13285 SW KINGSTON PLACE ,.. :,,...:.,...:�,, .:✓.e. ,fix, . �.
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13285 SW Kingston Place
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BLIP
Received ___ —_.Date Requested 2 b Q .3 —__-_ AM PM -- BUP
Location 3� ^_ k, - -
� ?..� S� � < --. Suite -- - ------- _-- MEC --
Contact Person Ph( ) _- PLM
Contractor_._____.-_______ --___ _ Ph
BUILP',NG TenantiOwner ---- _ _ _-__-_- - -- - ELC -------------- —
,'uoting ------ ELC
Fouiidation -
Access:
Ftg Drain ELR -- - -- - -
Crawl Drain
slab Inspection Notes. Sht —
Post& Beam --- - ------- -.....
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear - -
Framing
Insulation
Drywall Nailing ! — - — — — - -
Firewall
Fire Sprinkler --- --
Fire Alarm
Susp'd Ceiiing -- --
Roof
Other:
Final
PASS PART FAIL _
Fi.Ut1AslNG '
Post& Beam _ --.--...-
Under Slab — --- -
Hough-In
Water service
7.P. it'.ry Sewer
- ---
Ga;ch Basin/Manhole
Storm Drain — --
Sho' r Pan
Otr -------- - -- -- - -- - --- - - ----- --- - - -
Fi J
ASS PART _FAIL
r ,IECHANICAL
Post& Beam — r
Rough-In -------- -- - --
Gas Lire
Sr,ioke.Dampers -_ --- _ ._ --- --- --- -- ----- -- -- --- - -Final
p09S.--P T FAIL
ELECTRICAL)
Service - --_-- -
Rough-In
UG/SIat2 - �� --- ------ - -- - --
Fin y Reinspection fee of� _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PA* PART FALL_
SITE FPlease call for reinspection RE: _ -- __— Ll Unable to inspect no access
Fire Supply Line
ADA
Approach/Sidewalk Date r� 2 .. Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PAPT FAIL
CITY OF TIGARD 241.-Hour
BUILDING Inspection Line: (503)639-4175 MST 7n
INSPECTION DIVISION Business Line: (503)639-4171
S�f BLIP
Received Datp Heyiested — AM PM BLIP
Location 4isL_ Suite MEC
Contact Person PLM
Contractor SWR
BUILDING Tenant/Owner ELC --------
'-F0-6j7
ing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Sh(-ar
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
1.3usp'd Ceiling
Roof
Other. ------
Final
PASS PAPT FAIL
Post& Beam
Under SIW
Rough-In
Water Service
Sanitary Sewer
Rain Dre'os
Catch;3asin Manhole
Storm Drain
ShowerPan
'�F'
P40 PART FAIL
MMHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire_ arm
AS PART FAIL Reinspection fee of required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please of spection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk, Date Inspector Ext
--
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF"i"IGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BLIP —�—
Hecelved ________—.___.— Date Requested__ �a— ____ AM— _—PM_ _.�_ BUP
Location —_---/ Suite MEC --
Contact Person Ph(--) PLM -----------_ __--
Contractor_— ------- ---------- -- Ph(_ - ) ----_____ —_____---- SWR
_BUILDING Tenant/Owner _ __ —_,_.__-_ ELC
Footing -- � ELC _
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: Sir
''o , & Beam - -- - -- - - - --�._..
