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13325 SW Kinnston Place
A CITY OF TIGARD MASTER PERMIT___
PERMIT#: MS 2002-00064
DEVELOPMENT SEROIiC ES DATE ISSUED: 2/15/03
13125 SW Hall Blvd. Tigard,OR 97223 (533) 639-4171
SITEADDRESS: 13,25 SW KINGSTON PL PARGEI.: 2S104DA-19100
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4,.�
BLOCK: LOT: u17 JURISDICTION: 'I'l(i
REMARKS: S
BUILDING
REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK, NEW HEIGHT: FIRST. 17; of HASFMENT: �of LEFT: SMOKE DETFCTORS: Y
TYPE OF USE: SFA FLOOR LOAD: 50 SECOND 733 sf GARAGE: 547 t f FRONT: PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: I THRO 733 of RIGHT:
_''Z;uPANCYORP: R1 DORM: 2 CATH: 2 TOTAL: 1.636 of VALUE.: 162,203 80 REAR:
PLUMBING ^�
SINKr,: I WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS. RAIN DRAIN: TRAPS:
LAVATT,RIES. 2 TIISHWASHERB. 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS. CATCH BASINS.
TUBI-.10WERS: GARBAGE DISI• 1 WATER HEATERS: 1 WATER LINE:: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
_ MECHANICAL
FUEL TYPES T FURN<100K: BOIUCMP<3HP: VENT FANS. - CLOTHES DRYER: I
LPG FURN-10014: UNIT HEATHRS! HOODS. I OTHER UNITS:
MAX INP bb, FLOORFURNANCES: VEN'iS: 1 WOODSTOVES, GAS OUTLETS: 1
ELECTOCAL _
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS_ GRANCH CIRCUITSMISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS. 1 0 •200 snip: 1 0 - 200 amp: WISVC OR FPR. PUMPIIRRIGAT.ION: PER INSPIrCTION:
EA ADD'L 5003F. 1 201 - 400 amp: 201 400 cep. 1st WIO SVC/FDR SIONfOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 . 600 imp EAADDL BR CIR SIGNAUPANEL: IN PLANT:
MANU HMISVCIFDR 401 1000 amp: 601-amps-Imov. MINOR L.AbZL:
1000+■mp/volt:
PLAN REVIEW SECTION
Reconnect on1v:
)-4 RES UNITS SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL •RCorRICTED ENERGY_
A.SF RESIDENTIAL B.COMMERCV,L
AUDIO&S tREO: VACUUM SYST4 M: AUDIO 6 STEREO: FIRE ALARM INTERCOWPAGING: OUTDOOR LNOSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIONL:
GARAGE OPENER: CLOCK: INSTRUMENTATION, MEDICAL. OTHR:
HVAC: DATATTELE COMM: NURSE CAI LS: TOTAL 0 SYSTEMS:
Owner: Contractor:
TOTAL FEES: $ 5,500.08
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES,LLC This permit iE subject to the regulations contained in the
12670 SW 68TH PKVVY STE 200 12670 SW 68TH PKWY Tigard Municipal Code,State k w Specialty Codes and
PORTLAND,OR 97223 PORTLAND,OR 97223 all other applicable laws. All work will be done
accordance with approved plans. This permit will expire if
work is not started within 180 days of Issuance,o,-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 rules are set
forth in OAR 952-001-0010 through 952-001-9080. You
LIC 124627 may obtain copies of these rules or direct quel,lions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Sewer Inspection Plm/undslb Insp I raining Insp Firewall Insp Plumb Final
Footing Insp Electrical Service Gas Line Insp Gyp Board Insp Mechanical Final
Foundation Insp Electrical Rough-in InSL'lation Insp Water Line Insp Building Final
Wtr Proofing Bsm't Wa Mechanical Insp Shea:Wall'�Tsp Smoke Detector Final inspection
Slab Insp Plumbing Top Out Exterio:SheathlnC Ins[ Electrical Final
Issued By . _� � ��y�1/ / ' Permittee Signature dl��
Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day
CITU OF TIGARD —SEWER CONNECTION PERMIT
