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14675 SW KttpIAN C"1'
CITY O F T I G w R D Y_ ELECTRICAL PERMIT
f DEVELOPMENT SERVICES DATE ES UIED: 34/2004-00'10604
ooa 00106
13125 SW Hall Blvd., Tiqard. OR 97223 (503) b39-4171 PARCEL: 2S105DD-07000
SITE ADDRESS: 14675 SW KLIPSAN CT
ZONING: R-/
SUBDIVISION: PACIFIC CREST
BLOCK: LOT : 046 JURISDICTION: TIG
Project Description: Installation of(1)branch circuit!or hot tub.
_RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+arnps - 1000 vclts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _PLAN REVIEW SECTION_
1000+ amp/volt: >=4 RES UNI'11S: _ >600 VOLT NOMINAL:
Reconnect only: _SVC/FDR>=225 AMPS: CLASS AREAISPEC OCC.
Owner: CuntraLtor:
CHANG NORTH BY NORTHWEST
14675 SW KLIPSAN CT 326 S 15TH ST.
,TIGARD,OR 97224 ST.HELENS, OR 97051
Phone: Phone: 503-348-0505
Reg #: LIC 142140
FEES — — ELE 5-50C
_ SUP 45125
Description Date Amount'—__ —. Required Inspections
[ELPRMT1 ELC'Permit 3764 $46.85
['TAX]8%State Surcl,.rrp.c 1/4/04 — $3.75 Rough-irElect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code State of OR.Specialty Codes and all other applicable laws. All
work will be done1q accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if vvork is suspended
for mom aTh n 180&a—y%--ATTENTION: Oregon law requires you to follow rules adopttxf by the Oregon Utility Notification Center. Those rules are set
foyt in OAR 952-001-00101kough OA . 52-001-0100. You may obtain copies of thsse rules or direct questions to OUNC at(503)246.6699 or
1800-332-2344.
sued By: �1(,Q� Permit Signature
OV.'NER INSTALLATION ONLY
T-he instal!ation is being made on properly I own whin, is not intended for sale, lease, or rent
OWNER'S SIGNATURE: DATE:_—.—
Y CO A TOR INSTALLATION ONLY
SIGNATURE OF SUPR. Et.EC'N: K DATE:__
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
f?l_act ical Permit Application ' + +
City of Tigard Date �vv
D Pen,ut No
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date fi Other Permit,
Inspection Line: 503.639.4175 Date Ready/By try IZ see Page 2 for
Internet www,ci tigard onus NoufrJMethod_ I -1/�2 Supplemental Information
TYPE OF WORK PLAN R.FVIEW _---
❑ New construction UX Ae:-]inon,,alteration r4dcement Please check all that apply
E] Demolition ❑Othur: ❑Service over 225 amps,camm'I ❑Hazardous Icoanon
_ r ❑Service over 320 amps-rating ❑Buildng over 10,000 sq.ft.,
CATEGOIt CONATRUCTION of l-and 2-family dwellings 4 or more new residentia!
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure
Master builder Other ❑Building over three stories ❑Feeders,400 amps or more
❑ MuIU-f;tmlly ❑ ❑ ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan R'✓park
1— -- - L ----- - ----
Job no,: Job site address: G (1- ' '-7— ❑Health-care facility ❑Other:
�� �L.S'a✓ Submit-j-sets of plans with any of the above
City/State/ZIP: A, - The above are not apply-able to temporary construction aarvice
ltEE• SCHEDULE
De
Suite/bldg./apt.no.: Project name:
— ' acrlpuon � — Qty_ Fee robl
Cross street/directions to job site: New residential single-0r multi-family dwelling unit.
