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12938 SW Princeton Lane
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST ' ---
BUP -
Received Date Requested AM_ --- PM PM - _ BUP
Location _ /.� Suite - - MEC
Contact Ferson ---_ __ Ph(__-- ) __ -- PLM
Contractor _ - Ph(_. ) SWR
BUILDING Tenant/Owner _ _-_--_--_ -_ - ELC
Footing
Foundation Access: ELC
Ftg DrainUa"'�O y,
ELF!
Crawl Drain
Slab Inspection SIT
Post&Beam
Shear Anchors -- -----—
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Wailing
- C ( - ----------- —
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
Rain Drains
Catch Basin/Manhole
Storm Drain —
Shower Pan
Other: - -- —
Final
PASS_PART FAIL
MECHANICAL
Post&Beam - -
Rough-In
Gas Line
Smoke Dampers - —
Final
PASS PART FAIL --- - -
ELECTRICAL
Service ----- --- -- --
Rdug-fn
UG/Slab _ -
ow oae _
ire arm
F [�
PAS PART FAIL Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: ❑ Unable to inspect-no access
Fire Supply Line
ADA pate�a��`' Inspector,ector Ext
Approach/Sidewalk -
Other:_
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST
INSPECTION
.
__.
INSPECTION DIVISION Business Line: (503) 639-4171 BUP
Received _ ---------- Date Requested ___ AM PM BLIP --__--
Location �J Z 3 S� F2_('M_ c e �"'— -_ --Suite MEC _ _-
Contact Person — Ph j 5 3 1' PLM
Contractor -- — --
--. Ph(—) SWR -
BUILDING Tenant/Owner _- ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post& Beam -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing --- - -- - -
Insulation
Drywall Nailing --- - ------- - -- - ---
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling /
Roof _-
Other:
Final
-PASS PART FAIL ---
- m
Post 8 Beam
Under Slab -----
Rough-In
Water Service - -
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan - -
Other:
2S PART FAIL
_HANICAL ------ -- --- -
Post&Beam
Rough-In ----- ---- - - ------- ------- -
Gas Line
Smoke Dampers ----- - --------- -_- -- — -
Final
PASS PART FAIL ------- - - ___ -_ - -- -- --
ELECTRICAL --
Service �__--_--_-
Rough-In -_.._ -- ----- - ----- --
UG/Slab
Low Voltage ------ —�-
Fire Alarm
Final u Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_PASS _PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA Date Inspector
Approach/Sidewalk
Ixt
Other: `----._._--
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175Y
INSPECTION DIVISION Business Line: 503 639-4171 , MUT
BUIP
Heceived _Date Requested._ _ _ AM --_ PM BUP
Location Suite _ MEC
Contact Person _— Ph(__ _ ) PLM __-
Contractor —_ Ph( ) — -_____ SWR
_BUILDING _ Tenant/Owner _ __—_ ELC
Footing ELC
Foundation Access:�f �,,,.t; ~
Ft,gDrain I� � � � g , ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam -- -
Shear Anchors
r
Ext Sheath/Shear
Int Sheath/Shear
Framing - - - -- - ----_
Insulation
Drywall Nailing
Firewall '
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling
Roof
Other._- - -- - �—
%BING
PART FAIL
---..__....--------
Post&Beam f
Under Slab - -- - ---
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:_
Final
PASS PART FAIL_
MECHANICAL -- - ---- --- —
Post&Beam _
Rough-In -
Gas Line
Smokempers - ----- --- ----- — --
rna
FART FAIL
TRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final F-] Reinspecoun fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_
SITE - J� Please call for reinspection RE:— [] Unable to inspect-no access
Fire Supply LineADA �x /
Approach/Sidewalk Date 'L_ �L U Inepedor _ Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
STREAMLINE ELECTRICAL
DBA LAVALLEY CORORATION
6025 EAST 18TH ST
VANCOUVER, WA 98661
Electrical Signature Form
Permit #: MST2002-00112
Date Issued: 4/4/02
,'arcel: 2S104CA-QI IS49
Site Address: 12938 SW PRINCETON LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 049
,Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse, Unit # 49,Bldg 10,CS plan with deck
four company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER ELECTRICAL CONTRACTOR.:
BROWNSTONE QUAIL HOLLOW LLC STREAMLINE ELECTRICAL
12670 SW 68TH PKWY STE 200 DBA LAVALLEY CORORATION
PORTLAND, OR 97223 6025 EAST 18TH ST
ANCOUVER WA 98661
Phone #: 503-598-7565 NVone #: 360-933-5080
Req #: uc 116514
ELE 34-432C
SUP 4801S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2002-00112
Date 4!,','
t,','10
Parcel: 2S104DA-QHS49
Site Address: 12938 SW PRINCETON LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 049
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse, Unit # 49,Bldg 10,CS plan with deck
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 Dept.