DEVEL WMENT SERVICES PERMIT#: SWR2002-n0041
13125 S'V Fall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/19/03
SITE ADDRESS, I s32534 KINGSTON PL PARCEL: 2S104DA-19100
6013DIVISION: WAIL 1101-10W -SOUTH ZONING: R-4.5
BLOCK: LOT, 017 _ JURISDICTION: TIG —
TENANT N ME:
USP. NO: FIXTURE UNITS:
CLASS OF WORK: NEV) DWELLING UNITS: 1
TYPE OF USE: GFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: S
Owner: -- -- — --- -- FEES
BROWNSTONE QUAIL HOLLOW LLC
Description —gate Amount
—
12670 SW 68TH PKWY STE 200 ---
PORTLAND, OR 97223 1SWUSAI Swr Connect 2119/03 $2,300.00
1SWUSAI Swr Connect 2/19/03 $0.00
Phone: 503 c's8-7545 ISWINSP] Swr Inspect 2/15/03 $35.00
ISWINSP] Swr Inspect 2/19/03 $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 riot so located, the installer shall purchase a "Tap and Side Sewer' Perm
Issued b Permittee Signature: y Y
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
eeivPerm City of Tigard Dated a
Project/appl.na.: t' date:i
City cJTigard Address: 13125 SW {all BRIMk& 9 V
ED
;:one: (503) 639-4171 Date issued: — Ny:�,_ t' Rece pt na.:
Fax: (503) 598-1960 Case file no: Paym^.nt type:
Land use approval ISc2 family:Simile Complex:
e
U I &2 family dwelling or accessory U CommerciaUindustrial U Mult. family 0 New construction U Demolition
U Addition/alteration/replacement U'renant irnprovemcm U Firc sprinl1er/alarm U Other:
{ 1 1
Job address: ��_ . .C_ Bldg. no.: Suite no.:
Lot: {clock Subdivision: l( ;( �.� ,(T# I Tax ma /tax IoUaccount nt.: ,�5/Otfr�tq +QN,,17
Project name:
Description and location of work on premises/special conditions:
Name: t o
S �s—_QSw �c1L
Mailing address: ��;�>�^C�. tN _ 1 &2 family dwelling:
City ro I tti u. State:OR 7,I1) Valuation of work........................................ '6
PFtonc -A5 No.of bedroonm/baths.................................
Owner's representativ.: ' Total number of floors.................................
Phon^. t -r Fax: _s E-mail: --
� New dwelling arca(sq. ti.) .........................
(;arageicarp)rt area(sq. ft.).........................
Nance: _ - In �1Covered p„n•h area(set. ft.) .........................
Mailing address: .S f el _ Deck area(sq. ft.) .................................... ...
_
LI f q 4c? ? Other structure area(.sq. .ft.)
............... . ......
Phone: Fax: E-mail: Commercial/Industrial/rnultl-family:
tPValuation of work........................................ $ ----- --
Existiny hldg.area(sq. ft.) ..........................
--- -----
Business name: r u, ,A _ 4t Lb::�:_ New bldg,area(sq.ft.)
Address 0 g aL.S��� r ............................... --
l'it Slate (I"'ZI Number of stories........................................ __--
1'hone _ _ Fax:6 zp e .mail: Type of construction.....................................
- - �'��— --- -- Occupancy group(s): Existing:
--
CCB 70_— ILL y b A —__�
-- _ New:
City/metro lie.no.: — Notice:All contractors and subcontr•3etors are r..quired to be
r. liceriml with the Oregon Construction Contractors Roard under
Narrte { s (,Q provisions cf ORS 701 and may be required to be licensed in the
_Ad�dres�s:_ r jurisdiction where work is bring performed. If the applicant is
Citv:�• 1.IA _. _ State ZIP: exempt from licensing,the following reason applies:
_Contact persow A I'm no.:
Iruiai1: -- — -- _.. ---
Name: L �' Contact person: p t&N Fees due upon application ........................... $ -_--!