- Includes_attached garagr. _
1,000 sq,ft or less - 145.15 4
Subdivision: Lot no.: Fa.add'I 500 sq.ft.or portion 33 40 1
Limited energy,residential 75.00 2
Tax map parcel no.: _ _Limited energy,nun-residential 7500 2
Ir �' ESCItifON OF K _ Each manufactured or modular
— - dwelling,service and/or feeder _ 90.90 2
_ - -
Services or fee--- -
ders Installation,alteration,and/or relocation -
200 amps or less 80.30 2
— -_- 201 amps to 400 amps 106.85 2
tr ❑ TENANT
_—
_ 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 24060 1 2
Address: - Over 1,000 amps or volts 454.65 2
-- - - -- Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders Installation,alteration,and/or
----- — relocation
Phone:( ) Fax (_ ) 200 amps or less 66.85 I
Owner lnrtallatlon:This installation is bring made on property that I own which is not 201 amps to 400 amps 100.30 2
+,,tended for sale,lease,rent,or exchange,accuiding to ORS 447,449,670,and 7U I 401 amps to 600 amps 133 75 z
-hvner signature _Date __ Branch circuits-new,alteration,or extension,per panel
'` ❑ APPLICANT [ CONTACT PERSON A Fee for branch circuits with
service or feeder fee,each
565 Z
Business name branch ci-Vut
-- — - B.Fee for branch circuits
Contact name: without service or feeder fee, '
- ---- _ - 4685 2
each branch circuit
Address: Each add'1 branch circuit 6.65 2
City/State/ZIP Miscellaneous(ser-Ire or feeder not Included)
Phone:t ) I ( ) Pump or irrigation circle 53.40 2
Fox:
Sign or outline lighting 5340
Signal circuit(s)or limited-
^T - energy panel,alteration,or
CONTRACTOR
-- --- _=----- - J extension Descnue Page 2 2
Business name: _- jay
-'-`t-
Each additional inspection over allowable In any of the above
Address:
G S 15 5- _ Per inspection —r- J 62 50 ---7-
City/State/ZIP:Y 6T >k�ws DIL Investigation per hour(I hr nun) 62 50
Phone:( ) 4 Fax:( ) Indutitnal plant per hour
_ ;J'� -C�SJS >i•EI'tWr V&S* _
CCB Llc. ` . Su ryLic y5/„23 - - - Subtotal -
�
Supra. Electrician signature,required: '' l_* —_Plan review(25%of permit ft )
i State surcharge(8%of permit fee) 75
Print name: + � Date: 3��'O t+ � - .—. __— _ �
-- -- TOTAL PFRMrf FEE� tQ
Authorized signature.
This permit application eaplres If a permit Is not obtained within IPO
days after It has been accepted as complete
Print name: Date: Fee methodology set by Tn-County Building Industry Service Board
••Number of inspections pet permit allowed-
ittlnitdktgtlamdutaLC•larnaAppdoe 12M3 440-4619T(10/02,'C0K`W66
Electrical Pf rmit Application - City of Tigard ,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
F,,a for all residential systems combined........ $75.00
Check type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COM1� IA.L�'VORK
--. _ _ _
Fee for each commercial system....................... $75,00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boder Controls
❑ Clock Systems
C1 Data Telecommunication Installation
❑ Fire Alarm Instaliatlon
❑ 1{VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i\Bwldm&ermtxXFLC-Pe tApp doc OLOJ
- BUILDING PERMIT
CITY OF TIGARD _
PERMIT#: BUP2004-00030
DEVELOPMENT SERVICES DATE ISSUED: 1130/04
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639.4171 PARCEL: 2S105DD-07000
SITE ADDRESS: 14675 SW KLIPSAN CT
SUBDIVISION: PACIFIC CREST ZONING: R-7
r BLOCK: LOT: 046 JURISDICTION: TIG
P.EISSUE: _ FLOOR ARE_AS EXTERIOR WALL CONSTRUCTION__
CLASS C F WORK: OTR FIi�ST: sf N: S: E: W:
TYFE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: sf N: E: -- -N:
OCCUPANCY 3RP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf ARFA SEP. RATED:
STOR: NT: ft
GARAGE: sf OCGU SEP. RATED:
BSMT?: MEZZ?: REQD SETBACKS _ __REQUIRED__ _
FLOOR LOAD. psf LEFT: ft RGHT: ft Fip SPKL SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft ':i ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: CORR: PARKING:
VALUE: $ 1,800.00
Remarks: 144 sf. deck
Owner: Contractor:
CHING, VvAYMAN AMERICAN CLASSIC D&F INC.
