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12968 SW Princeton Lane
CITY OF TIOARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST _�2 —&j1�—
INSPECTION DIVISION Business Line: (503)639-4171
BUP -_—
Received Da a Requested - 7 AM - - PM BLIP - - - -
Location CIL _ ILA,64 ' Suite MEC _
Contact Person
C-- P PLM
Contractor-_ -1' (�) — - a � 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 ----------— 1
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -- -
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL --�-�y—
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 8 Beam _--
Rough-In
Gas Line
Smoke Dampers --- - --- - ---
Final
PASS PART FAIL --
ELECTRICAL
Service _
Rough-In
UG/Slab
Ffrr " t�c
P ,IFaT', .etc c�
Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
.PASS' PART FAIL
❑ Please call for reinspection RE:_ Ej Unable to inspect-no access
Fire Supply Line
ADA -�
Approach/Sldewalk Date _ '' --D Inspector L� d � 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 _ G0/ U7
INSPECTION DIVISION Business Line: (503)639-4171 ---BLIP
Received
Received Date Requested __ G� AM_ PM _ BLIP
Location _ ?-!2 6- Suite— MEC _-----
Contact Person Ph(—) — 5 -3` 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
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
S 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 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 LineADA (�
Approach/Sidewalk Oats Inspector_ Ext
666 111
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) 639-4175 OC
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP -
Received -- Date Requested " _AM__ —PM BUP
Location Suite MEC
Contact Person Ph(—) y 3- S3YT PLM
Contractor -_-_— Ph( ) -. __. -- - SWR
BUILDING Tenant/Owner ELC
Footing �-_----
Foundation Access: ELC
Ftg Drain ELF!
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 - -- - - - - -- -
Root
Oth�er:� ---
PASSi PART FAIL -
PLUMBING
Post& Beam
Under Slab
Rough-In -- _-.---------
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain -
Shower Pen
Other:_ --
Final
PASS_PART—FAIL - —
MECHANICAL
Post&Beam
Rough-In
Gas Line
S ke Dampers _ —
i
S PART FAIL - - -- —
ELECTRICAL
Service _ - — -- --- — -
Rough-In
UG/SIE b
Low Voltage --
Fire Alarm
Final [� Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_
SITE L] Please call for reinspection RE: — Unable to inspect-no access
Fire Supply Line ^ ^
ADA � // )
Approach/Sidewalk Date -. O —Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASt3 PART FAIL
— ELECTRICAL PERMIT-
CITY O F T I GA R D
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: EL.R2002-00138
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 7/29/02
SITE ADDRESS: 12.968 SW PRINCETON LN PARCEL: 2S104DA-22000
SUBDIVISION: QUAIL HOLLO`N - SOUTH ZONING: R-4.5
BLOCK: LOT: 046 JURISDICTION: TIG
Proiect Description: 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:
BROWNSTONE QUAIL HOLLOW L.LC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY STE200 P O BOX 508
PORTLAND, OR 97223 WILSONVILLE, OR 97070
Phone: 503-598-7565 Phone: 503-639-0110
Reg #: ELE 36-94CLE
SUP 2312JLE
LIC 145828
FEES Required Inspections
Type By Date _Amount Receipt Low Voltage Inspection
PRMT CTR 7/29/02 $75.00 2720020000 Elect'I Final
5PCT CTR 7/29/02 $6.00 2720020000
Total $81.00
This Permit is issued Subject to the regulations contained in the Figard Municipal Code. State of OR Specialty Codes
and all other applicable laws All work will be done in accordance with approved plans This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days ATTENTION Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0080 You may obtain copies of these rule$jr irect questions to OUNC at (503)
246-1987. ��' � (r �L Permittee Si nature v�
Issued by ,�_it v._. _�- g ---
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
ATE: - -_CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N _(I �t j4�/r2-r DATE:____
LICENSE NO: - j.
