Descri tion
ace (IMy. hee(ea. Total
Bldg.no.: uuc no. New 1-and 2-family dwellings only:
Tax map/tax lot/acr_ount no.: (I eludes Io0 ft.foreach mility coon"on)
(TR(1)bath
Lot: Blrx:k: Subdivision: SFR(2)bath -
Project natne:
SFR(3j bath
City/county: Zii': - trach additional bat1v1j1chcn
Description and location of work on premises: - SHeatW(jes:
Catch basin area drain
Est.date of completion/inspecti0": - Drywells/Icach linc/tnnch drain
1 1lt Footing drain(no.Jilin. ft.) _-- --
Manufactured horde utilities -
IEROME' CI_ECI kl(' Manholes
ISO BOX 751 Rain drain connector -"-`
HILLSBORO OR 97123 Sanitary sewer(W lin. ft.) - --
503-648-5144 Storm sewer(no.lin.ft.) --
Water servicr(no.lin.Ft)
CCB: 30051 30051 F LC: 34-1 19C SUI': 28775 Fixture or Nero:
Contractors representative signature: Absorption valve
Print name: - Back flow reverter --
f>atc: Backwater valve
1 Basins/lavatory
Name: Clothes washer -
Address: — --- '-- — Dishwasher -
Cit -- Drinking fountaln(s) -
Y• State: ZIP: - E'ectors/sum
Phone: Fax: E-mail p
Expansion tank
Fixtur sewer
Name_(print): Floor drains/Iloor sinks/Iwb ---
Mailing address: - ----- Garbage disposal -
Cit - --- Hose bibb �—
Y — State: ZIP: -maker -.--
Phone:-----� Naz: E-mail: Ice
.korl tra�1
Owner installation residential maintenance only: The actual installation Primers) -- ---will be made by me or the nWritenancx and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447 Sink(s),basi_n(s),lays(s)
Owner's signature: Dale Sum -- - -
- Tubs/shower/shower pan - --"
Name: l)rinal __--
Addrrss:
Watercloset -
--
- -Water heater _--
City State: ZIP: _ Other. --
Ptwne___ ._
—=PAX - Tofid
Nex all haiediniam saM l at&,cwk alone call kx"ctian _ Minimum fee................$ .
O Via ElMasterCard Notice: Ibis permit application ---
expires if a permit is not obtained Plan review(at
tJredli card mmihv. _-- —_ E ._ within I80 days oiler it has been State surcharge(8%),...$
Nanr of cudholAer u elmn W actin rj rnj — accepted as complete. TOTAL .......................$
f
-- Cardboldrr _ Awow
4/0-4616(WOKUM)
Mechanical Permit Application
Dalr received: Permit no.:
City of Tigard Project/appl.no.: Expire date
City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 - — -1----
Phone: (503) 63911171 Date issued. By: J Receipt no.
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
MMMGMM=
U 1 &2 family dwelling or accessory U Commercial/lndustrial U Mulu-family U Tenant improvement
U New construction U Addition/alteration/replacement U(hher
1 INFORMATION 1MNIERC'IAL VALUATION SINIEDULE
_
Job address:/ ��,; S�.y � 1 i0k 4 Indicate equipment quantities In boxes below. Indicate the dollar
Bldg. no.: _ Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: lock: - Subdivision: *Ser checklist for important application information and
Project name: jurisdiction's fee schedule fo. residential permit fee.
City/county: _1 ZIF': —__-- DIVELLANG F lil
Description and location of work on premises: I •1 I c a « 1
Fee(ea.) Total
Est.date of compledon/inspection: I)esc�iption _ Qty- Res.only R_es.onl)
Tenant improvement or change of use: —
Is existing space heated or conditioned?U Yes U No Air handling unit -_CFM__
Is existing space insulated?U Yrs U Nti °n
Ait cdlfit;n ng(siteplanrequired)
A t—T iabono T---exisf g TITANsystem
MECHANICAL CONTRAtTOR Boiler/compmu)m -- --- --
State boiler permit no.:
Four Seasons Ileating& A/C Service Inc lit' Tons_—_.BTLIM
FirPO Box 6(1409 sm� ductsmoke detectors --
eat pump(site plan required)
Portland OR ')721)0-6409) nsta UT replacefurnace mer—BTU/14
503-775-5919 Including ductwork/vent liner C]Yes U No
CCB: 48283 -InstalU—UrcTacelm-T65teh,eaters-eu�pen�d— --
_ wall,or fkxmr mounted
Name(please print): em forappliance other than furnace _-CON'tACT of mt
Absorption units BTI VII
Name: (]tillers _- _-- lip - -- -
Addness: -- -- ` - Com ressors_ _ HP -
'
irWonwenW! alit and Yeatiliflov
City: — Stale: ZIP: -- Appliance vent
Phone: Fa,< I•:-mail: )ryerex ausi -
1 p - s, ,ype res. etc to tazinat
hood fire suppression system
Name: _ Exhaust fan with tingle duct(bath fans) —
Mailing address: gust system acart from eaung or AC
_- - -- P ii a act on(up to out cis
City: Statc�� Z117..---
IP: T _ Utii NG Uil
Phone: mail -Tu,f to each additicn-_a1 ver�tc
pip (schematicreguired)
N7d7mss:
Number of owlets
- let app nce or eq pment: _
ADecorative fireplace
City: Slap 711' nsert-type
--------- --
Phone: jFay. !. mail 1 tov pe lot stove
("WI—_ ---
Applicant's signature: Uate.