14675 SW KLIPSAN CT. 14997 SW TUALATIN SHERWOOD RD.
TIGARD, OR 97223 #102
SHERWOOD, OR 97140
Phone: 503-430-0958
Phone: 503-925-9530
Reg #: LIC 153783
FEES `— REQUIK-:.- INSPECTIONS
Description Date Amount Footing Insp
flit II'D I 11rr11111 1 rr 1/30/04 -- --$62.50
Final inspection
I.1'AX] K State Surrhart 1/30/04 $5.00
l3ut't'I I'In It,
1/30/04 $40.63
Total $108.13
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes
and all other applicable law. All work will he done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the 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 a copy of these rules or direct questions to OUNC by
calling (503) 246-6699 or 1-800-332-2344.
Issued By: K / L — —
Pennittee
Signature
Call 639-4175 by 7 p.m. for an Inspection th,i next business day
Ol,'12/2004 18:01 FAX 5095981980 CITY OF TIGARD 41001
W1d' P�_ >I UEDI,
City of Tigard l�N r� U L ��ed G/, hrnnlrao
1312'i 5W Hall Blvd,Tigard,Ofl1 9')727` pun Ravaw Uthet Isemut
Phony' 50)6)9.4171 Pvv: !�
Mspecnon Line 503 639-41 TIGARD Date 9eadyMy , :C -6k Srr Ananeu checklist rn�
Internet. wstrwei,"gardurRUILDING DIVISION Mhlred/Mtethod supae �rraru;!„orlon
DWIL UNG
s r� , od,r .'� 'y�di tt�: I $. 1�; ..�.l�e C."•.:'rilFy ,.Irlh,11
Demoddor Pcnn.t fees'arc bats;;on aloe value of the work performed
[j New c�nrtruetion _ Indicate the valYr.(rounded to the neer-^st dollar)of all
AddtueNdtr*aantyrrylacemem ❑Other rgnipment,materials,labor,overhead,and the p:otit for the
,---_ work mdecatcd cn this apphccuon
rL wllrro"� r 111 pstW.il "ISTRUCil7[1fY11y I"w r« -- — _�
I
!-
!-ad 2-fly dwelling [jWeQtrnettie t/tadustriel
-- Number of hedrootm.
[�Accessory building ❑Muhi•fati ily ---
- - - U 016er Number of bathroom.:
[]Master btrilder — -
Total number of floors'
IT
Jobtateaddress \ylolS SW �41PShh r-T _ _Newdwdlitlg.ra. square feet
Ciry/S itefM T I G 14R� Garagdcerport arra: - square ten
Soitr161t'g./apt-ro. Project name!!- Covered porch arc aquae feet
host rareedd inxtimn hi job site Dock eres: ft$C 00 square feet I►�r�
Other structure area Square feet
1_ot tw PcmmC f rc*A.-or NAW!C oAC-tU9$.rCH CKLJS r
_-�._._� arra. -_-� ` .,• .-
yerfnrmtd
sum Iiliom —_�---- - Indurate the value(rr•'--aed to the Rcatctt dollar)of all
Tax rmp/paed aro,: _ _- equipmeM maternk,labor,overhead,and the profit for the
4pr 1�C i tiI work inrSicaicd oo this applrution --
valwnc• S
-----
----- - --
Exiadng building area square leer
--- Now building arca Square feet
,rrl, L[i' i 'i!j qj tJ J*dOUL', E;N nes: --
, -.gip.
Number of stones:
''� • ..'.pry.,. 's' !Q: ytye_S�.Ww„ � ..-��. ..�
Wtiywtll�^C14Mb
Type of construction
New:
Address. (U,' '1S SW Occupancy groups.
City/Stalazw: T I(imp a?- l '111.Z"S _Existing
Phone l Sr>3) '436-dim (Say) 2t,3-(.SIE weggr.
New
�y "i .", •I i� � I
't �e.
Businm acme: AuMTQ-sl./ �1 ifs(( DEr E�n�r� Ali cnnttactote and subconrrac"Lots are required to he
lictwcd wilt rJe Ckrgon Coomuetlon Controc!rim Board
Contact ngmt fslr CI��EL yLW _ under OPS 701 and may be requited to be hcerued to the
Address: MITMP1t-plj I n- SIlf�rt�oD�Q_ IDZ juritdreuon in winch work i;hung performed If the
--- -- applicant Is nternpt from Itctm mit the following Beacons
oty/statez(ZJP S-ftAWO&SOP- 9lI 0 aprdv.
rllo (So_) 2S I t P.x So3) q q S 3n
--
l;mail' CLCA.. S Saar 0.01 (&A,\ — _--
t,:. G.c�' NYn I' 1'y•'Y','��� ;. ._.-- --_..__ -_.