She Anchors -�
Cir' ,neath/Shear
Int Sheath/Shear
Framing A- _
Insulation �'� CJ ��
Drywall Nailing
Firewall
Fire Sprinkler —
Fire Alarm
Susp'd Ceiling
Roof
Other: -- - —
n � _
_ S ART L r —
U IN_a —---- —-— ----
Under Slab --
Rough-In
Water Service -
Sanitary Sewer
Rain Drains --- - - -- --
Catch Basin/Manhole
Storm Drain -- - ---------- —
Shower Pan
Other ----- .------ - -
Final
PART
PASS FAIL --------- - --- - ----- - -- --- --
ASS _
_MECHANICAL
Post&Beam
Rough.In - -- -
Gas Line
Smoke Dampers --- - - -
SS t PART FAIL -
TRICAL
_.._------.__----
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_
SITE _�r ❑ Please call for reirs.nection RF: _T_____—_— _—_- Unable to inspect-no access
Fire Supply Line -17
ADA c7� � �`
Approach/Sidewalk Date _.irJ _ Inspector_--.. —__Ext
Other:
Final DO NOT REMOVE it%!- inspection record from the joh flkite.
PASS PART FAIL
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CITY OF T I G A R D MASTER PERMIT
DEVELOPMENT SERVICESPERMIT#: MST2002-00070
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 3i6/03
SITE ADDRESS: 13285 SW KINGSTON PL PARCEL: 23104DA-19500
SUBDIVISION: QUAIL HOLLOW- SOUTH ZONING: R-4.5
BLOCK: LOT: 021 JURISDICTION: HG
REMARKS: SP rowhouse, Unit#21, Bldg 3, AS play,
BUILDING
REISSUE STORIES: 3 FLOOR AREAS
_ REQUIRED SETBACKS REQUIRED _
CLASS OF WOR!i: NEW HC!,HT: FIRST: 172 of BASEMENT: of LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 733 of GARAGE: 547 of FRONT: PARKING SPACES!
TYPE OF CONST: 5N DWELLING UNITS: t THRD 733 of RIGHT:
OCCUPANCY GRP: R3 SDRM: 2 BATH: 2 TOTAL: 1,638 of VALUE: 11311 203 80
REAR:
PLUMBING
SINKS: I WATER CLOSETS: 2 WASHINri MACH: 1 LAUNDRY TRAYS: RAIN_P;MN: TRAPS:
LAVATORIES: 2 DISHWASHERS- 1 FLOOR DRAG S: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: I WATFR LINES: RCKFLW PREVNTR: GREASE TRAPS:
-- MECHANICAL OTHER FIXTURES:
FUEL TYPES TURN r 100K BOIL/CMP<3HP VENT FANS: 3 CLOTHES DRYER: i
LPG FURN>•10JK. UNIT HEATERS HOODS: I OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPEC1IONS
1000 SF OR LESS: 1 0 200 amp: 1 0 - 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPEC71ON:
EA ADD'L 50OBF: 3 201 400 amp: 201 - 400 amp: tat W/O 9VCIFOR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 600 amp: EA ADDL OR CIR, SIGNAL/PANEL: IN PLANT:
MANUHMISVCIFDR: 601 • 1000 amp: 901+ompa•1000y: MINOR LABEL
1000+amplvolt:
Reconnect only:
PLAN REVIEW SECTION
>-4 RES UNITS: SVCIFDR>=d25 A.: >800 V NOMINAL. CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIALELECTRICAL
COMMERCIAL
AUDIO d STERFn VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCCMIPAGING: OUTDOOR LNUSC L 1:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS-
Owner: Contractor: TOTAL FEES: $ 5,500.08
This permit is subject to the regulations contained in the
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES, LLC
Tigard Municipal Code,State OR Specialty Codes and
12670 SW 68TH PKWY STE 2.00 12670 SW 68TH PKWY all other applicable laws work will be done i
PORTLAND,OR 97223 PORTLAND,OR 97223 p
accordance with approved plans. This permit will expire H
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION.
Phone: Oregon law requires you to follow rules adopted by the
501-;98.7565 Phone: 503-595-7565 Oregon Utility Notification Center. Those rules are Set
forth in OAR 952.001-0010 through 952-001-0080. You
Reg 0: I IC' 124627 may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion Control Insp 8, Slab Insp Plumbing Top Out Exterior Sheathing hist Electrical Final
Sewer Inspection Plm/undslb Insp Framing Insp Firewall Insp Plumb Final
Footing Insp Electrical Service Gas Line Insp Gyp Board Insp Building Final
Foundation Insp Electrical Rough-in Insulation Insp Water Line Insp Final inspection
Wtr Proofing Bsm't We Mechanical Insp Shear Wall Insp Smoke Detector
Issued By : .Icl _.
Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an Inspection needed the next business day
'r„
7
CITYOF TIGARD SEWER CONNECTION PERMIT
SWR2DEVELOPMENT SERVICES PERMIT#:DATE ISSUED: 3/6/03 3/6/03 2-00045
13125 SW Ha' Blvd rigard, OR 97223 (503) 639-4171
PARCEL: 2S104DA-1 J5UO
SITE ADDRESS; 13285 SW KINGSTON PL
SUBDIVISION: QUAIL HOLLOW-SOUTH ZONING: IIG
I
BLOCK: LOT: 021 __ _ JURISDICTION: fl �_—_-- _
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 SIE 200 -- --- --PORTLAND, OR OR 97223 [SWUSA]Swr Connect 3/5/03 $2,300.00
[SWUSA]Swr Connect 3/5/03 $0.00
Phone: 50:-s'�X-7;0, [SWINSP]Swr Inspect 3/5/03 $35.00
[SWINSP]Swr 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
ch-.;l 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
/ r
Permittee Signature:
Issued by:
Call 1503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
Datereceived: Pep mitno.:NiT'�,ca,'(vro�
City of Tigard
Chy a%Tignrrl
Address: 13125 SW Il t ProJecdappl.no.: i3r,,ircdate.
Phone: (501) 039-417 Date issued: Receipt Receipt no.
Fax: (503) 598-1900 BBBBBB Case file no.: IPaymenttype:
Land use approval. I&2family:Simple Complex:
❑ 1 &2 family dwelling or accessory _ mercial/industrial U Multi-family U New construction ❑Demolition
U Addition/alteration/replacement U Tenant improvement U hire sprinkler/al:rrn CI Other:
li SITE INFORMATION
Job address: I�-r A , �u c { Bldg.no.: Suite no.:
Lot: .11 1 Block: Subdivision: ' Vii` ��a,;� - _-rete I"/ I Tax map/tax lot/account no.: g
Project name:
Description and location of work on premises/special conditions:
FOR SIPFCIAL INFORMATION,
Name:
Mailingaddress: 61 &2 family dwelling:
City: o Statc:0R ZIP: t� _ Valuation of work........................................ $
Phone�y -' - Fax: F' mail: No.of bedrooms/baths.................................
Owner's representative: r' Total number of floors.....................
Phone: Fax: ...r f mail: New dwelling area(sq.ft.) ..........................
joij
Garagc/carpor.arca(s+ft.).........................
Nanta v�� �,�_ ,* Covered porch arca(sq. ft.) .........................
Mailing address SLJ _ Deck area(sq.ft.) ........................... ............
City: h _tate: ZI Other structure area(sq. ft.)..................I......
Plnonc: Fax: &mail: Commercial/indastrinl/multi-family:
1 RA(TORValuation of work......... .... ......................... _--
Business name: (j 0 W Existing bldg.area(sq.ft.) ..........................
r ti t
g^ _ New bldg.area(sq.ft.)................................
Address:
'
5tale�. ZI
Number of stories........................................
City:
Type of construction........................ ...........