At dmsS: 6 < w Date received:
City: c,- _ r tateZIP: _ ��3 Amount received ......................................... $--------
.Ahp_r FaxA F mail _ Please refer to fee schedule. _
I hereby -ertify I have read and examined this application and the v Nd all)uriadicaotu atom tit rards,please call jurisdiction for nxmr lntoxmarion
attached checklist. All provisions of laws and ordinances governing this U Visa U MasterCard
work will be compliedO whether ' ed herein or not. Credit raga numxr
Authorized sign - 1 � —= Non-
Print
acaroduu�mm oo r canf
UP
IMS
ar
Print name _ IC _,y ` -S
Canirwldet ilanattue Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted m complete. 440-4A I I tt OW)OMr
Plumbing Permit Application
City of Tigard Daterxeived: Permit no.:/+/ CD2•t .�
Address: 13125 SW hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.:
City of Tigard phone: (503)639-4171 Prqject/appl.no.: Expire date:
Fax: (503)598-1960 Dateissued: --- E:y_ Receipt
Land use approval: -- .:ase file no.: Payment type:
C I &2 family dwelling or accessory U Commercial/induscial C Multi-family 0 Tenant imps;„enrenl
U New construction U Addition/alteratiorureplacemen( U Food service U Other:
JOB SITE INFOliNIATION
' , ,
lob address:f �_� 5 SUS �� —�- f7[ g- �+cri tion
_tel_ 'L_� 1�ec(ea. Total
Bldg. no.: __ 1 Sun. 1'dew 1-and 2-[amlly dwellings only:
-`�_---- '.Ddud.100 ft.for each utllit
_Tax map/tax IoUaccount no.: YcotDectlou)
1.cx: Block: Subdivision: 'I??(1)bath
_SFR(2)haUi
Project name:
City/county: __v---- ZIP; --- Lech additional bath kitchen— _ I
Description and locatin• of work on premises: Site utWties-tch hisin/area drain CaI
Est_date of a tnpleLion/inspeetion: — — Urywclls�eaclintrench drain —
PLUMBING Ct Footing drain(no. lin.
Manufactured home utilities -'
Wolcott 1'lunlhing Alanholes _ - -
PO Rox 2007 Rain drain conal .tor -
Gresham t)R 97030-0594 Sanitary sewer(no. lin. ft.)
503-667-1781 Storm sewer(no.lin. ft.)
R 17 I'1 �1 ii;2G-208PR Waler service(no.5n.ft.)
_ Uxtrrre or Nem:
Contrecter s rpepresentative signature: Absor 'on valve
Print name: - _ --- Uatr. Beck flOwprcventer
Backwater valve
tiesins/lavatar --
Name: Clothes washer --
Address: i Dishwasher -
City: A State: Zfp; Drinking fountains)
Phone: �� Ejeetors/sump
Fax: E-mail: Mpansion tank —
Fixturelsewercap -
Name(print): Floor drains/floor sinks/hub
Mailing tultiress: — - Garbage disposal - —
Hose bibb —
City_ ZIP: — Ice maker ---
flrgn� ^_ Fax: E-mail: —
—� lnrcx�or/g
teres.”trap _--_
Owne, installation/residential maintenance only: TFu rMhra! installation Fiimer(s)
will be made by fine or the maintenance and repair made Ly my regular Roof(fin(commercial)
employe^_on the property 1 own tts per ORS Chapter 447. Sink(s),basins ,lays(s) -
Ownet's signature: _ Date. Sump -
'irlTubs/showcr/shower pan — —
Nar:ie: Urinal- _ --
Address Water closet _ -
-- Water r
Other. - ---
Phone: E-snail_ Tdal -
Na W jrei�icllm WTI G&I Mrd►01—call JuH1"m . ;finimum fee.................$
0 Vita U MuteWard Notice ThI+cnnit application
ex rir-s if; Plan review(at _`. % $
Cyt cid� f permit is tart oblained ) -- ._
-� -`-- -=e - within 180 lays a,ler it her been State surcharge(8%)....$
--N—.m- aCrtarnJoh
accepted 6.Ont{l ste TOTAL ......................