4
I ty1F-- :t{y�iyr r+tK 1.:1!ti��l�n .91�i�ilt4•l'r e":11e
Duaisessrrnde: !, i`: ",', iBlAl 'IE 1rPRh'lI'1 8Fr'S" --
Addmsv P/aae refer to fee sehedeln
Ciry/StatdZll' _- fees due upon applteatron
Pax (
Phone 1 ) �- Amount reteived
Authorised aigrlahat, This ptrscit application espirra if a permit Is not obtained
Within 190 days after it hat been accepted as compku
�• _, MI a EL�stat�ra�D DYE 1119 ] ' Pec methodology ser by h+County building Industry
_.�_ .�_-�----- -
9ervite 8otrd
1adt4,aMslaarMUFrerartAq are Ives weJatf7'It tJO)ICOWMa1t
�. Ll0
of
LV)
�71f
Son kULW1419 Site Assessment
Junsdiction CO. 6%
Map&Tax Lot 0 7cx"o )W,,-, W%
-Sito Address
ok-CID, CAL C'=t z-5. Contact
Prripmed Activity Address
% *'N%
C)
Phone
C-1
cylklio Uar Cory. ow 10M typ'..
Y N NA Y N NA
]
r-
For Seitsitive Area Compocift Map S',rniwntnr irlfm7,w,:(�ttjr(! rlip!-,
_1 7
I j LN Lorally adnMed studies or rnap-s- n r Other
L
f3a". d on a review o!the above information and the requirement!;of i-,1eafi W-1101
Si4rwices N--siqFt and Cou,slitiLlimi Standards R&r.ortition and -11
Ord(tr No. 03
'9misitivo- areas potertfially ex(St on site or within 20(J' nf the site. THE APPLICANT
MUST PERIORMA SITE CERTIFICATION PRIOR TO ISSUANCF OF A SFRVICE
PROVIDER LETTER OR STORMWA I ER CONNF( I ION PERMH.If Sensitive Arri-4s
r-xv;1 oti the site or within ;?00 feet onadjacerif Natural Resources
Asnonmnlpnt Relmirt miy also be required.
Sefl-jitive area-3 do riot nppear to exist onsite or within 200'of,!he site.This pre
screening site jusec-sinent does NOT ellp"inate the need to evaluate and protf;ct
water quality sensitive areas if they are subsequently discovered on your
property, NO FUR7KER SITE ASSrSSMFNT OR SFRVICF PRCOVIDFR LETTER IS
REQUIRED. THIS FORM WILL SERVF AS AUTHOR17ATION TO ISSUE A
STORMWATFR CONNECT)ON PERMIT
The Proposed activity does riot meet Ole def"millors of developfriprit. NO S1 T E
ASST-SSMFNT OR SrRVIr-C PROVIDER LETTER 15 REQUIRED,
(:onnw�ntea
Rp%oiowod By: Dam.
R.-furned fnApplicant
Pcwt-4t'rax Wte 7671 Dille IX4 03 -NeilFrLic _ Cvienfer_-
//,:z 9/0 9 Lr 1,
r7LXmA
RY6
f A'
711DIf 114n1i
P/\C FIC cRES—r sur �tvistc�t�1
46
ci-IF v o
TWE APPROACH 5W4LL BE
A MINNMUM Of 8"r 12'x70'
OF CLEAr� P C,RAvEL
LANIDSC;A,'ING FOR TWE ENTIRE LOT
` 5.#ALL BE FINISWED OR THE LOT
- -- _ T SURROUNDED Br EROSION CONTROL
-
PRIOR TO 5REAK OUT OF COMMUNI r'
`- - - -
`� ER051ON CONTROL FFINI5WED SLOPES
5WALL. BE LESy TWAN 2 TO I
O NOTE i
I.ROOF DRAINS TO E,TORI`I
N00059 ' 4. 2
` ' OO o5 t �t s,. i►E t j LAT IN STREET,
w^r ', 1 / 0 `` (� I �� -^ 2 FOUNDATION DRAINS TO
`��^^- BACKY4RD 50AP;AGE TRENGN
5 gat. ____"--- SEE ATTACWED DETAIL
60. 0
4 1 it API EMP GRAVEL '•
RIvEUA'y
r s,1 L \ '
r
C ,
-_
SGPT = 156
- ----- -- ---
-
- ---
- ---
PLAN : 35MA
---LN11�}-r-+dap?._------_ Q
FIN EL-. 490'
-----_ - -O
J _o
--- ------
?' Z CITY OF TlGi,RD
� proved..............................