No plumbing inspections will be authorized until this completed form is received
011/NER: PLUMBING CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LLC WOLCOT r 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 #: 1 ir. 23847
PI M 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signatures uth zed Plumber
If you have any questions, please cell (503) 639-4171, ext. # 310
GA R D i— ELECTRICAL PERMIT-
CITY
OF
T I"
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2002-00141
13125 SW Hall Blvd., Ticiard, OR 97223 (503) 639-4171 DATE ISSUED: 7/29/02
SITE ADDRESS: 12938 SVV PRINCETON LN PARCEL: 2S104DA-22300
SUBDIVISION: QUAIL HOLLOW- SOUTH ZONING: R-4.5
BLOCK: LOT: 049 JURISDICTION: TIG
Proiect Description: Install all encompassing Low Voltage.
A.RESIDENTIAL _ B.COMMERCIAL
AUDIO& STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL#OF SYSTEMS:
Owner: Contractor: V __
BROWNSTONE QUAIL HOLLOW LLC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY STE 200 P O. BOX 508
PORTLAND, OR 97223 WILSONVILLE, OR 97070
Phone: 503-598-7565 Phone: 503-639-0110
Reg #: ELE 36-941,;LE
SUP 2311JLE
LIC 145828
FEES Required Inspections
Type By Date Amount Receipt r Low Voltage Inspection
PRMT CTR 7/29/02 $7500 2720020000 Elect'I Final
5PCT CTR 7/29/02 $600 2720020000
a
Total $81.00
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 done in accordance with approved plans This permit will expire if wort; is
not started within 180 days of issuance, or if worm 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
952-001-0010 through OAR 952-001-0080 You may outain copies of these rules or direct questions to OUNC at (503)
246-1987
Issued by i, r r' _ 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 SUPR. ELEC'N !. ) ! i ',d[ DATE:__--___
LICENSE NO: �—
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Date received: Permit no.i )` r
City of Tigard 11roject/appl.no.: Expire date:
c to r/ig(rd Address: 13125 SW Hall Blvd,Tigard,OR 97_' I)ateissued: Bys? Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval
TVPE OF
U I & 2 family dwelling or accessory U Commercial/Industrial ❑Multi-family U Tenant improvement
D&New construction U Addition/altenuion/replaccnlcnt U Other: U Partial
.1011 SITE INFORMATION
Job address: �2 5 f r �Z�rtlC�.� I bldg. no.: Suite no.: Tax map/tax lot/account no
Lot: Block: Subdivision: ZA
rPraject name: f ou6t,' Description and location of work on premise~/QED_
Estimated date of completion/inspection:
CONTRACTOR APPLICATION. I
Job no: l`,V Mav
_ Description Qty. (ca) Total no.imp
i3usiness nallle: 7 6'111 10-, 'trA 77c,KINew rt�itkntial singk or multi-fandiv per
AdgnC �S ,lY• C t, l dwellingunit.Incluticvallaclndgarage.
City: t - I t- _ State: LIP: u7() Service in,luded:
Fax: - E mall. 1000 sq It (If less
Phone: /lU �D363'J�!1 ... Each additional 500 sq ft or portionthereof
CCB net.: f tES 2h f lac.bus.lie. no: 3 IF�'C - I,inutedenergy,residential _
City/mg-tro lic. no.: L2&(�O& ( Limnedenergy,non-residential
_ finch manufactured home or modular dwelling
Service and/or feeder
Signature of supervising of metas(re aired) Date — i
f Services or feeders-installation,
Sup elect name("11110 t!Q( F' Licenseno�yf21LF alterallonorreloallon:
III ItIll III FlU191MOLK11111W 200 amps or less '
i D L' 201 amps to 400 amps _
7State:
401 amps to 600 ampsress: 601 snips to IWO snips ZIP: Over 1000 snips or volts
Phone: Fax: E-mail: Reconnectonl
Owner Installation:The installation is being made on property I own Temporary services or feeders
Installation,alteration,or relocation
which is not intended for sale,lease,rent,or exchange according to 200 amps or less
ORS 447,455,479,670,701. 201 ams to 400 amps
Owner's sl mature: Date: 4111 to 6W ern s
Branch circuits-new,alteration,
ENGINEER or extension per panel:
Name: J A Fee for branch circuits with purchase of
Address: service or fec&r fee,each branch circus
City: _T State: ZIP: B Fee for branch circuits without purchase —H
of service or feeder fee,fust branch circuit.