Phone - - Fax:62p.c -mail;
CCB no.: �Cl New:
- Occupancy group(s): Existing:
City/metro lie.no.:
Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: �_ (�j provisions of ORS 701 and may be required to be licensed in the
- _ jurisdiction where work is being performed. If the applicant is
Addres:_..L�.QL_C1r VC,_.�c,.���e. 0.1.-� j g Pe
City: �, State ZIP: exempt from licensing,the following reason applies:
Contact person: Plan no.: _ — -
Phone: Ix: h-mail —
Name: - ¢ Contact person: Fees due upon application ........................... $
Address: w t 4„c c4 Date received:
City: tate: ZIl': 3 Amount recd ved ......................................... $
Phone: _ p Fax: E-mail: Please refer to fee schedule. --_
hereby certify I have read and examined tris application and the Not an jurisdictlorn accept credit war,pteue W1 iurtAcuon for mote information.
attached checklist.All provisions of laws and ordinances governing this OVisa t]MasterCard
work will be complied yitp whethe ed herr.in or not. eYedp card number.
Flap
Authorized si re: — �tt: �. Name of cardholder u shown on credit real _—
Print name S —
. �___--------- Cardhnldu alanatore Atrvwot
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613(b(YWOM)
Plumbing Permit Application
- Date raxivea: Permit no.:
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl no.: - Expiredatc:
City of Tigard Phone: (503) 639-4171 -- - --
Fax: (503)598-1960 Date issued: By: Receipt no.
-rse file no.: Payment type_:
Land use approval: _—--
0 1 &2 family dwelling or accessory 0 Commercial/industrial
U Multi-family U Tenant improvement
0 Ncw co t'
U Addition/alteration/replacement U Food service U Other:
Descrintion Qt . tee(".) Total
Job address:( _ '� S W `��. .���ac�_-
_ - New 1-and 2-tamily dwejlingx only:
Suite no.: -, (Includes 100 ft.for each utility cOmwdiou)
Tax map/tax lot/accoun(no.: _ - SFR(1)bath
( ,� / Block: Subdivision: -� SFR(2)bath --
Project -__--
City/county: _Y ZIF': _ - Each additional batlt/kitc'hen
Site otWtler:
Description and location of work rite premises:- -- Catch basin/area drain
fhywells/leach lineltrench drain
Fst.date of completion/inspxtion: Footing drain(no.lin. fl.)
f Manufactured home utilities
B,'siness name: Manholes
Rain drain connector _ --
Wolcott 1'lumbtng -Sanitary ie.er(no.lin.ft.)
Stone sewer(no.lin.ft.)
PO Box 2007 Water service(no.lin.ft.)
Gresh. .1 OR 97030-0594 lrlxture or Item:
503-667-1791 Absorption valve
CCB:23847 PLM o/:26-208PB _ ---
�r Back Oow preventcr -�
Print name: Dam: Backwater valve--
1 Basins/lavatory -
Clothes washer
Name: - - Dishwasher
Address: ---_--- �- Drinking fountain(s) -- --
City: __ - state: _ Dectnrslsump _ --
Phone: lrax: G marl: Expansion tank
t IAN 111� Fixturr/sewer cep
Floor drains/floor sinkOiub
Name(print): _-- _.-- - Garbage disposal -_
Mailing address: F1ose bibb _
City: JNta _�`j'' - --- Ice maker -
Phone: - _LjFax: - Email: Inte or/grease tray---
Owner installation/resi�lential maintenance only: The actual installation Primer(s)will be made by me or the maintenance and repair made by my regular Root drain(commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),Icvs(s) _ - -
I)ate: um --
Owners signature:- -- Tubs/shower/shower an
r urinal _
Name: Water closet -__-_--
Address: -----_-- --- _- _ -_ Wateiheaut _
City: - _- State: ZIP: J--- Other.
Phone: Fax: `r�E-email: 7'oW
Minimum fee................$ -___---- -
Na sa)wiut✓bi soupy Vest ardk glare cal hcidredao fa more idanutlm Notice:T is permit application Plan review(al ` %) $
O Yeas U Msste Cud expires if a permit is not obtained ;tate surcharge(9%)....$ --
� cmd=raw - ___F�- within IRO days aflc it has beexr
_ TOTAL .......................$
accepted as comple+c.