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Date received: PeMIit no. _
26 City of Tigard Project/appl.no: Expire date:
AL
City q(%'igord 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 I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
gNew construction U Addition/alteration/rcpl;tcenrent U Other: U Partial
JOB SITE INFORMATION
Job address: ,� ), . C700� W Bldgno.:fa Suite no.: i,rax map/tax lot/account no.:
Lot: Block: Subdivision: f L",IL J
ProJect'name:QQ&L. out Description and location of work on premises: ( ' -
Estimated date of completionhrispecuon:
IEDULF
Job no: 1 Mu.t
S Description (ea) total no,iosp
Business name: 1 &11,141L,10)s Ne"residential-single ormulti-family per
Address: ''� j S,Irl• G' L dwelling unit.Includmami(tied garage.
City: f >iJ4r1L.lt Slate:04 1 ZIP:CJ7o]b Service included:
Phone, 0//L) I Fax;; 36,yy0//S" E-mail: I W)SCI rt.or less _ a
/N r��r r Each additional 5(N)sq ft or portion thereof
CC13 no.: Elec,bus.lic.no: C(L- Limited energy,residential
City/nletro lit'.no.: C)Utt)6572 Limited energy,nun-residential _
Loch manufactured home of modular dwelling
signature of supervising electric (requited) Dote service and/or feeder
License no: Services or feeders—installation,
Sup clect.narne(prinq E L� Z_j- aheratlonorrelocatlon:
/ 200 amps or less _
(p 1�U4�N S r1��� 201 amps to 400 amps -
Name(print): 401 amps to 600 amps '-
Mailing address: 601 amps to 1000 amps
City; _ State: ZIP: Over 1000 amps or volt% 2
Phone: Fax: E-mail: Reconnect only
Owner installation: The installation is being made on property I own Temporary semices or fteders
which is not intended for sale,lease,rent,or exchange according to installation,alleratIon,orrelocation:
201 amps or less
ORS 447,455,479,670,701.
2U1 amps to 4W amps
Owner's si nature: Dale: _ 401 to 600 amps
Branch circuits-new,alteration.
or extension per panel:
Name: _ ___ __ A Fee for branch circuits with purchase of
Address: _ service or feeder fee,each branch circuit _
City: Stale: ZIP: b] Fee for branch circuits without purchase
of service or feeder fee,fust branch circuit ?_
Phone; I;tx l tlLtil Each additional branch circuit
Misc.(Service or feeder not Included):
^i
U Service over 225 amps-commercial U Health-care facihry Each pump or irrigation circle
U Service over.120 amps-rating of 1&2 U Hazardous location Each sign or outline lighting
fanulydweihngs 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,orexlenston• _.
U Building over three stones U Feeders,400 amps or more •Ikscri tion
U tkcupatit load over 99 persons U Manufactured structures or RV park Fitch additional Inspedion over the allowable In any of the above: —1
U Egress/lightingplan U Other _ _ -- Per inspection L -7Y I
Submit jets of plant with any of the above. Investigation fee
Ilse above arc not applicable to temporary cottstnlction service. Other
Nut all jurisdiction accept credit earls,please call jurisdiction for more information Notice:This permit application
Permit fee................ . ..
U visa U MasteKtard expires if a permit is not obtained Plan t^view(at w) $
Credit card number L_ within 180 days after it has been State surcharge(8%) . ..
Expires accepted as complete. TOTAL ........ . ..
No of cudholdet u shown on credit card
S _
Cardholder signature Amaum +4ig-461 s I&M UM
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total
Check Type(if Work Involved:
Residential•per unit
1000 sq It or toss _ $145 15 4 I ❑ Audio and Stereo Systems"
Each additional 500 sq ft or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00 _ .S r I
Each Manuf'd Home or Modular
Dwelling Service or Feeder $9090 2 Garage Door Opener'
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80,30 2 r�
201 amps to 400 amps — $10685 2 0 Vacuum Systems'
401 amps to 600 amps _ $160 60 2
601 amps to 1000 amps — $24060 2 Other____
Over 1000 amps or volts — _ $45465 _— 2
Reconnect only _ $6685 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each systlm.......................................................... $75 00
200 amps or less _ $66852 (SEE CAR 918.260-260)
201 amps to 400 amps $10030 e _ 2
401 amps to 600 amps v� $133 75 —� 2 Check Type of Work Involved.