Phone: Fax: E-mail:
Each additional branch circuit.
Misc.(Service or feeder not Included):
U Service over 225 amps-commercial U Health Cate IuC:ltt) Each pump or irrigation circle
U Service over 320 amps-rating of 1dr2 U Hazardous location Each sign or outline lighting
familydwell ings U Building over 10,000 square feet four or Signal circwt(s)or a limited energy panel.
U System over 600 volts nominal more residential units in one structure alteration,or extension'
U Building over three stories U Feeders.400 amps or more •tkscn tion - --
U chcupant load over 99 person, U Manufactured structures or Rc'park Each additional Inspection over the allowable In any of the above!—f
U Egress/hghtingplan U Other - -- -.- -- ---_..___ Per inspection
Submit sets of plans with onv of the above. Investigation fee
The above are not applicable to temporary construction service. Other
— Permit fee.....................$ _�_' .()U
Not
_
Not all lunedicttons accept credit cards,please call)untdiclion for more infontution Notice:This permit application Plan review(at — %) $
U visa U MasterCard expires if a permit is not obtained f r/
utedo card number / within 180 days after it has been State surcharge(8%) ....$
— Expires accepted as complete. TOTAL ....................... --
Name of cardholder its shown on credit card
_ _S _
--�- —Cudholdtr signature A mount lal d61 S,nixkc't lsl
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
!— TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below:
Restricted Energy Fee...................................................... 515.00
Number of Inspections per malt allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved.
Residential-per unit
1000 sq ft or less $145 15 _ 4 L Audio and Stereo Systems'
Each additional 500 eq ft.or
portion thereof $3340 -- 1 Burglar Alarm
Limited Energy $7500 cr
Each Manufd Home or Modular ❑2 Garage Door Opener'
Dwelling Service or Feeder $9090
A
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less — $8030 2 Vacuum Systems'
201 amps to 400 amps $10685 1
EI
401 amps to 600 amps $16060 2 Other
601 amps to 1000 amps $240.60 2
Over 1000 amps or volts $45465 2
Recwnnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED • COMMERCIAL ONLY
Fee for each system......._.................................. _. $75 no
Installation,alteration,or relocation
200 amps or less $66.85 2 (SEE OAR 918.260-260)
201 amps to 400 amps $100.30 2
401 amps to 800 amps $133.75 _ 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑ Audio and Stereo Systems
see"b"above.
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)1he fee for branch circuits Clock Systems
with purchase of service or
feeder/ea.
Each branch circuit $6.65 2 Data Telecommunication Installation
b)The fee for branch circuits
without purchase of ssrvlce Fire Alarm Installation
or feeder feo,
First branch circuit $46.85 _ f�I HVAC
Each additional branch circuit 56.65
Miscellaneous [� Instrumentation
(Service or feeder not Included)
Each pump or Irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting _ $53.40
Signal circuits)or a limited energy C� Landscape Irrigation Control'
panel,alteration or extension _ — $75.00
Minor Labels(10) $125.00
Ll Medical
Each additional inspection over
the allowable In any of the above Nurse Calls
Per inspection — _____ $6250
Per hour — $62,50 _ ❑
In Plant $73.75 Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ Other —.-- -
8%State Surchal go $ — Number of Systems
25%Plan Review Fee No licenses are required Licenses are required I all other installations
See"Plan Review'section on
front of application -
Fees:
Total Balance Due $
k=nter total of above fees S—
❑ l rust Account p _-__ P.State Surcharge $ --
-- �_- ��---------------`---^ Total Balance Due $All New Commercial Buildings require 2 sets of plans.
r dsts\forrnV c-fees.doc 08130/01
1
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MASTER PERMIT
CITY ®F T I G A R f?