�M _
1101616(60(1"OW
Mechanical Permit Application
Date received: Permit no.:MST QAC L 'i G
City of Tigard ProjhxUappl.no.: N.xpiredate:
City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97221 —
Phone: (503) 639-4171 Darc issued: — _ By: Receipt no.:
Fax: (503) 598-1960 Case Iileno.: Payment type:
Land use approval: _ Buildlog permit no.:
TVPC1 .�
U 1 &2 family dwelling or accessory U Commeruial/industrial U Multi-family U'renant ifr pmveme.nt
U New construction U,Addition/afte.ratioti/rr.placcment U Other: _--
t MIT INKWMATIONffL, 1VALVATIOASCHEDULE
lob address: 3��-j ' .Sw — , Indicate equipment quantities in boxes below.indicate the dollar
Bldg.no.: Swte no.: value of all mechanical materials,equipment,labor,overhead,
Tax lnap/tax lot/account no.: pr^f".Value S
Lot Block: Subdivision:_ •Sec checklist for important application information and
Project name: jurisdiction's fee schedule for residential,emit fee..
City/county:
)Description and location of work on premises: PE
1
_ — Fee(ea.) ToW
Est.date of completion/inspection: _ _ DQty. Rrx.onlY Res.ewly
Tenant improvement or changr of use:
Is existing space heated or conditioned?U Yes U No Air handling unit —_— CFM
Air conditioning(Rite plan n require )
Is existing space insulated?C]Yes U No teraxrsungHVAC system ---
1 1 mailer/compressors ---
State boiler permit no.:
Lour Seasons I leasing& A/C Service Inc NP —_Tons___—BTU/tlF�Us
PO Box 66409 sonoa arnpers/duct amo c detectors
Portland OR 97290-6409 eat pump — plan requu j
nstalUroplaZece fumacc�rner
501.775-5919 Including ductwork vent liner U Yes U No
('('L': 48283nst�Ihcplacereoc�ateheaters--suspended, ---
_ _ wall,or floor mounted
Name(please print): Vent for appliance other than furnace—�— —
1N R
'TAtT PE SON cy a
Absorption unitsBTU/ _
Name: Chillers-_ -_- —_ Hp _
Address: _-- -- Compressors___ HP
kbTiMUMMIL&Itu'1 iia Ten on:
City—_—` State: ZIP: Appliance vent
Phone. Fax: E-mail: Dryer exhaust — - --' —
1 s,Tyin res. tc icTi Te`n/ha7inat-- --� ----
hood fire suppression system
Name: _ Exhaust fan with single duct(bath fans)
Mailing address: — �— Faust rystteem a an m.a reattn oruC
ne p! Tpin iibwt on up to oar eLs
City: -- --- — State: ZIP: Type: LPG -- NO __ Oil_
Phone: Fax E-mail: ucl r:rn 'eachi7diticnal o�ovtlet —
roemp P (schematicrequt.-ii)
Name: Nnmtxr of outias
Address:---1-- --- ---- -� er app nc
aeor-ijuilp teni:
_ _ _ Decorative fireplace
City: — state: ZIP. ns_crt-type — '---- — —
Phone: ___
Fax: E-mail: W tov pc etstove
Applicant's signature: tate: ther-
cr.
Name (print): -
No w juri.ekuom aenept cr�h c",place call rr"ctim f !luticx:This permit application ar nae WmhaGaa Permit fee...............�5
VMS -- _.
U a U MasterCard Minimum fee................$
expires if a permil is not obtained
rpt card.omtrr ----[ �_- Plan review(e( %) $
_ Fxprhra within 180 days after it has been State surcharge(11%)....$
N ow d cxitx leet rm_J m haeea,�.rd v accepted as complete. TOTAI. .......................S _
--
--—_ Cardbolder daammv �-— -- --Amomh_ 440-4617(GODODW
Electrical Permit Application
Date received: - – Permit no.: q4r�00 •Q�'�2
City of Tigard Project/appl.no.: Expire date:
ML
fln n Address: 13125 SW Rivd,Tt),ard,UR 97223
J"1%f;nrd ys' luDate issued: � By. etptno.:
Phone (503) W94171 --
Fax: (503) 598-1960 Case file no.: Paymenttype:
Land use approval: .