*3 nditionally Approvod.............
r only the work as describPrf in-
'IMI r NO
e I eller to-_.Follow....... ............ j 1
AttPich,......
.
b Ad:rgss
FI••�P
Date
S F
b SETBACK REQUIREMENTS
FRONT Y ARL TO GARAGE 20
5 Q r� 5 1 V E YARD 5'
�) REAR YEARV 15'
RL , 1AD.K. Horton Homes �
Si.•4LE r 70 ----
o•*� 5125 5.11 Macadam 4veneue
P"CVe so, use Portland Oregon sn. ,o,.,,,,:,
CITY OF TIGARD - SITE PLAN HLVIFAN
131)IL DING PfiRMIT NO.:
PLANNING; DIVISION:
Required Seta-hs: 0 Approved ❑ Not Approved
Side: S Street Side: s-
pl-ml. Garage- Rear:
Visual Cleurunce: f4A ❑ Approved ❑ Not Approved
MHximmn Building Height. J-3 feet
t'11 • `ervicu Provider Letter Required: Yes E3No
❑ Received
Oatc:
I
:NGING .ZING DE11Ait"I M!:N
Actuul Slope- /4 Vj Ap,hruved ❑ Not Approved
Site III Approved /Not pproved
Hv �cJL� Date: 5( 0f--
r
DECK. �XpArJS�JrJ
HIDIAM
f
PR
1
PEfZ- GoD j
93M
OBIS M
le I2 a,
CITY or i I "n14— co �
Arrojec; ....................... h ��E w
-,rt DATE: VI11
�� r on�y tt a work as descrrGF�.I in.
.,;tech_....... ._. _( 1
9381P
.�- C��r�T Y - 6 3 0 �aa. . -�-�► 5262 �----C
r OBBaO
TVL3 (r-r-oreN) 'y 22,N
5q�2
/5 FSF 9X P. DATE: 1 1311
C17Y OF TIGARD 24-Hour
Bb*,LDING Inspection Line: (503)639-4175
IIJSPECTION DIVISION Business Line: (503) 639-4171 MST
Receive !:q-140-ate Requested__cam -� AM--__
Location B U P
----------`-__
�—
- --���.��lu��_._
- — — -- -
Contact Person MEC
�, pn(_ �' ) _ �`� _ PLM
--- - - .—
Contractor _ - - _-- - r•n(.--_) SWR
--
BUILDING Tenant/Owner
Footing —. LC
Foundation Access: ELC
Fig Drain --
Crawl Drain ELR
Slab Inspection Notes: SIT
Post& Beam _
Shear Anchors --- -
Ext Sheath/Shear - -- --
Int Sheath/Shear
Framing --- —
Insulation - -------------Dr-wall Nailing
— -
ir,awall -------- ---t
Fire Sprinkler 1��L-._-_ bysp��.t •) QI� ��
Fire Alarm -
Susp'd Ceiling - --
Roof --- -
Fin
A PART FAIL —-------.—. -1p
LUMBING
—
Post& Beam
Under Slab
Rough-Ir -- -
Water Service
Sanitary Sewer --
Rain Grains -
Catch Basin i 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 --
Low Voltage
Fire Alarm - -- -- - ---
Final
PASS PART FAIL -� Reinspection fee of$ — — required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Fire Supply Line n.Please call for reinspectioRE:--�_ _
- Unable to inspect-no access
- ----
A DA
Approach/Sidewalk Date =.Q -- _ -- Inspector
Other:
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job 91te.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECT ZA DIVISION Business Line: (503) 639-4171 MST
BLIP - --- ----
Received Uate Requested-- /
Location ___ 1 �-�Z�e �t.�. — --Suite MEC -
';ontact Person _1��� rh (- ! - 1- Jac PLM -a—
rltractor .-- -- ---- —_ - - —_ Ph SWR _