N.me d a.!wader as Bowratai a s
11(11616(blldC01611)
MechanicalVermit Application7,v ,:
l Permit no.�City of Tigard .no.: Expire date:City of Tigard
Address: 13125 SW flail Blvd,'Tigard,OR 97223 Bv: RecciptnPhonc. (503) 639-4171 PaymentsFax: (503) 598 196(1 ylie_—
---
Building pennit no.:
Land use approval: _
illy Q
U Multi-family U Tenan,impmveuttnt
❑ I &2 family dwelling or accessory U Commerrialfindustrial - �-
U New construction U Addition/al'eration/replacement U Other: _
� S 111 A
( : t ' r' ,
to I c` Indicate equipment yuatttitics in hazes belc,w.Indicate the dollar
!ob address:f j `;_ S-_L1 value of all mechanical materials,equipment,labor o�erhead,
Sutte no.:
rBldgn --__ — profit.Value S _
IoNaccount no.: — See checklist for important.pplication information and
Block: Sut>•fiviston:----— jurisdiction's fez schedule for residential permit fee
:. 7.IP: 11 1W I 1and location of work on premises: — -- -- i er(►a) Total
— — pesniption _Qt . Res.oul• Rec.only
Est.date of completion/inspcction: C:
Tenant improvement or change of use: Air handling unit _Cllvl_--_--
Is existing space heated or conditioned?U Yes U No -Kir- .ion nng(site plan regt�)
Is existing space insulated?U Ye: U No Alicrat of n )Fexisting ( system -- _
'11 Lt r mol er comfxs
essor
1116 1 FAL
State hoiler permit no.:
BT1Jtll ---
�ir onto a amlx ductsmok.: etec.ors
Four Seasons I leating& A/C Service Inc eat pum—p(site fl,.,roqutt --
PO Box 66409 1 ata rep acefuroa7Urn er
Portland OR 97290-6409 Including ductwork/vent liner U Yes U No —-
503-775-5919 nstall/rep a relocate eatetr•-susPen ed,
ff'B: 48293 wall,or floor mounted_ --
ent fora fiance other t ran urnaa-
Name(please print): a era
CONTACT PIE1tSON Absorptionunita------- BTT1/11
HP
L
_ Com ressors—_.__ Ill _
_ _ __ -..------ _ onmentila— State: ZIP: _- ApplianceventFax: E mail: Dryer ex aust yl�eUiDreSTtticTic azmat
hood fire suppression system
Exhaust fan with single duct(bath fans) —
Nnme: `__ - - — ElTaust system a art rem heaun orC
_Mailing address: __ - p� st�r on up to ou ets)
City: _— State: ZIP: TYPe Li'G NC; C)il _
phone: Fax Email: tie l to eac a iticnal over outlets
L'i HUS LU asp p (st emaUcrequi )
Numlter of outlets --
Name: __ —_-----._ t6er- tit-erapp wKc or eq pineal:
Addrr s Decorativefrreflace _ --
_ Insert-type _
City:
ctoveTpcl etatove
Phone: - Fax: E marl: er:
Applicant's signature:- Date- _ U
Name (print) — - - - Permit fee.....................$
Nd an Juri�tictiarn aur{•anal rardt,Okatt call peiulic60"far mare 4damrtim. Notice:This it hexGOn '
t app Minimum fee............. $ _
O crus O MasterCard expires if a permit is not obtoi,ted Plan review(at _ %) $ — ---•
�r cad 00n*,M --- ---- Eat- within 1 Bo days after it ho been State surcharge(840)....$ - --
accepted as complete. --
_— Naim d ccdt+nlda a as reedit crd TOTAL .......................$
—_---`— Cardfwlder Hraatue _-- Ara°aa�
Electrical Permit Application
-- Date received: Permit no.:
City of Tigard Project/appl.no.: Expire date: — —
C:iq n(Tif arA Address: 13125 SW Hall Blvd,T�pard,OR 97223 Date issued: By:— Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERNUT
U I &2 family dwelling or accessory U Commercial1industrial U Multi-family U'renant improvement
U New construction U Addition/alteration/replacemei,t U Other. U Partial
1 1 'y 1
131dF. n Suite ria: Tax map/tax lot/account no.:_^_-_
l.ot 2.L_ Block Subdivision:
Project name:, _ -- Description and location of work on premises: _
Estimated date of compaction/inspection
1L1111W.1 W WIFILS11 I1
Fee Flat
Job no: __ ------— .DesertP tion Qq. (n.) Total -10.ins
.JEROME I LECTRIC New residerrtLI-tthngieofaarltl—tandlyper
dwelling mit Inclstil s attired Rarage.