1 '
U7iop
welling or accessory U Commercial/industrial U Multi-farnily O Tenant improvement
C] U Addition/alterauon/replacemcnt U Other: U Partial
11 f 1.lob �' 71r1g. 110.: Sui' n0.: 1 ax map/tax lotlsccount no.:
Lot: r BBlock: Su i��ision: — --•-- _ ___ ___ _—
Project name_ _ Description and location of work on pm.,iises�_
Estimated date oft- nnpletion/inspectrm
1 N I]R APPLICATION 7TEE SUIEDUIX
Job no: Ifee Max
---�.a....._..__.._..__ Description Qly. (ea) Total no.lns
Streamline Electric NewresideaWl ai�korrr>ttHl-famllyper
DBA LaValley Corporation dwelliMmit.Inciorksararl,edgrwW.
6025 East 181h St serumsola".
Vancouver WA 98661 1000 all it or less 4
Each additional 500 sq ft.or portion thereof
360-993-5080
Limited energy,
CCB:116514 ELC#: 34-432C StIP#: non-enUd 2
Littuled energy,twn•residendal -2
Each manufactured home or modular dwelling
Signature of supervising electrician(required) IJate Service and/or feeder -_ - 2
Sup elect name(priot) I.uen•rnl, Senlcesorfeeden-lirmalUtIon,
P1tallentiatr a relocation:
1 1 200 amp,or less _ 2
(lame(print): 201 amps to 400 amps — 2
- ------ 401 amps to 600 amps 2
Mailing address: 601 amps to 10(10 amps _ 2
City_ State: ZIP: Over 1000 amps or volt_ — _ 2
Phone: Fax: E-mail: Reconnect onlI
Owner installation:The installation is being made on property I own Temponryservkesorfeeders
which is not intended for sale,lease,rent,or ex(,hange according to kwallatlon,ahcrati n,of reloca:4on!
2
ORS 447,455,479,670,701. 01 amps or 2
W00
201 amps to 400 amps 2
Owner's signature: _ Date: 401 to 6(Ki amps -- 2
Branch circuits-new,rheral Ion.
or exleosloa per Panel:
Name: �N A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit _
C Ily: -�— Stale: Zip: B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
- fax E-mail: -- - ------
Foch additions;branch circuit:
Misc.(Service or(ceder not included):
U Servrcx over 225 amps-cornrnrtcial U Health-care facility Each pump or irrigation circle 2
U Service over 320 amps rating of 1&2 U Hazardous location Each sign or outline lighting - _2 _
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s)or a!irniled energy panel,
U System over 600 volts nominal more residential units in one structure alteration,or extension* 2
C3 Building over three stories U Feeders.400 amps or more +Ikscri tion:—`
1:]Occupant load over 99 persons U Manufactured structures or RV park Each additional ins"lon over the allowable N my of live above:
U Egressllightingplan U Other Per inspection
Submit!sets of plans with any of the above. Invutisarr>n fa
_ The above are not appOcobie to temporary coulruction service. ,i
CITY OF TIGARD
13125 S.W HALL E,LVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Farm
Permit #: MST2002-00064
Date Issued: 2119103
Parcel: 2S104DA-19100
Site Address: 13325 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 017
Jurisdiction: TIG
Zoning: R-4.5
Remarks: S
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 GREENAM, OR 97n-)n
Phone #: 503--'98-7565 Phone # 667-1781
Reg #: LIC 23847
PLM 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature uth ized Plumber
If .,ou have any questions, please call (503) 639-4171 , ext. # 310
CIT!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#: MST2002-00064
Date Issued: 2/19103
Parcel: 2S 104DA-19100
Site Address: 13325 SW KINGSTON PL
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 017
Jurisdiction: TIG
7oninv. R4.5
Remarks: SF rowhouse, unit#r17,Bldg 2, AS plan
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 Flectrical Signature Form prior to the
start of the work to the address above,ATTN: Building Division.