PERMIT #: MST2002-00112
DEVELOPMENT SERVICES DATE ISSUED: 4/4/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12938 SW PRINCETON LN PARCEL: 2S104DA-QHS49
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: 049 JURISDICTION: TIG
REMARKS: SF rowhouse, Unit tt 49,BIdg 10,CS plan with deck
BUILDING
REISSUE STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: 320 if BASEMENT of LEFT. SMOKE DETECTORS: Y
TYPE OF USE: SFA FLOOR LOAD. 50 SECOND: 744 of GARAGE- 412 of FRONT PARKING SPACES:
TYPE OF CONST: 514 DWELLING UNITS. 1 FINBSMENT: 732 of RIGHT.
VALUE $113.3U55U
OCCUPANCY GRP: R3 BDRM: 7 BATH: 2 TOTAL: 1.79600 at REAR
PLUMBING
SINKS WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES. ) DISHWASHERS: I FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS,
TUBISHOWFRS: GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: 1 BOIUCMP<3HP: VENT FANS: 4 CLOTHES DRYER: 1
P. FURN>•100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL.
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADVL INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 1 0 200 amp: Wl8'/C OR FDR: PUMPIIRRIOATION: PER INSPECTION:
EA ADVI_500SF: 3 201 400 amp: 201 400 amp: tat W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY 401 600 amp: 401 600 amp: EA ADDI.BR CIR: SIGNALIPANEL: IN PLANT:
MANU HM/SVC/FDR, 801 1000 amp: 601+3mpa•11000v: MINOR LABEL:
1000•amolvoll
PLAN REVIEW SECTION
Reconnect only: >•4 RES UNITSSVCIFDR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
:
_ ELECTRICAL•RESTRICTED ENERGY
_ A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 9 STEREO: VACUUM SYSTEM AUDIO S STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR
HVAC: DATAITELE COMM: NURSE CALLS: TOTAL a SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,599.33
This permit is subject to the regulations contained in the
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES,LLC Tigard Municipal Code,State of OR. Specialty Codes and
12670 SW 68TH PKWY STE 2.00 12670 SW 68TH PKWY all other applicable laws. All work will be done in
PORTLAND,OR 97223 PORTLAND,OR 97223 accordance with approved plans. This permit will expire If
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg e: LIC 124627 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 INSPECTIONS
Sewer Inspection Electrical Service Gas Line Insp Gyp Board Insp Plumb Final
Footing Insp Electrical Rough-in Insulation Insp Rain Drain Insp Mechanical Final
Foundation Insp Mechanical Insp Shear Wall Insp Water Line Insp Building Final
Slab Insp Plumbing Top Out Exterior Sheathing Insl Smoke Detector Final inspection
Plm/undslb Insp-._` Framing Insp Firewall Insp Electrical Final
Issued Gy Permittee SignatL+re
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TI GAR D SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00037
DATE ISSUED: 4/4/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S104DA-QHS49
SITE ADDRESS; 12.938 SW PRINCETON LN
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: 049 JURISDICTION: TIG _
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
Owner: �-- --- _FEES _ --
BROWNSTONE QUAIL HOLLOW LLC Type By Date Amount Receipt
12670 SW 68TH PKWY STE 200 -
PORTLAND, OR 97223 PRMT CTR 4/4/02 $2,300.00 27200200000
INSP CTR 4/4/02 $35.00 27200200000
Phone: 503-598-7565 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections _
This Appli(;ant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will he 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 log -,I thQ installer shall purchase a "Tap and Side Sewer' Perm
Issued b c a), ►� l` Permittee Signature:
y _ (_ o
Call (503) 639.4175 by 7:On P.M. for an inspection needed the next business day
n Plumbing Permit Application
"eceived: Petmitno.:i
City of Tigard Sewer permit no.: Building pertrut no.:
Andress: 13125 SW Hall Blvd,Tigard,OR 97223
City of Tigard Phone: (503) 639-4171 Project/appl.no.: _— Expire date:
Fax: (503) 598-1900 Date issued:--- By I Receipt no
J.and use approval: Case file no.: Payment type:
1
U I &2 family dwelling,or accessory U Commercial/industrial U Multi-family ❑'Tenant improvement
U New construction U Addiuoii/altcrttion/ieplacemerrtNNW
U Ftxrcl set-vice U Other: ._-_
Job address: Desai tion Qty. Fee,(ea.) `Iota(
1 ; " (C i ` �t c L'{� ' New I-and 2-family dwellings only:
Bldg.no.: Suite na' (includes 100 ft.for"ch utility connection)
Tax map/tax lot/account no.: _ SFR(1)bath
Lot: V(( Block: Subdivision: SFR(2)bath
Project name: Slit(3)bath
City/county: ZIP: Each additional batli/kitchen
Description and location of work on premises: basin/arra
Catch ba
— a ies:
5iteutsin arra drain -
-` _ - Drywells/leach line trench drain _
Est.date of wmpletion/inspection: Footing drain(no.lin. ft.)