Over 600 amps to 1000 volts,
see•'b"above. ❑ Audio and Stereo Systems
Branch Circuits i—1
Now,alteration or extension per panel LJ Boller Controls
a)The fee for branch circuits
with purchase of service or C] Clock Systems
feeder lee.
Each branch circuit _ $665 2 F—P Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First brands circuit _ $46.85
Each additional branch circuit _ $665 ❑ HVAC
Miscellaneous instrumentation
(Service or feeder not included)
Each pump or imgation circle _ $53.40
Each sign or outline lighting — $5340
Intercom and Paging Systems
Signal circuit(s)or a limited energy
panel,alteration or extension _ S75 00 _ Landscape Irrigation Control'
Minor Labels(10) _ $12500
Each additional Inspection over Medical
the allowable In any of the above
Per inspection — $6250 _ Nurse Calls
Per hour _ $6250 _
In Plant $7375 _— Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ Other
8%State Surcharge $ T —_Number of Systems
I
25%Plan Review Fee
See-Plan Review"section on S " No licenses are required Licenses are required for all other installations
front of application — —
Fees:
Total Balance Due $
— — Enter total of above tees
❑ Trust Account tf 8%State Surcharge S_—
Total Balance Due S
All New Commercial Buildings require 2 sets of plans.
i Asts`,formsklc-fees doc 09/30/01
CITY OF TIGARD
1312 7) S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERM T `:OTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007'
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2002-00107
Date Issued: 4!4/02
Parcel: 2S104DA.-)HS46
Site Address: 12968 S11V PRINCETON LN
Subdivision: QUAIL FJOLLOW - SOUTH
Block: I.ot: 046
Jurisdiction: TIG
Zoning: R-4.5
Remarks- SF rowhouse,Unit 46,Bldg 10,13N plan with a 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
OWNER: PLUMBING CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LLC WOLCOTT PLUMBING CONTRACTOR!
12670 SW 68TH PKWY STE200 PO BOX 2007
PORTLAND, OR 97723 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
X
Signa ure of A66thoriked Plumber
It 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
STREAMLINE ELECTRICAL
DBA LAVALLEY CORORATION
6025 EAST 18TH ST
VANCOUVER, WA 98661
Electrical Signature Form
Permit #: MST2002-00107
Date Issued: 414102
Parcel: 23104DA-Ql I S46
Site Address: 12968 SW PRINCETON LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot: 046
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse,Unit 46,Bldg 10,13N plan with a deck
Your company has been indicated as the electricol 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 STE200 DBA LAVALLEY CORORATION
PORTLAND. OR 97223 6025 EAST 18TH ST
VANCPUVER WA 98661
Phone #: 503-598-7565 Prrione 360-9 3-5080
Req #: LIC 116614
ELE 34-432C
SUP 4601S
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 __ MASTER PERMIT
PERMIT#: MST2002-00107
DEVELOPMENT SERVICES DATE ISSUED: 4/4/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12968 SW PRINCETON LN PARCEL: 2S104DA-QHS46
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: 046 JURISDICTION: TIG
REMARKS: SF rowhouse,Unit 46,13Idg 10,13N plan with a deck
BUILDING
REISSUE: STORIES + FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT FIRST: 172 at BASEMENT at LEFT: SMOKE DETECTORS e
TYPE OF USE: SFA FLOOR LOAD: `,U SECOND: 733 at GARAGEof FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: I FINBSMENT: 733 at RIGHT:
VALUE 5 1 :'UJ u�
OCCUPANCY GRP: R3 BDRM• 2 BATH: 2 TOTAL: 1,639.00 at REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: I LAUNDRY TRAYS. RAIN DRAIN. TRAPS:
LAVATORIES: DISHWASHERS. 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS CATCH BASINS:
TUBISHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: i WATER LINES. BCKFLW PREVNTR. GREASE TRAPS:
OTHER FIX1 ORES:
_ MECHANICAL
FUEL TYPES FURN c 100K: BOIL/CMP c 3HP: VENT FANS: 3 CLOTHES DRYER I
I P' FURN>•100K: UNIT HEATERS: HOODS 1 OTHER UNITS.