' BUILDING .__._� Tenant,n�^riui __-_- -- _---- -- ELC
Footing
Foundation Access: ,rk ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Nutes: SIT
Post& Beam
r Shear Ar chors st� � ---- ------
Ext Shee.th/Shear
Int Shea,h/Shear
— --- - - --
Framing
Insulatio 1
Drywall flailing - - -- --- -- --- --------- --- --- -----
FirewallyS
Fire Sprinkler
Fire Alarm �' � --
Susp'd Ceiling
Roof
Other-
Final
ther Final 457-?A
PASSt,ART FAIL --- - _-_- --
PLUMB_ING
Post& Beam
Under Slab
Rough-In
Water Service I -- - - -- - -- - ------
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 --
_C_R
vi
Se' cp - -- —
Hough-In
UG/Slab
Low Voltage
Fire Alarm T_--- -
PAS PART FAIL Reinspection fee of$. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
t S — F-] Please all for reinspection RE:______ --_—_ �J Unable to inspect--no ac-ess
Fire Supply Line ��^ (� (� s
ADA L. I --\.I �`" N.."' l�a
Approach/Sidewalk Dats / Z_ V Inspoetoir _ Ext
Other
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
�R
i
CITY OF T I CSA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00195
13125 SW Hall Blvd., Tigard, OR 9.1-223 (503) 638-4171 DATE ISSUED: 4/30/2004
31TE ADDRESS: 14675 SW KLIPSAN CT PARCEL: 2S10rJDD-07000
SUBDIVISION: PACIFIC CREST ZONING: R-7
BLOCK: LOT: 046 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
!=IXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow preventer install.
Owner: FEES --
`-- - Description Date Amount
CHINE,JOUE
14675 SW KLIPSON CT I I:�\I �i;�i� tial lour 4/30/20Q4 $2.90
TIGARD, OR 97223 IN I'%Ilij IY1111il I rr 4/30/2004 $36.25
Total $39.15—
Phone : 503-430-0958 - — --�
Cnntractor:
ESEQUIEL ROBL.ES LANDSCAPING
7076 RIDGEMONT DR N
KEIZER, OR 97303 REQUIRED INSPECTIONS
Phone : 503-390-4353RP/Backflow Preventer ---_ _
sinal Inspection
Reg #: 111,Ni 7784
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and ail other applicable laws. All work will be done in accordance with approved
plar.s. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952.0001-0010 through
OAR 952-0001-0100 You may obtain copies of these rules or direct questions to OUNC by calling
(503) 246-6699.
Issued By- � i"� L�! ;j'�� .� Permittee Signature: q
Call (503! 639-4175 by 7:00 P.M. for an inspection needed the next business day
BuildIng.Fila- tures
Plumbing Permit Avi lication A§10111
City of Tigard Received
$� Permit No, l
13125 SW Hall Blvd.,Tigard,OR 97223 DaWB
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Pernut No
Date/ey
24-Internet VVWW.Ci tigard or us Hour Inspection Line 503.639.4175 Date ReadyBy: t o See Page 2 for
Int --`- Nohfied/Method: r Supplemental Information
TYPE OF WORK FEF.* SCHEDULE
[:]"New construction ❑Demolition Fors ecialInformation use checklist.