PO BOX 7`1 ServicehKiand:
1-11 LLSBORO OR 97123 1000.,.q n or less _ —_ _-- __--- _ — 4
503-h48-5144 Fach additional 500-Ili or portion thereof -
2 8 775 Limitrd energy.residential 2
CCB: 36051. EI.C: 34-119C SUP: Limitedenergy,non iL11:1enual_ 2
- --- Each manufactured home or modular
Each
Service and/or feeder 2
Signature of supervising electrician(required,, pate Servimorfteders-Irrdallaliun,
Sup.elect name(print). License r o alteration or relocation:
1 1 200 amps or less _ _ 2
201 amps to 4(10 amps — 2
Name(print): - 401 amps to 600 amps 2
Mailing address: _ 601 amps in 1000 amps - 2
City: __ Slate: ZIP: — Over 1000 amps or vohs - 2
Rernnnect ons
Phone: Fax:
Fr---m ail: ---
Owner installation.17ic installation is being made or property I own Temporary wi vires or feeder
which
orrcbcatlou:
which is not intended for sale,lease,rent,or exchange according to 200 amps
ORS 447,455,479,670,701. 201 amps to 400 amps
Owner's signature: Date: _ 401 to 600 s 2
Branch circaits-new,alteration,
of eIlenswe per panel:
NA A Fee foi lhranch circuits with purchase of
Address: - -_ service of feeder fix,each branch circuit _ 2_
�_— (ale: ZIP: B. Fee for branch circuits without purchase
City: of service of feeder fee,first branch circuit _ 2
Phone F tx' Tz�1.mail: Each additional branch circuit —
Mlsc.(Service or feeder not Included):
Each pump or irription circle 2
U Service over 225&nips tonmw•i'rel U Health-care facility Fach sign_or iffine h ncirc 2
U Service over 320 amps-rating of 1&2 U Hazardous location Stprod circuit(s)or a limited energy panel,
family dwellings U Building over IO,0Wsquare feet(our or g I 2
U System over 600 volts nominal rmne residential units u;one structure alteration,or extension• _ s
U Building over three stories U Feeders.400 amps or more •Gescn tion --
U Occupant load over 99 persons U Manufactured aructures or RV park Fach addiiitral Inspection over the allowable in w)of the above:
U Egress/Iightingplan U Other - _--- --- Perhnspect,on
Submit__Wil of plarm with may of the above. irrvestigeiirnr%tx _
The above ars not applicable to temporary construction service. Other _ _ -
Pctmit fee.....................$
Not W jurisdictions ecce"cm1ir cods,please call jurisdiction for more infarnatio n Notice Tltts permit application plan review(at _— %) $
–-
U visa U MasterCard expires if a permit is not obtained
credit card number _--__ ___ _____I�L._ within 180 days after it has been State surcharge(8%)....$
Expires accepted a+complete. TOTAL .....................S —
Nurr r!carsatoldrra
-ii—own nu--c�-card S
— Cardttddcr situature �_Atnount 4 l}4615 IfvOGCOMI
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX. 2007
G,2ESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2002-00070
Date Issued: 316103
Parcel- 2S104DA-19500
Site Address: 13285 SW KINGyTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block- Lot: 021
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse, Unit #21, Bldg 3, AS plan
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 return
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
OWNER: PLUMBING CONTRACTOR.