Name (print): - -
Na all haidictiarn a x--etr credit cards,plew call jurisdiction for mar lararmriarPermit fee.....................$
13 V'tu Q Mavtercan! or ce,11iis pennit application Minimum fee................$
expires if n permit is not oliutmed
credit card camber. __._ --.-�� within 180 days after it has been Stale
review(at -_ �) $ -- --
Naar d cantfwldn a Tio.ve on seen card— accepted es complete
State surcharge(846)....$
TOTAL .......................$ �._.
Cardholder tiViature ^� Aammi
440417(6AOS-tiAf)
A
Electrical Permit Application
Datertxeived: Pe7no,.: 7City of Tigard 1'rojecUappl.no.: ExAddress: i!125 SW hall Blvd,Tigard,(1R 9%223 Date issued: fio,CirynjTignnl y'
Phone: (50i) 639-4171
Fax: (503) 598-1960 Case file no.: Payrnenl type:
Land use approval:
TYPE OF OMMIT
U I &2 family dwelling or accessory O Commercial/rndustnal U Multi-family U 1'enant impmvcmrni
U New construction 0 Addiiion/altcration/replacement U fhher._-- U Partial
-JOB SITE INFORMATON
LI
oh add, ss: � 141 1} r o.: Suite no.: Tax map/tax lot/account no.:
ot: �L4 Block: Su ivtston: _
roject name: Description and location of work on premises:
Estimated date of cons letion/inspection
APPLICATION1
,lob no: fee Max
Description (Jay. (ea.) Total nn.fns
IEROME ELECTRIC per
PO BOX 751 d�ellutKtaeh.IrreMsdesatucisedRstra�-
5ervlce Included
H1LLSBORO OR 97123 10()osq ft or ICU 4
503•.648-5144 Each additional 500 sq ft.or porvon thereof _
Limited energy,
CCB: 36051 ELC: 34-1190 SUP: 2877S residential
-revel 2
Limiledenagy,non-residential 2 ,
Each manufactured home or modular dwelling
Signature of sac rvising elxtrician(required) Date Service and/or feeder _ 9
Sup.elect name(print) License no Services or Feeders-installation,
allemllon or reloration:
1 1 200 amps or less 1 2
Name(print): 201 amps to 4110 amps _ 2
401 amps to 600 amps2
Mailing addrers: — —'
.--___ ---- _ 601 amps re.100(1 amps 2
City: Stalc: ZIP: — Over 1000 amps or volts — — 2
Phone: Fax: E-mail: Recnnnecronl I
(honer installation:The installation is being made on property 1 own inst7emJ»nr7 a lsevat in feeders-
which is not intended fur sale,lease,rent,or exchange according to 200 amp or lessr'rl'"'•°r relocation:
ORS 417,455,479,670,701. 101 amps or las � 2
101 amps l0 400 amps 2
Owner's signature: Date: 401 to 6(x)amps -- 2
Branch circuits-nen,alteration,
or exrensiost"r panel.-
Name:
anel:Name: _ A, Fre for lxuxh circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: Sade: ZIP' B Fee for branch circuits without purchase
— — of service or feeder fee,first branch circuit: 2
Phone I ax F. mail: Tech additional branch circuit
Misc.(Service w feeder not included):
O Service over 225 amps-rntnnk i L ial J Heaith-cue facility Each pump or irrigation circle 2
O Service over 320 amps-rating of 1&2 U Hazardous Incat;on Fach sign or outline lighting -- 2___
familydwellingc U Butidm0 over 10,000 square feet tour or Signal circui0)or a:imited energy panel,
❑System over 600 volts nominal more residential units to one structure sherauGn,or extension* _ 2
•Building over three stories ❑Feeders,400 amps or more "Description.