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS, +
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 1 0 200 amp: WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION.
EA ADD'L 5009F: 3 201 400 amo: 201 400 amp: tat W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL SR CIR: SIGNALIPANEL: IN PLANT,
MANU HMBVCIF.IR: 601 • 1000 amp: 601.amp6•1000v: MINOR LABEL
1000+Imp/volt:
PLAN REVIEW SECTION
Reconnect only:
>s4 RES UNITS: SVCIFDR>.225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL-RESTRICTED ENERGY _
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO A STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR
HV4C: DATA(TELE COMM: NURSE CALLS TOTAL a SYSTEMS.
Owner: Contractor: TOTAL FEES: $ 5,500.08
This permit is subject to the regulations contained in the
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES,LLC Tigard Municipal Code,State of OR. Specialty Codes and
12670 SW 68TH PKWY STE200 12670 SW 68TH PKWY
PORTLAND,OR 97223 PORTLAND,OR 97223 all other applicable laws. All work will be done i
accordance with approved plans. This permit will expire N
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 a: LIC 124627 forth IIT 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 Slab Insp Plumbing Top Out Shear Wall Insp Water Line Insp Building Final
Footing Insp Plm/undslb Insp Framing Insp Exterior Sheathing Inst Smoke Detector Final inspection
Foundation Insp Electrical Service Fireplace Insp Firewall Insp Electrical Final
Wtr Proofing Bsm't Wa Electrical Rough-IIT Gas Line Insp Gyp Board Insp Plumb Final
Wtr Proofing.8mT.We Mechanical Insp Insulation Insp Rain Drain Insp Mechanical F
Issued 1 1116( ' Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD _ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00082
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/4/02
SITE ADDRESS; 12968 SW PRINCETON LN PARCEL: 2S104DA-QHS46
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: 046 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSVJR IMPERV SURFACE:
Remarks: Sewer connection
Owner: v FEES
BROWNSTONE QUAIL HOLLOVV LLC Type By Date Amount Receipt
12670 SW 68TH PKWY STE200 —_ —
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 Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. Tne 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 not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Issued y: D1<L Permittee Signature: yr
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
Plumbing Permit Application
Dateteceived: (/ 0� Pamlt oo.:
City of 'Tigard Sewer permit no.: Building permit no.: —
Address: 13125 SW Ifall I1lvd,Tigard,OR 97223
CiryojTigard Phone: (503)639-4171 I'rojecUappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: - lty: Fteccipt no.: - I
Land use approval: _ , Case file no.: Payment type: {
TYPE OF PERMIT
U I &2 family dwelling or accessory U CommerciaUmdustrial U Multi-family U Tenant improvement
U New construction U Ad(lition/alteration/replaccment U Food service U Other:
O:
]ob address: jc('b-9 SW II Description (jt Y. I PC e2. Toln
�VNew I-and 2-family dwellings only:
Bldg.no.: tSuite no.: Owindes1000.fortact►utilityconnedion)
Tax map/tax lot/account no.: _—� SFR(1)bath
Lot: q6 Block: Subdivision: SFR(2)batik --�-- — -
Project name: — -- SIFR(3)bath
City/county: ?.IP: - Each additional bath/kitchen
Description and location of wort on premises: SiteutlUtles: —
Catch basin/arra drain
Esc date of completion/insptxtiah:PLU51 III N(I CONTRACTOR-- - - -- -- Drywells/Ieach line/uench drain -
Footing drain(no.lin.ft.) -_
Manufactured home utilities
a...i—re Manholes --- -- --
Wolcott Numbing Rain drain connector
PO Box 2007 Sanitary sewer(no.lin.ft.)
Gresham OR 97030-0594 Storm sewer(no.lin.ft.)