No alectrical inspections will be authorized until this comple'pd form is received
OWNER E-LLC 1 RICAL CnM*1RACTOR
BROWNSTONE QUAIL HOLLOW LLC DAVID JEROME EI_E(__;'RIC
'12670 SW 68TH PKWY STE 200 PO BOX 751
PORTLAND, OR 97223 HILLSBORO, OR 97123
Phone #: 503-598-7565 hone #: 648-5144
Reg #' LIC 36051
SUP 28775
ELE 34-119c /
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Xc_�_.�
Signature upervi q ,.rician �!
If you have any questions, please call 503,718 2433.
Lnoz iaia 9?7q aavgj,L HO U13 T99Ct'7,8C09 TVA 99.7.1 ]Hl C0i02/eo
ELECTRICAL PERMIT-
RESTRICTED ENERGY
CITY OF TIGA,RD
DEVELOPMENT SERVICES PERMIT#: ELR2003-00'128
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639.4171 DATE ISSUED:
PARCEL- 2S104DA-19'.00
SITE ADDRESS: 13325 S'N KINGSTON PL ZONING: R-4.5
SUBDIVISION: QUAIL HOLLOW - SOUTH JURISDICTION: TIG
BLOCK: LOT: 017
Ps oiect Description: Limited energy for voice/video.
A.RESIDENTIAL.— B.COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
CLOCK: MEDICAL: II
GARAGE OPENER: NURSE CALLS:
HVAC: DATA/TELE COMM:
VACUUM SYSTEM: FIRE.ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
— _ TOTAL#OF SYSTEMS_
(-- Contractor:
Owner: AZIMUTH COMMUNICATIONS INC
BROWNSTONE QUAIL HOLLOW LLC P.0 ROX 508
12670 '.V 68TH PKWY STE 200 WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: 503-5987565 Phone: 503-639-0110
Reg#: ELE 36-94CLE
Slip 2312LEA
LIC 145829
FEES Required Inspections
D�: crlptlon Date Amount Low Voltage Inspection
$75 00 Elect'I Final
[ELPRMT] ELR Permit 518/03
(TAX] 9%State Tax 5/8103 $6.00
Total $81.00
This Permit is 'ssued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicatle laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 18C days of issuance,or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follaw ruLe,,adopted by the Oregon Utility Notification Cenler. Those rules are set forth in OAR 952-001-0010 throuc
Q')"
Issue }� Permittee SignatureL
�.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, ar rent.
OWNER'S SIGNATURE: _-_-- ----
DATE: ---
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 Application
Date received: �J" G>:3 Permit no.. Xfioo cv/, T
City of Tigard Project/appl.no.: redate:
City ltldress. 13125 SW liall Blvd,Tij ard,OR 97223 Date issued: B�jp Receipt nu.
Thune: (503) 639-4171
Case file no.: Payment type:
Fax: (503) 598-1960
Land use approval: ----
TYPF t
❑ I &2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant improvement
9�New construction U Addition/alteration/replacement U Other:__ U Partial
JOB Silh INFORMATIONtea,
Joh address: S' y,1. , / '(� Bldg.no.: Suite no.: Tax map/tax lot/account no.:
Lot: 12Block: Subdivision:
Project name: u.ir Sett tN Description and location of work on premises: ✓�)1 c f /,, i)t 0
Estimated date of completion/ins ection:
XIDUUM 11111111
i
Fee Max
Job no: bescri tion Qt , (ea.) Cntot nn.ins
Business name: ?InuiLd, CrOril s utvIC' 11t✓JS Ncwreddeniint-single ormuld-familylrer
AddresL '1g t-7f4"')
/K) s]DUr �(- ds+cllinganit.lncludesallarlwdgnrngc.