BROWNSTONE QUAIL HOLLOW LLC WOLCOTT PLUMBING CONTRACTOR:
12670 SW 68TH PKWY STE 200 PO BOX 2007
PORTLAND, OR 97223 GRESHAM, OR 97030
Phone #: 503-598-7565 Phone #: 667-1781
Reg 11: LIC 25847
PLM 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
--- =
Sig natureat--Aithcriz I,,.,rr ber
If you have ,any questions, please call 503.718.2433.
CITY OF TIGARD
131215 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
DAVID JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2002-00070
Date Issued: 3/6/03
Parcel: 2S104DA-19500
Site Address: 13285 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot. 021
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse, Unit #21, Bldg 3, AS pla.
Your company has been indicated as the electrical cont-a:- s,,, the permit indicated above. In order for the
electrical permit to be valid, the signature of the supe, uiectrician is required. Please have the
appropriate individual from your company sign bels . return this Electrical Signature Form prior to the
start of the work to the 'ddress above, ATTN: Buil ,ng Division.
No electrical inspections will be authorizeA 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 #: 503-598-7565 Phone #: 648-5144
Req #: Lica 36051
SUP 28775
FLE 34-1190
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature o -Supery ing E ec+.rician
If you have any questions, please call 503.718.2433.
ELECTRICAL PERMIT-
CITYOF TIGARD RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2003-00166
13125 SW Hall Blvd..Tiqard, OR 97223 (5031639-4171 DATE ISSUED:
17/03
EL: 2
P 19500
SITE ADDRESS: 13285 SW KINGSTON PL ZONING: R-4.5
SUBDIVISION: QUAIL HOLLOW - SOUTH JURISDICTION: TIG
BLOCK: LOT: 021
Project Description: All encompassing low voltage. —
A.RESIDENTIAL _ B.COMMERCIAL
AUDIO & STEREO: X AUDIO& STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE/IRRIGAT:
CLOCK: MEDICAL:
GARAGE OPENER: X NURSE CALLS:
HVAC: X DATAiTELE COMM:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
HVAC: PROTECTIVE SIGNAL:
OTHER: ALL ENCOMP : X INSTRUMENTATION: OTHER:
TOTAL#OF SYSTEMS:
Contractor:
Owner: AZIMUTH COMMUNICATIO14S INC
BROWNSTONE QUAIL HOLLOW LLC P.O. BOX 508
12670 SW 68TH PKWY STE 200 WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: 503-598-7505 Phone: 503-639-0110
Reg #: ELE 36-94CLE
SLIP 2312LEA
LI( 145929
FEES Required Inspections —
Description Date Amount Low Voltage Inspection
it l.l'RM`I'j L•LR Permit 3/17/03
$75.00 F_lect'I Final
1 A X 911 1,,State Tax 6117/03 $6.00
Total $51.00
This Permit is issued subject to the regulations contained in the Tigard unicipal Code, State of OR. Specialty Codes and
M
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started ollohw rules
0 days of s ado tedSsuance, or if by the Oregon Utility Notificationk is dfor Center. Thotse80 days.rules are set forth ION� Oregon law nn OAR 952001 001 O thrc�uc
you b follow p
Issued by 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 INSTALLATION ONLY
SIGNATURE OF SUPRDATE:. ELEC'N _ --- -- —
LICENSE NO:
Call 639-4175 by 7:00 P.M.for an inspection needed the next business day
Electrical Permit Application
— Date receiver-/"? ,�, Permit no.•;j/('- a _a)14
+1tV Of Tigard Projecdappl.no.: Expire date:
Address: 13125 SW Flall Blvd,Tigard,OR 97223 pate issued: 13y: _ Receipt no.