U Occupant load over 99 persons U Manufactured swcturm or RV park Fach additleml inspeellon over the allowable N nay of de above:
U EgiessAighting plan U Other: - Pet inspection F—=-
.Submit __ sets of plans with anv of the above. Invesugationfee _
'floe above are not applicable to Itmporary construction service. Other
Nd all)un4tLctiont sccep credit cards,please call Jurisdiction fix rant information Notice:This permit application Permit fee.....................
U Visn U MasteK'ard expires if a permit is not obtained Plan review(at _._ %) $ __-
CreAu card number, _ _ within 180 days after it has been State surcharge(8'f6)....$ _--.
-—
aplft1 accepted as complete. TOTAL $
Name a-cardholder u shown on cre I card
CWhdder stgnaturr — Amount 4404615(WWOM)
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2002-00073
Date Issued: 3/6/03
Parcel: 2S104DA-19800
Site Address: 13255 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 024
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse,Unit #24,Bldg 3,13S plan with a deck
Your company has been indicated as the plumbing contractor for the permit indicated above In order for the
plumbing permit to oe valid, please have the appropriate individual from ;our company sign below and return
this Plumbing Sic nature Form prior to the start of the work to the address above, ATTN. Ruilding Division.
No plumbing 'Onspections will be authorized until this completed form is received
OWNLR PLUMBING CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LI.0 WOLCOTT PLUMBING CONTRACTOR!
12670 SW 68TH PKWY STE 200 PO BOX 2007
PORTLAND, OR 97223 GRESHAA, OR 97030
Phone #: 503-598-7565 Phone #: 667-1781
Reg #: LIC 23847
PLM 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signa[ure thori e . Plumber
If you have any questions, please call X03.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
DAVID JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2002-00073
Date Issued: 3/6/03
Parcel: 2S104DA-19800
Site Address: 13255 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 024
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse,Unit #24,Bldg 3,13S plan with a 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 F'KWY STE 200 PO BOX 751
PORTLAND, OR 97223 HILLSBORO, OR 97123
Phone #: 503-598-7565 r'�ione #: 648-5144
Req #: LIC 36051
SUI, 29775
F L F 14.11O('
AN INK SIGNATURE IS REQUIRED ON THIS FORM
-_ _
Signature of Supervising ectrician
If you have any questions, please call 503.718.2433.
ELECTRICAL -
1 CITY OF TIGARD _ RESTRICTED N RIGY
DEVELOPMENT SERVICES PERMIT#: ELR2003-00169
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 DATE: ISSUED: 6/17/03
SITE ADDRESS: 13255 SW KINGSTON PL PARCEL: 2S104DA-19800
SUBDIVISION: QUAIL HOLLOW- SOUTH ZONING: R-4.5
BLOCK: LOT: 024 JURISDICTION: TIG
Proiect Description: All encompassing low voltage.
A.RESIDENTIAL _ B.COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTEF:,_;OM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: 0I'HEFk.
--- _ TOTAL#OF SYSTEMS:
Owner: Contractor: -_--
BROWNSTONE QUAIL HOLLOW LI_C AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY STE 20U P.O. BOX 508
PORTLAND, OR 97223 WILSONVILLE, OR 97070
Phone: 5(13-598-7565 Phone: 503-639-0110
Reg #: ELE 36-94(11
SUP 2312L1?A
I-t5!i �{
_ FEES _ Required Inspections_
Description — DateAmount _ Low Voltage Inspection
�I I PR%I l I I.I.It I'Vrniit 6/17/03 $7500 Elect'I Final
I \\ 8 titve,hip 6/17/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale of OR. Specially 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 i3suance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to fo iow rules adopted by the Oregon Utility Notification Center. Those nines are set forth in OAR 952.-001-0010 throuc
Issued by �j t L l�', Permittee Signature
— — 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 CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO: -- - -- --�—� -- -- _
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit,Applicatin
Date n.crved t-n_c 3 Permit
City Of Tigard Prolc,Uappl.no_ Expire date:
City ofTigard Address: 13 125 SW I fall Blvd,"Tigard,OR 972.:, Date issued: F3 kecel)t no
Phone: (503) 639.4171
Fax: (503) 598-1960 r';ItiC rile 110.: Payment type.
