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12230 SW Tippitt Place
/ �� MASTER PERMIT
CITY
ITY ®F T I G A R
PERMIT#: MST2001-00445
DEVELOPMENT SERVICES DATE ISSUED: 6/28/01
131;:5 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SI1 E .ADDRESS. 12230 SVI TIPPIT-1 PL PARCEL: 2S10313C-08300
SUBDIV'SION: 1VlLP1999 00005 MOSES PP200t1-0/7 ZONING: R-4.5
E;',_OCK: LOT: 003 JURISDICTION: TIG
REMARKS: Construct new single family detached residence. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS_ _ REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,6.1 al BA" _.T; a1 LEFT: P. SMOKE DETECTORS: Y
TYPE OF USE: SF FLOUR LOAD: 40 SECOND: 1,654 at GARAGE: 134 at FRONT: 20 PARKING SPACES:
TYPE OF CONST: 5N CWELLING UNITS: 1 FINSSMENT: if RIGHT: 6
VALUE: 5 305,903.20
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,`195 00 at REAR: 29
_ PLUMBING
SINKS: I WATERCLOSLTS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: '00 TRAPS:
AVATORIES: 5 DISHWASHERS: I FLOOR DRAINS: 0 SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS:
TUBISHOWERS: 3 GARBAGE DISP 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTW 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: BOIUCMP<AHP: VENT I:ANS: 5 CLOTHES DRYER: I
GAS FI IRN>•100K: 1 UNIT HEATERS: H0008; 1 OTHER UNITS: 1
MAX INP: btu FLOOR;URNANCES: V,NTS: 1 VOGDSTOVES: GAS OUTLETS: 1
&ECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS_ ADD'L INSPECTIONS
10n0 SF OR LESS: 1 0 100 amp: 1 0 •2C .,,.p 1 WISVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 111 0 201 •400 amp: 201 -400 amp: tat WIO SVCIFDR; 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 •600 amp: 401 •600 amp: EA AO DL BR CIR: SIGNAUPANEL. IN PLANT:
MANU HMISVCIFDR 601 • 1000 amp: 601+ampa-1000v: MINOR LABEL:
1000+amolvolt: PLAN REVIEW SECTION
Reconnect only: r•/RES UNITS: SVC/FDR:,-225 P.:
>600 V NOMINAL: CLS nREAISPC OCC:
ELECTRICAL-RESTk,CTED ENERGY
_ A.SF RESIDENTIAL B.COMMERCIAL _
AFIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
AUDIO b STEREO: VACUUM SYSTEM: AUDIO b STEREO
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCA?EIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TF.LE COMM: NURSE CALLS: TO(AL M SYSTEMS:
TOTAL FEES: $ 8,345.51
Owner: Contractor: This permit is subject to the regulations contained in the
WHITFORD SCOTT LLC WHITFORD/SCOTT Tigard Municipal Code,Slate of OR. Specialty Codes and
4888 NW BETHANY BLVD#381 4888 NW BETHANY BLVD. all other applicable laws All work will be done in
PORTLAND,OR 97229-9260 K5#381 accordance with approved plana. This permit will expire N
PORTI AND,,OR 97229 work Is not started within 180 days of Issuence,or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg#: LIC 107990 forth In OAR 952-001.0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INr3PECTIr.N3
Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Shear VVali Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final
Puoting Insp Crawl Draln/Backwater Electrical Service Low Voltage Water Line Insp Final Inspection
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appl,;id:.Ak Insp
Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrl,;al Final —
< Permittee Signature
Issued B,r -
Call (503) 639-4175 by 7:00 p m. for an inspection needed the next husiness day
t
e�
CITYOF TIGARD _SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-0025
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/28/01
SITE ADDRESS; 12230 SW 1-!13PITT PL PARCEL: 2S103E3C-08300
SUBDIVISION: P.'LP19' 9-00005 MOSES PP2000-077 ZONING: R-4.5
BLOCK: _— LOT: 003 _ JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK. NEW DWELLING UNITS: 1
TYPE_ OF USE: SF NO OF BUILDINGS: 1
!NSTALI TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer:onnection permit for new single family residence.