City of Ilgard Phone: (503) 639-4171Glse file no.: Payment ment I e:
Y type:
Fax: (503) 598-1960
Land use approval:
strial U Multi-lunuly Jlcn;uu inili ,rntenl
U 1 &2 family dwcllir g or accessory Addition/alter ion/rplacemcltt ❑Other: U Partial
Art construction
job address: /3 ' 5 A,16 L Bldg. no.: Suite no.: ITax map/tax lot aunt no.
Block: Subdivision:
Lot: � �__-__-- ---- -- -
Project name: C,(t� t_ cr<<rn bescription and location of work on premises: UO lir C L)
Estimated date of completion/inspection. {
,•. Mas
)lob not - Desertt ti„❑ Qly. (ea.) I ural no.insp
Business nafne: Z.1 M S&A" t' ry,e i I "J'5 New residential•%Ingle lir multi-6nnjls ewer
7.i/r dw ,ellhr unit.Includes altaclrs'l garngr.
Address!'-%,c �' ie A D
City: r . - State ) 7(P: ej G Service included: -- a
'
1000sq fl lir less
Phone: ri 1 FaX:�,� -L'I 1 S E Incl l: (lath additional 5110 sq f! or portions lhereol
CCB no.: ( ►E Z' Elec.bus. lie.Lo: ctV CC t' Limited energy.residential _ 2
2
City/ntetrolic.no.: (,1CC)[vG•+S Icl_ _- Limiledenergy_nun•residrnUnl
/U U U3 Each manufactured home or modular dwelling v
Date Service and/or feeder
Signator of supervising electric (required) __ 5erricrsorfeeden-installation,
I..icen%e no. Z 3 t 2 LO
Sup.elect name(print): I C alteration or relocation; 7
1,RopERty OWNER 200 snips or less l
t t 20!amps to 400 am s
Name(print); �(��!�J lv 1 b,�_I 401 amps to 600 amps
Mailing address. _ _. 601 amps to 1000 amps 2
St
- _ ate:_ V over 10(10 snips or volts
City: i
Fax: E mall: Reconnectmhl
Picone: Temponry services de
or feers-
Owner installation: ,"he installation is being made on property I own Installation,alteration,or relocation:
which is not intended for sale,lease,rent,or exchange according to 200 amps or less
ORS A47,455,479,670,701. 201 amps to 400 amps
O%vncr's 51 nature: _ l>;ur - -- 401 to 600 strips
Branch eircom-new,alteration,
or extension per panel:
Name: A Fee for branch citcu its with purchase or
service or feeder fee.each branch circus
Address: It '-cc for branch circuits without purchase
- State: ZIP: 2
Cll)' of service or feeder fee,first branch circuit
Phone' Fax: TIi-nail• Each additional branch ee r not rnot
Ise.(Service or feedIncluded);
Each pump lir irrigation circle 2
O Service over 225 arnps-conunercial J Health-care facility Each sign or outline lighting
U Service over 320 amps-rating of 1&2 U Hazardous locauot+ Signal circuit(s)or a linuted ever anal.
U Building over 10.(100 square feel four or g Fy p 2
family dwellings g alteration,or extension'
U System over 600 volts nominal more residential units in one structure
U Building over three stones J Feeder,400 amps or more •Descn lion —
tkcupantload over 99 persons J Manufactured structures or RV park Each additional Inspection over the ellowabie in any of the above:
U Fghcsslhghangplan J Other ferrnspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. ()(her _
-- Permit fee.....................$ -
lJor all funsdi:nom accept credit tarda,please call jurisdiction for more mfrxmation Notice: this permit application plan review(al %) $
U visa U MasterCard expires i1'a permit is not obtained State surcharge(8%) $
C'redrt card number -_ — — ` within ISO days after it has been
-"•'- Expires accepted as cornpkle, TOT ....... ...3r _�--
Name of cardholder u shown on ere it car _ S
.t.r110I1iMxvl'i.HI
Cardholder stpnuum Amount