--- -- ---- --
Description I Qty. I Ea Total
❑,kdditiom'aiterauoiv'replacenirt't ❑Other. New 1.2-family dwellings(includes 100 fl. for each utility connection)
CATECOI;.{1{ F CONSTf1CP10N SFR(l)bath 249.20
❑ I-and 2-family owelhng ❑Commercial/industrial SFR(2)bath j 350.00
❑Accessory building _ ❑Multi-family SFR(3)bath 399.00
❑
Master builder _ Each additional bath/kitchen 45,00
❑Other
Fire sprinkler(r_sq.R.) Page 2
t.OkT�01
Site utilities
Job site address: 7 5" LJ l S Catch basin or area drain 16.60
City/State/ZIP: "WC Q V, Q -) 2.2 Drywell,leach line,or trench drain 16.60
St: Jbldg./apt.no.: Project name: Footing drain(no.linear ft ) Page 2
Cross street/directions to job site:
-- Manufactured home utilities 1 1000
— -- Manholes 16.60
5 1P _ _ Rain drain connector 16.60
Sanitary sewer(no linear ft.:_� Page 2
Stone sewer(no.linear ft.:,) Page 2
Subdivision: _ Lot no.: Water service(no.linear fl.: ) Page 2
Tax map/parcel no.:
-_-" — - �---- Fixture or Item
------- --- ---------- Absorption valve 16.60
_- -_-- _ DESCRIPTION OF WORK �t� r Backflow preventer Page 2
✓: - _ Backwater valve 16.60
Clothes washer 16.60
-- -.� --��------- --�--
Dishwasher 16,60
Qrinking fountain 16.60
p o>iiw owN>�tt ❑ TENAN r
-- —
Name: Ejectors/sump 16.60
Address: Expansion tank 16.60
� ----
Fixture/sewer cap 16.60
City!Slate/ZIP: Floor drain/floor sink'hub 16.60
Phone:(`f-3 4 36 GQ 5rsj' Fax I Garbage disposal 16.60 i
APKI Hose bib 16.60
T _ ❑ CONTACT PERSON —�
_-_-. Ice maker 1660
Business name: - —
___._e._,_____ Interceptor/grease trap 16.60
Contact name:
Medical gas(value.E ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain(commercial) 16.60
Phone: Sink/basin/lavatory 16,60
-- — —
E-mail: Tub/shower'shower pan 1660
n� _ Urinal 16.60
R °;` a' - _ CJy,a,.•�°x'M1* ';;ri;.. rt..�,. Water CIOSCt 1660
Business name: E S P qy,e SA I e 3 C QH S C t , >7 _ Water heater 16,60
Address:7c,,(r F.- lyt�' �� ,v Other
City/State/ZIP: z L' -�30� _ Subtotal -�
Minimum permit fee S7250
Phone:(5%y ?11-7 Fax:( ) — Residential backflow minimum permit fee $3625_
CCB Lic.: "1 �_- Plumbing Lic.no:^--- Plan review (25%of pern t fee)
Authonzed signature: State surcharge(8%of permit fee)
J TOTAL PER1l11T
Print name: -zh& D. /� This permit application expires If a permit is not obtained thin
180 days after It has been accepted as complete.
*1 cc methodology set by Tn-County Building Industry Ser%.ce Board
i iBai1dina1PermiWPt.M1`PemutAfy d- 1201 aad6i5r(iaoLTON1 ATM _n
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171,7, 6�14 MST
BLIP
Received � - Date Requested -�r�� y AM PM BUP
Location - - -(_Suite MEC — _ —_--
Contact Person Ph
Contractor_-- — Ph( ) SWR
BUILDING _ Tenall n , ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Orain _ ---
Slab Inspection Notes: SIT ___—
Post &Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear ^^ -
Framing -- - - — —----- -- ----
Insulation
Drywall Nailing -- ---- -- --.-- _ _ _
Firewall
Fire Sprinkler — - -�---
Fire Alarm
Susp'd Ceiling ----- —
Roof
Other: -- - - -- ---- - - _--.- - --
Final
PASS PART FA;L
PLUMBING__
Past& Beam
Under Slab
Rough-In i
i
Water Service ----------
Sanitary Sewer
Rain Drains --- -----_._ - -- - _!---
Catch Basi i/Manhole
Storm Drain -- — - --- -- ---
Shower an -_ _-- - -- -,- -_
Ottua�. k
PASA PART FAIL
MECHANICAL
Post&Beam .--- -- ------ - _ ----- -
Rough-In
Gas Line -- _-- ---- ---- - - -- -- ----
Smoke Dampers ------- --- _.- _ _-
Final
PASS PART F_AIL — - — ----- - -
_ELECTRICAL_ _
Service --- — --_-- --- -----�--- - - - - --- ---__
Rouyh-In
UG/Slab ____ -- ---- --- - ---a-�__- ----- ----
Low Voltage
Fire Alarm -
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
PASS PART FAIL—
SITE
AIL$ E Please call for reinspection RE:__- -_- r i Unable to inspect-no access
Fire Supply Line
ADA � �-
Approach/Sidewalk Dat L__ _ Inapoctor -1,c_. _!_1�._
- _ - ----- --�-Ext --
Other: _
Final DO NOT REMOVE this Inspection record ft om the fob site.
PASS PAnT FAIL