Owner: - —
WHITFORD SCOTT LLC _ - ----
4888 NW BETHANY BLVD #381 _Type By _ Date FEES__ _ Amount Receipt
PORTLAND, OR 97229-9260 PRMT CTR 8/28/01 $2,300 00 27200100000
INSP CTR 8/28101 $35,00 27200100000
Phone: 503-533-2255 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inz pections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewago Agency. The permit expires 180
days from the date Issued. The total amount paid will be forfQitPd if the permit expires. The Agency does n ! guarantee
the accuracy of the side sewer 1,-ierals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the(.!stance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm
Issued by: 1 •�. �r` Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the —xt business day
��u�l2e'iool-•e�%��
Builth-hm-Pcrinit Applicatioi,
----- ---- IDaiereccived: 6 /D O/ Permit no.:�f i h'u/4
City of . 'ilgalr(� ProjccUappl.no.: Expire date:
Ciryu(Tigarrl Address: 13125 SW I tall Blvd,Tigard,OR 97223 ;
Phone: (503) 639-4171 ^, Me issued: By: Receipt no.:
Fax: (503) 598-1960 Cas'file ro.: Payment type
Land use approval: -0000' I&2faiinl� Simple Complcr:
tYPE Of PERMIT
U I &2 family dwelling or accessory U Commercial/indwaiial J htulu lankly *( cw construction U Demolition
U Add ition/alleration/replacement U'I'enanl improvement U Fire sprinkler/alarm U Other: _
SOB SITE 1 ' 1
I
Joh address: "ZZ...�V [� Bldg.no.: Suite no.:
Lot: Block: Subdivision: M ► ITaxmap/taxloUaccountno._21 VC_. 3LO
Project name: /G1Z �0/4799
De=scription and location of work on prernises/special conditions:NCS ('1)Iri (I I�odplain.scIA le capaeity,solar,etc.)
STQ1
011 NUR MR SPECIAL INI-OHNIA I ION, USE
Name: 'V, lll
Mailing address — —'I 1 &2 family dwelling;:
is 7.1 C Valuation of work................. ..... ................ $J
I'honc: - Z_ r" Fa e - C mai No.of ixdtYmms/baths.........a.....................
' Owner's represeTotal number of floors.................. ......_.. .
Phone: Fax: E-mail: New dwelling area(sq.ft.) .................. .......
Coaragelcarporl arca(sq, fl.). .... ._. .... ........
Name: {� X �1�17Z�, covered porch arca(sq.('t.) ... ... .................
90
Mailing address: heck..-ca(sq.ft.).........._............................
City: Scute: ;r Other snucture arca(sq. li.)......................... --_-__---
��---- Comme"cial/industrial/multi-family:
Phunc: I �x: E-mail:
Valuati.m of work...................................... . h -
Existing bldg.arca(sq.ft.) .......................... `-
Business name: c 14 +}`> t,*,Q ►�e.�- New bldg.area(sq.ft.)
................................
Address: Number of stories
City: Fax: State: 'LIP: T of construction
Phone: Email
Occupancy grou s) Existing:
o.: M -----
C - --�—, New:
City/metro lic. no.' Notice:All contractors and subcontractors arc required to he
1 licensed tta,itw, Board under
NariteV._Q 9provisions of ORS 701 and may he required to be licensed in the
Address: - — ,jurisdiction where work is being performed. if the applicant is
St, ' 7,If. .— exempt from licensing,the lullowing reason applies:
Contact pers•m: Plan no.: �• --
Peon
Name: - '.mlact person: Fees due upon application ........................... 1; SI-7
Address:"- hate received:
City �_��All,1�.� State: r-17 Amount receit,ed .........................................tr- $.-----
Phonl�;f Please refer to tc' schedule.