503-667-1781 Water service(no.lin.ft.) _
('('13:23847 11I.M #:26-2081113 Hxtureorhem:
Absorption valve —
Contractor's reptesentaUve signature: Back flow preventer _
Pri name: Date: Backwater valve
t t Basinstlavatory _ J
Name: Clothes washer _— -
- -- - -- Dishwasher
Address: Drinking fountain(s)
City: State:
_ LIP: Ejectors/sump — - --
Phone: I az Email: Expansion tank
ixture/sewer cap _
}loor drains/floor sinks/hub _
Name(print): Garbage disposal
Mailing address: Hose bibb _—
City: State: — ZIP. Ice maker �-
Plhone:—J F-mail: Interceptor%grease trap —
Owner installation/residential maintenance only: The a►xual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) —
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ —
Owner's signature: _ — Date: Sum
rubs/shower/shower pan - I
Urinal 1
Name: - Water closet
Address: _ _Waterheat_er_ _
City: ------ ---- .._.... tate: ZIP: Other. - —
- —�
Phone: TFax: f nhail: Total l
Minimum fee................$
Na an haidicttaa kxreo c ed,cards,please earl jnis&-don ear I Hultman Notice:This permit application -
Plan review(at _'i6) $
U Visa ❑Mastacard expires if a permit is not obtained
l mil card number: --- ----1--1--- within 180 days after it has been State surcharge(8%)....$ __..
F:pba
_ -------- accepted as complete. TOTAL .......................
Natty.d wdhold"r u elsow•o ae ctodi cant =
Cardb.l tlpo Aaost 1 4"16(6MICO i
McchanicalPermitApplicationNo
Date reCelVed: .�"/-) 1'amll no.: /v"/ II'r_
City of Tigard Projecl/appl.no.: Expiredate:
16 CiryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- --Date issued: B-
Phone: (503)639-4171 y: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvemen,
U New construction U A(1(iition/alteratioll/replacemenl U 01her:
1 { SITE INIPORMAT16N1 1SCHEDULE
Job address: r���' U a �r. acne-- �v�-�---- IndlLAW equipment quantincr,in Nixes below.Indicate the dollar
Bldg.no.: — Suite no.: value of all mechanical malcrials,equiptnent,labor,overfiead,
Tax map/tax lot/account no.: _ profit. Value_$
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: -
Description and location of work on premises: 1 1 1 1 1
_ Fee(m) Total
Est.date of completion/inspection: — Description Qty. Res.only Rmotdy
Tenant improvement or change of use: I�'V C.
Air handling unit _--CFM
Is existing space heated or conditioned?U Yes U No Air^—conditioning(site plan required)
Is existing space insulated?U Yes U No A Iteration of existing HVAC systemNIECIIANICAL _
CONTRACTOR TioilTmpreasors -
State boiler permi(no:
HP Tons R'rU/11
Four Seasons Ileating&A/C Service Inc ire/smo a arnperiTucts-moteelectors- --
PO Box 66409 tatpump(a(siterequired)an
-
Portland OR 97290-6409 n-T-stal�eplacefurnaccW6i er_—BTU/11
503-775-5919 Including ductwork/vent liner 0 Yea O No
CCB: 48283
Install/rep
ac rrelocatehealers--suspend
wall,or float mounted
Name(please print):
Vent fora) fiance other than furnace
-
1 engemE .
Absorption units_-- -_ IITU/Ii
Nance: Cltilltxs --.- - IIP — -- -- -
- --- - --- tesscxs--- -- IIP
Co
Address: nm trot stn vent ton:
City: - State: - 7.IP: Appliancevent - -- --
Plione: _ - - I,ax. F mail: Dryer extaust--�- — -
1 loo s, ypGjlVieS k101cn/ha7m3t
hood fire suppression system ---.