City: S SlalC:�)E' ZIP:e� Jfj J� Senicelncluded: 4
Phone j r,s p C Fax:("F Oils
E mai I: l oU0 sq.rt.or less
{:ach additional SOU sq Il.or portion thereof
CCB no.: / Elec.bus. lic•no: 7,6" Limitedenergy•residential 2
City/metro lic. no.: V j(V6S 1`/ Lt,nitedencrgy,non•residcntial 2
Fact.manufactured home nr modular dwclh ig
_
__3r
pct_ Service nndlur feeder 2
Si noturc of supervising lectriciaircd) [)ate
Set vices or feeders—Installallon,
Sup.elect.name(print).D L L ZE-4
License no j/j L t ra alteration or relocation:
200 amps or les- 2
201 amps', e A amps
,
Name(pent): �ttij)� 5 D,�f 401 amps OU amps 2
Mailing address: __ 601 amps to )00 amps 2
2
City: State: ZIP: over WOO amps or volts
Reconnecionl I
Phone: Fax: E-mail:.
Temporary serried or feeders-
Owner in.;tallation:The installation is being made on property I own installation,alteration,or relocation:
which is not in; nded for sale,lease,rent,or exchange according to 200 amps or less '-
ORS 417,455,479,670,701. 201 amps to 400 amps _
Owner',, si'natUll" --- Date: aoI w600amps
--
- Branch circuits-new,alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase ul
-- _ _ A ,
Address, r service or feeder fee,each brooch circuit
State: ZIP: H Fee for branch circuits without purchase
CItY. -- of service or feeder fee•first branch circuit 2
PhoneFax: I mail Bach additional branch c,rci it —
Misc.(Service orfeeder no;Included):
U Service over 225 amps•cornmercial l7 Health-rarc I, ,i ' Each pump or ort•�anon circle 2
Each sign or outline lighting
U Service over 32(l arnps•raling of&2 U Hazardous loc.nnIn Signal circuit(sJ or n limited energy panel.
firmly dwellings UBuilding over 10,W0square feet four oi g
U System over 600 volts nominal more residential units in one structure alteration,ur extensiun•
U Huilding over three stories U Feeders,400 amps or more Description
U t kcupant load over 94 persons U Manufaciwed structures or RV park FAch additional Inspection over the allowable In any of the abuse:
U
1igres0ightingplan U Other _._--_- per Inspection
5uboill____sets of plant with any of the above. Investigation fee
The above are not applicable to temporary construction service. other
rPermit fee... ................ $
Nur all junadtcoons accept credit cark please call jurisdiction for more inforoatrat Notice:This permit application Plan review(at _ %) S
Visa U MasterCard expires if a permit is not obtained
[ / within 180 days after it has been State surcharge(8%) ....$
Credit card number Expires
accepted as complete. 1'01'AL ..................
Name of cardholder as shown on ere It Tarir s
—`��� Cardholder rigmuure _ Amount Ia)•JelS MU/CU�Ii
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 -�
INSPECTION DIVISION Business Line: (503)639-4171 MST
BLIP
Rect ived _-.--__ ___ Date Requested.- _ AM_�/PM BUP __—
Location --- -,� -- -- T-_-..—_Suite______ MEC
Contact Person Ph �s7�d
--- --- ( ) 1�1-- - --- -- PLM _-- - ----
Contractor -__...__------ -- -- Ph (--`) -- -- SWR ----__--
BUILDING - Tenant/Owner -__ ELC
Footing ELC
Foundation Access: -
Ftg Drain ELR
Crawl Drain —
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ,LL (J
Drywall Nailing
Firewall
Fire Sprinkler `�r -------
Fire Alarm
Susp d Ceiling { —
Roof
Other: - -
Final -------__—__
PASS PART FAIL
PLUMBING
Past&Beam ----!_- —�-
Under Slab
Rough-Ir
Water Service
Sanitary Sewer
Rain Drains _—
Catch Basin/Manhole
Corm Drain -
Shower Psi
UthOr:- - ------ _
A PART FAIL --- ------- - - ------ -. _ -- -- - - -- - - --
_W
At
Post&Beam
Rough-In - -- ----
Gas tine
Smoke Dampers -------- -
Final
PASS PART FAIL - _ - -- ----- - -- - - .