I hereby certify I have read and examined this application acid the Nra all Jurisdiclirms accept credit cords,1.6.1 ,all lun.du lim lo,mote nd.amalio�
a(lached checklist. All provisions I laws and ordinances gtiverping:(his Uvisa U Matim-Card
work will be complied with.w r IwOfied heroin Ut notrmut card number
Authorized slLl]atllrC: Name of carfiralder al;shown on urdn crud —
Print name:—_ `� _-- 1 — — _ ('ardholder aigttmure ---_ —.— 4uunml
Notice:This pennil applicalion expres if a permit i. nut obtained within 190 days after it has been accepted a5 complete. I•ul aM 1 if.AXWOM)
l
Flectricai PermitAppikation
-- — - — "Diterece�"Iived:� e f Peru no.;
City of Tigard Projeellappt no.: Gxpiredatc: -
Ciryoffigam Address: 13125 SW Ball Blvd,Tigard,OR 07' t I nate issued: 13y: Rcccipt no.: —
Phone: (503) 61,•-4171
Fax: (503) 599-1960 Cm file no.: Payment type:
Land use approval: ___--�-
U I &2 family dwelling or accessory U Com mercial/industrial U Multi-family U'1'enant improvement
"*Vcw construction U Addition/aIivrat ion/ryplace ntetit A Other: _— U 11mlial
JOB SITE IM ORM ATION
.lob address: Z3b Ski ' if I L; I I,I, n...: aur Tax 1111111/tax lot/accountnu
IAW - 13hx k: Sub i siun-.W 125f;
I'mject name: IDescrilifion and location of work on premises:
I�•:IinuAcd d:Ae r1f rrnuplclion/im i, ,�n•n— 1 �-
t r
Job not _ Fcc �1ai
1151nes3lt �Y - --- rwrrvra -suRUecocrrnipollun-
Qly, (ca.) Total no,111%11
r (maper
AddfeSS1 dwellngrmil.Include%miarliedgarage.
CilySfale; Z11a:
- 3 Service Included: )
unc: G Fax:— - — I:-nlnil: I04N)sr;,It.or less _ �_I. '.I ys 4
Cc - 8 f?nch additional 510 sq.It.or portion Ihcrcuf
l�f race.bt lie,mr 3 q I.illllled energy,residential 2
Oily/f 'dro lic.110.: 14 tAf l.inriledemeigy,non tesidenlial 2
---- ----- Emelt manufactured hame or modular dwell:;
Siynn co su rvisiug elec0iciml Urquinsl) _ bate —�- Service and/or feeder --- 2
Snp,elec1.11a111C(plinl): ,e License on. _Services or feeders-Initalinflon,
allcrallon or relocation:
PRO.PERT
O
2(x)amps or less 2
Nome(print): `_ tot amps to 4Mamps 2
- 401 neaps to 600 amps 2
Mlliling addlossA f -� - -
LUuMAr 6111 amps ur 111(x)mops 2
CI y: Sial l I I'• 7 - - river V100 amps or volls
Phos•: I'a L'-mail Itrcniuu•cl out I
ownci installution:The installation is living made on property I own !'ruglo,ary scrvlcei or ferder�-
which is not intended for sale,Ier rent,or exchange according In Dlilalint Ion,aHerat Ion,orrelocalIon: r
(1RS 447,455,479,670 70 -21()amps or less 2
�'' � 2n I mops lu 4(X1 amyls _ 2
Owner's signature: Date: r 40l Ice(•00 nal 1s -- 2
Branch circuili-new,alteration,
or exlenilon per panel:
h1aI11C: �.LLLr l A. t7ce1'nrhr:uuhrurnu�+vnhpulchnsent
Address: I service or(cella fee,each branch cuctia 2
Oily: �rc� _. Stith l.I l. P Fcc for brmrch circuits without purchase
+4 service or G•eder fee,fit 'bralCh citcuiC 2
L
I'houc I':t ,mail: -
atch additional branch circuit.