Name: Exhaust!an with Bingle duct(hath fans)
Mailing address: x taust
system apart from heating or AU
-^ State: 7.IP: pip-Ingon(up to 4 out cts)
City: _ _ -- Type: 1,PG NG -- Oil
Phone: 1�a x: Firman: Ivcl Tpiping-cO.5d`itional over 4 outlets
'rocesspiping(schematic required)
Number of outlets
Name: _ - ter ap or eq pu pmenf:--- -- ---- -
Address: Decorative ftrcplace
City: -_tate: ZIP_ pert-type --
Phone: Fax: E-mail: - stov etaove —_ -
Applicant's signature: Date: �1-uille—r,
Other. —
_Name (print):
Na all furlsdicU«u aroetw crtdit cards,pkau call juris&-don fur rnue idarMesorr Permit fee.....................$
Notice:ibis permit application Minimum fee................$ -
U Visa U MasterCard expires if a permit, not obtained
ordit cid mmtKr: _ --_ --- F L- within 18()days atter it has been Plan review(at —'!6) $ -
Name d n ahowv oa credit card State surcharge
acce,)ted as complete. (896)....$ --
= TOTAL .......................S —
cardWda alxnamm Amoaol 440-4617(601AXWO
Electrical Permit Application
Date received: Permit no.: %Y19' OC G 7
City of Tigard Project/appl.no.: Expiredate:
CiryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no,
Phone: (503) 6394171
Fax: (503) 598-1960 Case file no.: Payment type
Land use approval: _
Id 9
1
❑ 1 A 2 family dwelling or accessory U Cominercial/indusuial U Multi-family ❑Tenant improvement
❑New construction ❑Addition/alteratit)n/replacement U Other:_ _ ❑Partial
joB Sin mokmAvON
lob address: i1cn ., Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRAC]Oft1 $01EDULF
Ab no: f n Mat
.. - — ---- --- --- Dewrirtiun Qt). (ea.) Intal no.fns
Streamline Electric Newresidattial-skwkorrarhi-famlls per
DBA LaValley Corporation eweULsgmn.lneYsdxrlga
esattactr e.
6025 East 18"'St �Ceh'cM'�
Vancouver WA 98661 1000sq h orless — 4
Each additional 500 s ft.or portion thereof _
360-993-5080 Limited energy,residential 2
CCB:116514 EI.0#: 34-432C SUP#: limited energy,nonresidential 2
Each manufactured home or modular dwelling
Signature of su rvising electrician aired Uate Service and/or feeder 2
Sup elect.name(pnnt) J I,rcenseno, Ser rleeso►feeders•-InstallaAtra,
alteration or relocation:
PROPERIN OWNER 200 amps or leas 2
Name(print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: - State: J ZIP: over 1000 amps or volts _ — _ _ 2
i,hone: Fax: I E-mail: Reconnect only - _- I
Owner installation:The installation is being made on property I own Iemporarraervic"orfeeders
which is not intended for sale,lease,rent,or exchange according to Insr'Nation,alteratios,orrelocation:
ORS 447,4.55,479,670,701. 2W limps or less 2
—
201 amps to 400 amps _ 2
Owner's signature: Date: 401 to60f1ons J 2
Branch circuits-new,alteration,
or extension per panel:
Name. A Fee for hramch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: smote: z1P: It Fee for branch circuits without purchase
-- - -- of service or feeder fee,first branch circuit. 2
Phone: I'aK: F Inail: lachadditional branch circuo
PLAN REVIEW(Please check all flint applit) Misc.(Service or feeder not Included).
U Scn,wc„vrr 225 amps onr,nr v.,al U 11[A1111 care facility Elch pump or irrigation circle 2
❑Service over 320 amps-rating of 1&2 U Hs2adouslocation Each sign or outline lighting _ 2
family dwellings U Building over 10,000 square feet four or Signal circuit(i)or a limited energy panel.
O System over 600 volts nominal nxrre residential units in one structure alteration,or extension* 2
❑Building over three stories U Feeders.400 amps or more *Description
❑occupant load over 99 persons U Manufactured structures or RV park Eich additional Yapedion over the allowable In any of the above:
❑Egressnightingplatt U(hher — Per inspection —
Submit sets of plans with any of the oboire. Invesugationfee
The above are dol applicable to(emporar)construction tierrice. Other
Na sittuse tsactiau amept credit cards,pleacall jurisdiction for mac idermarim Notice:This permit application Permit fee.....................$ —
U Eisai ❑MasterCard expires if a permit is not obtained Plan review(at _ %) S _—_—
credit cant number. r at shown on _ within 180 days after it has been State surcharge(8%)....S
TOTAL .......................$
.�..
Named wldrreedit card Expires accepted as complete
S
Cardhdder siltnatun ^Amow1 4404613 f6eDCOMI
SEE 35MM
ROLL # 20
FOR
OVERSIZED
DOCUMENT