ING I'LUMB1 1 Manufactured home utilities
Rutineas name: Manholes —^ —
Wolcott Plumbing Rain drain connector------
110
onnector __-PO Box 2007 Sanitary sewer(no.lin. ft.)
Gresham OR '703(1-0594 Storm sewer(no.lin.ft.)
Water service(nolin.ft.)
503-667-1781
C'CI3:23847 14 \1 u:2G-20��1'I', flxtweorkem:
Absorption valve _--
Lontracwrs reptcaoutaum 81Kuatut,- - Back flow preventer _ -
- -
mum
hi
Print name: Date: Backwater valve —
Basins/lavatory
Clothes washer_
Name: — _--- -- Dishwasher _ _ _ _-
Addrrss: — Drinking fountains)
City: State: L[P_� Ejectorslsutnp
Phone. Fax: E-mail: Expansion tank
Fiztutelsewer cap
Floor drains/floor sinks/itub
Name(print) _ Garbage disix)sal
Mailing address: _ _ Hose bibb
City: State: ZIP:--- --- Ice maker
Phone -- Fax: Email: Interco tor/ cease.n
Owner imstallation/residential maintenance only: The actua! installation Primer(s) _
will be made by me or the maintenance and repair made by my reguiar Roof drain(commercial) —
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) —
Owmer's signature: Date: Sump
Tubs/shower/shower pan -
Urinal _
Name: _ _ Water closet
Address: _ _ Water healer
City: J State: 7dP.- Other.'— ---- —
Phone: _ Fax: —-- E-mail: Total
_ Minimum fee................S
Na tll Irk ,ardr,t cW i U&-tieo fa Notice:This permit applicaticm
Yiu ❑MastcrC_'ard Plan review(at r 96) $
U —_. —
expires if a permit is not obtained State surcharge(8%) S
aeAlr are ttnttta:--.----------- --
—�_-- within 180 days after it has been ""
accepted as complete
.......................$
----,W;W— bo&dn acTc is OrAn on credit cnt f
— (Ymolder teljeutae
— Amww pa blb(bOtl00M)
1
Mechanical Permit Application
"Dateived:d �l p'y Ptxmit no.� j �m, p
City of Tigard Project/appl.no.: Expire date:
City ojTiga.d Address: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
t
U 1 &2 family dwelling,or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U(►)her:- __ --_
JOB SITE INFORMATION COMMERCIAL t
Job address: _�' - (l ) ,ti. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax IoUaccount no.: profit.Value$
Lot: / Block: Subdivision: *See checklist for important application information and
Project name: Ijurisdiction's fee schedule for residential permit fee.
City/count-y: �- ZIP: t
Description and location of work on premises: t t
11
Iee(ea.) Total
Est.date of completion/inspection: Desai ioo I(My. Res.only Res.only
Tenant improvement or change of use:
Air handhng unit
Is existing space heated or conditioned?U Yes U No a conditioning(site plan requi—arc f -
Is existing space insulated?U Yes U No Aterauon o extsun Ff�A system -
1 of er compressors
State boiler permit no.:
HP Tons BTU/H
Four Seasons Ileatinb&A/C Service Inc --ir smo a amper. uctsmo a electors
PO Box 66409 ffeat pump(site p an requir )
Portland OR 97290-6409 nsta Urep ace fumac umer
503-775-5919 Including ductwork/vent liner U Yes U No -_
CCB: 48283 Install/replace/relocate heaters-suspen
wall,or floor mounted
Name(please print): Zent or a taoce other than furnace
CONIACTIIERSON e
Absorption units _ BTU/H
Name:
Chillers— Hr -
----
--- - --- Co ressors III'
Address: __ auaeo exhaust ren ton:
City: State: pphancevent
Cit ZIP: A� ---- — -- —
Phone: `--�-- Fax: T 1;-mail: Dryerexhausi - -_..--
sl�es. nc a tazmat
hood fire suppression system --
Name Exhaust fan with single duct(bath tans)
_Mailing address:y
Exhaust systema an rom�ieau2Lor A
- Slate: TZIl': ser piping and aunntwcroa pip lo�ou Ices)
City: _- -1— Typr: t_PG NG Oil
Phone: Fat: E-mail uel piping each a diuZTnal over o�u�Tw
pan h3I rocess piping(sc ematic required)
Numbrr of outlets
Name: -- - -LTi,e�i�ste�appLlance o—r e-Ta pmeni: ---
Address: _ Decorative fireplace
City: ZIP -- - Tnse" type
Phone: Fax. Email: _W(_;crstov pe et stove _
(Ttr-
Applicant's signature: -_-_� Date: _ Other. -
Name(print):
Na an)Wt8 CWM tet*credo card,pkar LAB kxudictian rR rose wurmabm Permit fee........... . .......$ --
Notice:This permit application Minimum fee.. $
U Yw t]MtuterCard expires if a permit is not obtained
C"t card somber _----- -- - within IAO days after it has been Plan review(at — %) $ ---•-
- � State aur:harge(8%) ....$
—
----�-��u�as aedt cold - S scrsined as complete.