MUM 10111—
Mise.(Service or feeder not Included):
U Servicenver225nn1ps-can• int U Health cntefacility IachIminporinigatioucircle 2
U Service.over 320 mops-nmml:of M2 U I laz idous locnlion finch sign or c Aline lighting 2
fnmilydwellhtgs U Building over 111,1)00 syuae feel four or Signal circult(s)or a limited energy pnncl,
U System over 6lx)vollsnonlhlal mote cesidemialuoitslit title strucmoe _alteration.orextension* --_- 2
U auddinµover Iflree slopes U Fecdcts,4(x)amps of more 'Il-Wi+tion
U(kcupanl Innd over 9911ersoun U hinnufactured structures or KV park tach additlottal Inspection over lire allowable In any of lire alcove:
U Fillietiolighlingpinn U Other . Virt inspection - —
submit sets orplans with Any of the rbove. Invesligalimn fie
'I'Ite above erre not applicable to temporary construction service. 011to
--- --- --
Nal all luli+allcurnls accep,radii cnida,planar call pulalicuon for more infonnnlFl Nolir c. I ITIS Im•t:llll dl+I+hc;dloll I't'ttllll Ii'I'..................'..$
U Visit masiviCald expurti if it permit is ani ohlailled plan Ka o 1„(AI __- '31) $ _-----� -
('icdil card un tilwl -._ . . i.,._. �. within I RO days alter it has been State Sol(lr,uyc (dr%) ....`F
accepted ns cnmplele. ...................$
—`--Plane of rn-niliohli•r nr a own on ne�Iii rmr —
• f
(mr ddrl rignnuur Anu+u°i 141L4615(6xln(t•oki)
Ntt:Vlv�.t7: H/ 7;q1 t1:D1AM� •i .iU VY�1CY0 r'tYPS lrly, r•ryt, c
fluC 0'7 L? 07 : 068 p
01/0fl/01 YUP 10:19 FAX 60J 608 1980 CITY OF TIGARD fD002
Mechanical Permit'Application
_-- -- -- - -- Uaianraalrad: % 1 c � ►4rmlt.a.1 '.
City of
Tigard Ne)twt/ogpl.w. Brcpindam
t_17V Gr)1Wa/d Addmu: 13123 9W Hell Blvd,Thud UA 9M3
fttnna (503) 679-,171 D1101'""0� n�� Reaapt no.:
Fu (501),19N-1960 Can 'eao.: poymwttype
LAnd also approval: _ -- — - BulldingPwmttno..
U 1 &2 tamity Gwel6ag or aocea►on, ::1 CummmutAVUWumnal U Multi (anuly J 1 enact tmprrnentau
New ..m&UucUoa AddiftiWalbultut►Yto{dammem U Other. -_-,-_--
at- �Lulto-,
- -
Job ed4teot fs zif jkL, ,1n ��1tntLcatt eratdprnettt guar tftlee in Dcl�a►he1nN WM cmm:he doter
)31dt.no,' orae as value of all nwchenical metnnel►.rywpmonl,labor,over!xrad,
1'u Atex tot/ac=mt no. `7 .3 •- ? pmtlt.Vehte S
Lor ' t31oe]r Sttbdlvutoo; / ,1t27 !fee chnWW for knoorteat spF!ieauon Infhnnation snits
_awe: teriMliollon'i fen mbar ale fbr Iesideatial peg-+it fee
Cttyh owlty Z12':
Deeuiptiun and Ittlan of oik on premien:�r--�_-.--,.