Land use approval:
U 1 &2 1'atnily dwelling or accessory U C'onimercial/industrial J .Multi-fanoly _j Tenant nrlpruven)ent
Ai Net,'construction U )Addition/;)Iteration/replacement A ()ther: -_ _ 'J Partial
JOB SITE INIFORMATION
Joh address: r S�. kiA)&_S foes i,_ Bldg. no,: Suite no.: 7TaX Inopltax 101/aCCUIIM no.:
LoDlcxk: Subdivision: GtAvN L
Project name: (4tky i L� lc ,tT1-y. 17eseription and location of work on premises: U )Il r 0 L, _
Estimated date of completion/inspection
CONTRA(7YOR APPLICATION KE SCIWI11311
Job no: Fee Ma%
Uescripfiun Qtv. (ea.) 'luful , no.Insp
Nen residential single ur multl-family per
Address: • 'Or! �). 7 �� ) Ci�� dnellingunit.Includes atn)cix-dgarage.
('fly: L 's, State' ) y I ZIP: el7 Seri Ice Included:
Phone: ?r' l L ���"C i Fax: ' Eil: 1000 sq It or less
e l 1 (s -ma __---- Each nddilional 500 sit It or purGon thereof
CCl3 no.: I y lace.bus. {ic.no: 3
-.� �_t—�-r Limited energy,res;denliul
City/metro lic.no.: 0000 6 S Is _ Limitedenergy,olio-residential
- � Each manufactured home or modular dwclhng
Slgnatuic rl supervising el ician(required) [)life Service and/or Netter
License no 2.312 Lt 01 Seri Ices Or feeders-In<tallation,
Sap.CICcI IIaII1C(prllll). I l_ L. (� alteration or relocutfufl:
PROPERTY OWNER200 allips of less _
n r
Name(print): l 201 amps to 400 amps
� 1µJtu�tp,Lt,.. _
401 amps to 600 amps
Moiling address: 601 mops to 1000 amps _
City: Male: ZIP: Over 1000 amps or volts 2
Phone: Fox: E-mail: Iteunulectonl) l
t)tuner installation:The installation is being made on property { own leruporary wr)ices or feeders-
wbrcll is nut intended for sale, Ir l,r. rent,or exchange according to Installation,alreratlon,ort�„.cal' ^
(
2
WS 447,455,479,67O,7[)1 amps less
?0011 amps 10
t0o AOIJ amps
(loner's si mature: I J,uc -101 to 000 un„—r ---
Branch circuits-new,nttetaliuu,
or extension per panel: I
Name: `
_ A Fee for branch circuns is lth purchase of
Atldl'ev, service or feeder fee,each branch circus '
CitPhtn)c - Stale: —1 I I P Vii.,�,`sefor
ibranch
e or IvedebrancluIM 11111 I i.pu n c U;
Ult
IIIIAN cheek all 1111thit apply) Mise.(Service orfeedernot inclu(led):
J Servicc over 225 amps-commercial J I lealth-carefacility Each puinp or intgation tittle I 2
J Seryice over 320 amps-tali ng of I&2 U Hazardous location Each sign or outline lighun
familydwcllings UBuilding over loA)0square feet four or Signal cIrcuil(S)orallrliltedenerglPanel.
J System over 600 volts nominal more residential units in one strut Lure altcrat)un,or extension'
J I)uildnigover three slurics LI Feeders.400an,psot more 'Desert tion
J t)ccupan)load ovet 99 persons J Manul actured sWvciutes or It V pal Lach additional Inspection over the allovialde In ant of fill'a
1 lw,e
J FTress/hghtingplall J()[her _. _ __ Ncnnspcction f— _ .
----- - —�- 1 L_
Submit—sells of plans with any of the above. investigation tee_
The above are not applicable to temporary construction sersice. Other -
Pennit fee......... . . . ~yy
Not all Junxhcuons n'eepr credo cards,please call JurixdirUun fur none u,furmaoon Nplll'e: I'ItIS perfttll application
J visa U MasterCard expires if a permit is not ubt4incd Plan review(at i W
t'Irdo card number _ within 180 days after it has hoen State tiurcharge(80/I . .. $ _
xpurs accepted as complete I MAIL,
Name of cardholder a shown on credit card
S
L7_w7hc halder si nature �_ —� --Amount 44,Ont s JWJu t t)Sl k