TOTAL .......................$
Electrical Permit Application
11D)atcreceived: Ptrmil no. aj' r OJj
City of Tigard Project/appl.no.: Expire date:
('tau (l ii arrl Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U 1 e42 family dwellitip or accetisory U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Other: U Partial
1 . SITE INFORM.ATION
Job address: 3 g" (t' ( c to , Illdg no tiuue nu.: _ Tax map/tax lotlaccount no.:
Lot: Bhxk: Subdivision: _
Project name: I Description and location of work on premises:
Estimated date of completion/inspection
SCHEDULECONTRU-70111 APPLICATION FEE
,lob no:
Sticamline ElecUt� Description Q1 (ea.) Total nu imp
DBA LnValley Corporation Nrw re-Wential-single or multi-family per
d"elling unit.Inchtdes attached garage.
6025 Last 18i1'St %ervimincluded.
Vancouver WA 98661 I(NN)sq ft orless — 4
360-993-5080 finch additional 500 sq ft.or portion thereof _
CCB:116514 ELC#: 34-432C SUPT: Limited energy,residential 2
t.Ityllileuu tic.Ili,. Limited energy,non-residential
Bach manufactured home or modular dwelling
Service and/or feeder
Signature of supervising electrician(requited) Date- — — Servleesorfeteden-installation,
Sup elect name(print i License nn
alteration or relocation:
PROPERTY1 200 amps or less _
201 amps to 400 amps 2
Name Ipnntl _---- - 401 amps to 600 amps
Mailing addresti 601 amps to 1000 amps
City: _ State: Llf'. Over I(IX)amps or volts E-mail: Reconnectonl rs-
Owner installation:The installation is being made on property I own InstTeeporwryaenktion,oereocwhich is not intended for sale,lease,rent,or exchange according to 'II■tlal aHeratlal,orrebcauon:
2(X)amps or less __,q!2
2
ORS 447,455,479,670,701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 ams 2
Branch cirtt-Its-new,alteration,
or extension per panel:
Name: _ A Fre for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State: ZIP: B Fee for branch circuits without purchase
of service or feeder fee,first branch circuit 2
Phone: Fax: E-mail:
Eath eddtttcmal hranch cretin
IWLA Misc.(Service or feeder not included):
pum or irigation circle ---
UService over 225 amps-commercial U Health-can F�eh facility - -- —
'-
O Service over 320 amps-rating of 1 Act U Hazardous iocation Each sitign or outline lighting _ _2-
familydwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel.
U System over 600 volts nominal more residential units in one structure alteration,or extension• 2
U Building over three stories U Feeders.4(10 amps or more •ikscri.tion —
U Occupant load over 99 persons U Manufactured structures or RV park Each milditiolul Inspection over the allowable In any of the above:
U Egressilighting plan U Other Permspection
Submit_acts of plans with an%of the above. Investigation fee _—
'Ilse above are not applicable 10 temporary construction serv',ce. Other
Permit fee.....................$
Na all juntufictioru accept credit cards,pkue call jtrrisdictim her mac itdamuion Notice:This permit application Plan review(at —_ 9f) $
U Visa U MasterCard expires if a permit is not obtained --- ---
within
__-_ _
_— thin ISO days after it has been State surcharge(RAF:) ....$
Credit rard number
Expires accepted as complete TOTAL ...... ......... ......S
Nturr e><cyn9toldrr u xl., on aedv pard --- s
CwdWdn sigaaturr, �-- Amount 4101615(~'OMi
SEE 35MM
ROLL #2 0
FOR
OVERSIZED
DOCUMENT