Ali c_t( ) Pe ILI
�ull11C L rT C'� � Wa(s)I low
—,e,".4 3
Be.detc of amtpIIUOa/utsFection: ! ___._ 1t•. li,r<ast.l
fee�tt improvetnma or cbanae of use: 1 Oft
Ir exls tag spec•+haaKd or oorttttlooed7 0 Yap ❑No Gur<unJ unit cT'Wm
it e%lufrtg tpect Inoulttted7 U Yes Q No u�tiar+o ► 9�-
Val
Hanna►name'Ad dAIkLD jKJ� Staeebollar patvut nt,
Adorns&► — FtP Itxu [lTLM
�_Q,{•� _ dsn►o Carlon
City: rLsutar+t l?F' w t
Now R Pts; ��H�mtuL o �.---
labtud►e9 wtatMorl %TW urian 0 Ya G No
CCB no. Pa fnitilT9irp w[`7i oaw raft-►u Low""",
1 CiL7t"atru tic nu. +all•ortloorumtaw
r, Nwar,tpiewm ptintt: p Ziutoo a e m rnacx
Abs trouca unlu_ r— BTtidc
Ntmt: (:blp•,s RP
Addrd►�_.__. _. _. .—_ Mott
(
City: 9lais r(P _ ruams
rst rw uet
NJ Rtonc: flair: ErNIIL' vU:au,suit
pt at _ ►r rani
rood an atppteutos panto
f
"Pint
B"Oust hs with t bof dt tbafb fano)
Mel mmms,�, 1 war rem t u
�+ O'jty: I d { art ` T L I'Q . NO b Ull
I'lfotte.' '>Cala' ' 'j f- tnesl:1t1 —
I "ch anrTovn?
P"(NOMMSAUC ftlQ�1 1
i f � '`tlt&bQ al eUtlGU1 1
Nem��►dl.� ESP?..11�_ �_ ..__ w egtrpe►a I ._, ;
_Addrse�� S�' �_LSZ1C.�- �. - -y� C>.00tittrafitsDta� __- 1 ,.�.—.•
s � � •Y It0.0'M I otn.e ...1 -� --1--
Applkt d'1 it
`� �.a.rr.a....aM :�u IrrOr.a lr sari Mn■ lrumt�e._...._.._....... t _
�; d viw 7 eWtKird »s,r•_: moll=ms Pam:ffw:jrabm Mlm-mn The S --
I.�1 &%puts If it I— t u r"cwt.+w>Po 1'1an tcvtew lar 0.') f ^
wltnln 110 days after it h.bane
$tats rurrtwRe(1176) L _
AUG-7-2001 07:09A FROrl:EDWARD 11ULLEtJ PLU1`I8I 503 628 4633 TO:5035334306 P:1,1
nuy. n ui ttl:ll FAX P. 2
i
Plumbing Permit ApOcation
Tigard City of TI�:
Detercceived: In Pearndr no.:� ' Y, •�•'��
Sewer permit no.: Butlding permit no.:
Addteti+: 13125 SW Holl Blvd,'fipard,O 97223
CiryvfTlpard 111sme: (303)639.4171 111o)ect/sppl,m.: 8spiredate:
Fax: (503)598.1960 Daieluued by: Recalptno.
Land use approval: _-- - - Cue Ole no.: - Payment type.
O 1&Z family dwelling or accessory CJ Comineml irulusoial U M11111-family U Tenant impmvement
)KNew consttveuon O Addiliortlall tlnnlrsplecemeni U Foul service U Other.
Job address: "Z_Z,� y IDracri not► Fee ra. T otol
6ld .no.: a no.: Nen I--sited 2- y do I _+nnlyt
Tax mep/lar<IttUncutunt nu.: 5' _ SFR(1)bat
0Cdr.lenn.rereArbut luycvxvmttan)
h
Lot: Hlock: Subdivision; Fit(2) alli
act name: S (3)both
City/count ' 71P- IA- Ch odditional badVititche"
Description u"I qation of world on premises r f411ea110llear
Cr.tch ba+inlaren drain
W.date of comp letionrinspt c•tlnn Urywell0leacb lineJ ch drain --
rtain
Manufactured home uLl�•iues
Btuineu name an o en _
Adtirbta 2 + Hann drain conne=r Sz
City: 5tete:a r Zl!* r' / damuvy sewer(no, in.It.) —_
Phone: Fax:(p r- il: Sloan serer(no.W.It.) MIL
—
CCB ao.: qcq(o�� Plumb.but.reg.no: star scrvtce(no. In, )
City/metro Iia no.: iFltdare or llemt
Coatractcrr's re{trexr.Mtivr siltnelute: Abeo tion valve
Print Dam: DOW 0 Back low nter
Backwater valve
Haaia.+/lovwury
Nam& CI washer
Addmn: — -- --Dishurmher
nking founialn(s)
City: State. — 7.11': E'ecunwou�m��� _
Phone: Fax!Prtttaii: xpansicxturt --
lT to sew"cap
Name(print): �- �,lae, our o floor sitrkalltutl
Mailinga t: a rposal--
State: Icern�• '��—. /
Phoae:' ' Y �' r f L'trtait: 6 1 tNr t t met*xp TIF-reale_imp _
Owner in.+tallotionfresiderditil mitinunonoe only: The artu 1 i'"hwation mer(s)
will be made by me at the mai"Arlm sad repair made hy my regular -Ro—of raln(con.mercial)
employee an Ore property s liar OR.4 Morder 447. in (R), tWaxl�ii(s).tevl(s)
owner's Signature: �— irate Sum
u showed ower an Z..