ELECTRICAL
Service -- - -
Rough-In
UG/Slab - -- ---------- --- ----.....-_.
Low Voltage _
Fire Alarm
Final Ll Reinspection fee of$__ _ required before next inspection, Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE r Please call for rein$pection RE:-- _ ._._ __ ..- n Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector - _ Ext
Other: l
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—
I INSPECTION DIVISION Business Line: (503)639-4171
Received ___—___- -Date Requested PM — BUP _
Location ____-__ 33�.�__ .._. -- -_Suite _ MEC
Contact Person __—_ __ _—__ Ph( _) 7 7 PLM
Contractor Ph---^ __ _._ -- - -� Ph SWR
tU'ILD{ Tenant/Owner _ —_ _—_ ELC
Fooling ---��----
Foundation ELC
Access:
Ftg Drain ELR _-_--
Crawl Drain
Slab inspection Notes: SIT
Post&Beam
Shear Anchors -- --�-- -
Ext Sheath/Shear
Int Sheath/Shear t ---------____
Framing __ C �� 1�► "Y —�� `> _ --
Insulation
Drywall Nailing -�' -, VL V - tffii+V 6''x�tt,
Firewall C-��v► 1 [7 � IF
,-(� �1
Fire Sprinkler -- --�— --�•—`�- --
Fire Alarm
Susp'd Ceiling 1----11 - --- -
Roof CC' ek
-- -- --
PART FAIL 1 Tripruma NG
--
Post& Beam
Under Slab —
Rough-In
Water Service -- -------_ - __-_ -----^�-
Sanitary Sewer
Rain Drains ------
Catch
-----Catch Basin/Manhole
Storm Drain __------. ._._- _ _--- -
Shower Pan
Other: -- -_--- -- --
Final -
3S PART FAIL
---CHAN —_L - — — ------
Post& Beam -
Rough-In --- -
Gas line _ --- -- —
Smoke Dampers -- --- - - — -----
A PART FAIL ---- - ---- .. --- ---- __--- --- -
EL- CTRICAL —
----------- --
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 reinspectiem RE: _-_. _ C� Unable to inspect-no access
Fire
ADAcupply Line /
./- � - �__ ----- - -
Approach/Sidewalk Date Inspector 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
INSPECTION D'�dISION Business Line: (503)639-4171BUP -- 2!
Received __— __._...______ Date Requested, _777 — AM_ !/ PM— __ BUP —
Location —._.__AJ. .._— -, —.-.-_Suite--_ MEC
Contact Person Ph 77 /C-3"- PI ^!! - --- ——
Contractor ____ ------- -_.---___-- ___-..._ __ — Ph SWR
BUILDING Tenant/Owner __— ____ ELC
Panting-- --�- ELC
Founcaation Access:
Fig 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
Other: - -- ----- --- _------- -� _
-- -
Final _
PASS PART FAIL -
PLUMBING___
Post& Beam
Under Slab ------- - - -----
Rough-In
Water Service -- - -- - -- -
Sanitary Sewer
Hain Drains
Cutch Bassin/Manhole S
Storm Drain
Shower Par
Other: - - - -- --
Final
PASS PAFiT FAIL
MECHANICAL
Post& Beam
Rough-In - - -------- —
Gas Line
Smoke Dampers --- -- ----
Final
PASS PART FAIL -- --— - - ------- --- - -- _--_
ELECTRICAL
Service
Rough-In _
UG/Sla ,
Fire Alarms�� �,
Reinspection fee of$ -.required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE - - -__ _____f�� Unable to inspect-no access
Fire Supply Line
ADAt
Approach/Sidewalk Date �� _-__ Inspector` ---�~;?
F tnal DO NOT REMOVE this Inspection record from the Jalfi site.
PASS PART FAIL