Name: t r Urinal
lite
Adtireae; — r a c.et
Ater fiiiFr
Cit r State' Zli '� CREW.
F'h Ns F mail: '1 tslal
Nn ea Mialydwntm ttrxp mei
CAM.pray cart LWWrian he VW%Waromw A- htinimutn fee................3 _ (i►`i' I'rr•
Notice:This prmdt applleanon
DM" 0 M4nrrtlyd rur+itee if a permit is net obtained Plan rrvtew lot
6.mr era camber whltin 1110 days after it bas been Stale surollarpn(896)....S _
����..�r"",1� um complete. T(YfAL..........-...........
S -- --
Nine d rfdFnlde rMrs nn sada eaN '•"` • mp -
_ S
A1AWW 44D4616 MW'"l
� T
ooq
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CITY OF TIGARD
13125 S.W. HALL BLVD,.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MULLEN PLUMBING
24470 SW RAINBOW LANE
HILLSBORO, OR 97123
Plumbing Signature Form
Permit #: MST2001-00445
Date issued: ti moi
Parcel: 2S10313C-08300
Site Address: 12230 SW TIPPITT PL
Subdivision: MLP1999-00005 MOSES PP2000-077
Block: Lol: 003
Jurisdiction: TIG
Zoning. R-4.5
Remarks. Construct new single family detached residence. Path 1
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 Dent.
No plumbing inspections will be authorized until this completed form is received
OWNER: PL.UMBING CONTRACTOR:
WHITFORD SCOTT LLC MULLEN PLUMBING
4888 NW BETHANY BLVD #381 24470 SW RAINBOW LANE
PORTLAND, OR 97229-9260 Hll_�-SBORO. OR 97123
Phone #: 503-533-2253 Phone #: 503-628-1632
Reg #: I Ir 92.689
PI M 34-260PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X rl �\-
Signature of Authorized Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
i
FROM : ROSS ELECTRIC PHONE NO. : 5036422900 Oct. 29 2001 06:35PM F+
CITY OF TIGARD
13125 S.W. HALL BLVD,
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ROSS ELECTRIC
23810 SW DRAKE LN
HILLSBORO, OR 97123
EleLlrical Signature Form
Permit M MST2001-00445
Date Issued. 8i28i0i
Parcel: 25103BC-08300
Site Address: 12230 5W TIPPITT PL
Subdivision: MLP1999-00005 MOSEF, PP2000-077
Block. Lot. 003
Jurisdiction: TICS
7oning' R-4.5
Romarks: Construct now single tamily detached residence. Path 1
Your company has been indicated as the electrical contractor foi the permit tndkated above. In order for the
electrical permit to he 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 Dept.
No electrical inspections will be authorized until this completed form is receiv:d
OWNER. FI t c;TR1CAL CONTRACTOR:
WHITFORD SCOTT LLC; DOSS ELECTRIC
4888 NW BE=THANY BLVD#381 23810 SW DRAKE LN
SPORT-LAND, OR 97 229-92 60 HILLSBORO, ,DR ST123 -
Phone #: 503-533-2.255 Phone ft G42-2300
Roo 4: El-k 34-43MC
LIC IIM7t
Slip 4212X
AN INK SIGNpl URE IS REQUIRED ON THI;i FORM
x 24—e
Signature of Supervising Electrician
if you have any questions, pleese call (503)639 4171, ext. # 310
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)09-4171 MST ul__
OUP —
Received — Date Requested — AM_ PM BUP
Location Z _�_ —��- Suite MEC
Contact Person Ph(--) Ft 1 D Z I — PLM _.
Contractor_ —___ Ph( ) SWR _
BUILDING Tenant/Owner _ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors -- ----
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall NailingC't
Firewall
Fire Sprinkler - -
Fire Alarm
Susp'd Ceiling - -- ----- - ----
Roof
Other: - - - --- - -- -
Final ----- _--�
PASS_ PART- FAIL ----- - --- -----
PLUMBING _
Post RBeam -
Under Slab
Rough-In
Water Service ------ ----- --- - -
Sanitary Sewer
Rain Drains - __------ -- - -- ---------
Catch Basin/Manhole
Storm Drain -- ------- -- -.._
Shower Pan
Other: ---
PART FAIL - ------ - - ----------._ _. .._�_-----
HANICAL
Post&Beam ---_-_--
Rough-in ___--
Gas Line --_--------- ---- -
Smoke nampers - ---- ----- ----�-_---__.----
Firil
PASS PART FAIL - ---- ---- ------- ---- -- - --- -.
ELECTRICAL -_
Service -_ _ ---------.�---------------_ -- --
Rough-In
UG/Slab _-------_--. -------- -- _.-�-----------------
Low Voltage _ -- -- - ----------- _-_ - --.
Fire Alarm
Final F1 Reinspection fee of$- -._required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE�- - - [] Please call for reinspection PE:_ -___ _ Unable to inspect-no access
Fire Supply Line
ADA Data_-/~ Inspector_,L�1L Ze- 6ft C
Approach/Sidewalk
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 C�
INSPECTION DIVISION Business Line: (503)639-4171 MST
i''�f l� • `"CC BUP
Received 7 _Date Requested�— j� AM — PM BUP
Location & -"L Suite — MEC --__
Contact Person_ Ph(---) _L10—( I PLM
Contractor `
.�.--._-�i�� Ph SWR
BUILDING Tenant/Owner __ _ —� _ ELC
Footing ELC
Foundation Access: -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam — 7_01V
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -- ----- — -- -- -
Insulation
Drywall Nailing - - --•-- --- --------- �_._- __ _
Firewall
FireSprinkler _ —__-----_-----____-------.--..----- - .___ .--.___.---
Fire Alarm
Susp'd Ceilinc ---- - - -----------...
Roof
Other. -
Final
PASS PART FAIL --------- -- ------..----- ---------
PLUMBING ---- _ _-- - ---------------------
Post 8, Beam
UnderSlab - ----- _.. - - ----- --------- -------------- -_
Rough-In
Water Service
Sanitary Sewer
Rain Drains --- ---
Catch Basin/Manhole
Storm Drain --
Shower Pan
Other: -- - -- ------- ---- -- ----- ---
Final
PASS _PARTFAIL ---- _ _-___�---------------- __-- _ --
MECHANICAL W
Post& Beam - -- ---- -- --------- -
Rough-In ------ - -- —
Gas Line
Smoke Dampem
Final
PASS PARTFAIL --__—_ ------- - - --._ -- ----
ELECTRICAL_
Service ---- ----- — -- ------__-�_.-- --- ------
Rough-In ------- -- - -- -- - ---------
UG/Slab
Low Voltage
Fi,fa larm
`-"t [l Reinspection fee of$— _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE _ [� Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspfltator 1. Ext
Other: 611/_
Final DO NOT REMOVE this Insapect?ion record from the job site.
^4SS PART FAIL