13035 SW PRINCETON LANE 13035 SW Princeton Lane
CITY OF TIGARD
13125 S.W. HALT- BLVD.
TIGARD, OR 9722.3
IMPORTANT PERMIT NOTICE
DAVID JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit#- MST2002-00092
Date Iszoed: 914102
Parcel: 26104DA-23000
Site Address: 13036 MAI PRINCETON LN
SLiodlvlsion: QUAIL ijOL.LQW -SOUTH
Block Lot: 056
Jurisdiction: TIG
Zoning: 1.4.5
Remarks SF rowhouse,Unit 56, 811d9l2', SS pian with deck. STRUCTURAL FILL., REQUIRES
GEO-TECH INSPECTIONS AND-REPORTS
Your company has been indicstr±d as tha 8ledrlcal contractor for the permit indicated above. In order for the
electricAl permit to be valid,the signature otthe 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 Drvislon.
No elec=trical inspections will be authorized until this completed form is received
OWNER- ELECTRICA!. CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LLC DAVID J ER6OME ELECTRIC
12670 SW 66TH PIt1WY PO I-IILL.IDSBOR 1
STE 200 OR 97123
PORTLAND, OR 97223
Phone X. 503-598-7566 hone #. 648.5144
Reg #: LIC 36051
SUP 29775
ELF 34-11 oc
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X y
gnature o -upervising .ectrlcian
If you have any questions, please call (503, 839-4171, ext. #�3 3
r0nfj Td3Q %F19 '9COS "L.A 97. 'OT (THY, CO/20 '10
^ CITY O F T I G A R D MASTER PERMIT
/ \ PERMIT#: MST2002-00092
DEVELOPMENT SERVICES DATE ISSUED: 9/4/02
13125 SW Hail Blvd.. Tigard, OR 97223 (503) 639-•4171
SITE ADDRESS: 13035 SW PRINC'-TON LN PARCEL: 2S104DA-23000
SUBDIVISION: QUAIL HOLLCIvd OUTH ZONING: R-4.5
BLOCK: LOT:056 JURISDICTION: TIG
REMARKS: SF rowhouse,Unit 56, Bldd12, BS plan with deck. STRUCTURAL FILL, REQUIRES GF_O-TECH
INSPECTIONS AND REPORTS
BUILDING
REISSUE: STORIES: 7 _ FLOOR AREAS _ REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST 171 at BASEMENT: of LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 135 of GARAGE: 547 of FRONT: PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT. 135 o1 RIGHT:
VALUE: S 162.566.20
OCCUPANCY GRP: R3 BDRM: 2 BATH: 2 TOTAL: 1,642.00 at REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASH'-IG MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS. I FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: I WATER HEATERS: 1 WATER LINES: RCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL _
FUEL TYPES FURN<100K: BOILICMP-c 3HP: VENT FANS: 3 CLOTHES DRYER: 1
111; FURN>•1001(: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OU rLETS: I
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 500SF: 201 400 amp: 201 •400 amp: tat WIO SVCIFDR: SIGNIOUT LIN LT': PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 •600 amp: EA ADDL OR CIR SIGNAUPANEL: IN PLANT:
MANU HM/SVC/FDR: 601 • 1000 amp: 601+ompa•1000v: MINOR LABEL:
1000+amplvolt: PLAN REVIEW SECTION
Reconnect only: ,z4 RES UNITS: SVC/FDR),-225 A., 600 V NOMINAL: CLS AREAISPC OLC
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO 6 STEREO FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: MVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL
GARAGE OPENER: CLOCK- INSTRUMENTATION: MEDICAL: OTHR.
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL a SYSTEMS.
TOTAL FEES: $ 5,500.08
Owner: Contractor: 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 12670 SW 68TH PKWY all other applicable laws All work will be done in
STE 200 PORTLAND,OR 97223 accordance with approved plans This permit will expired
PORTLAND,OR 97223 work is not started within 180 days of issuance,or if the
work is suspended for more then 180 days. ATTENTION
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Rep N: 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
Stab Insp Plumbing Top Out Exterior Sheathing Insl Smoke Detector Final Inspection
Plm/undslb Insp Framing Insp Firewall Insp Electrical Final
Issued By : �' -- Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITY OF TIGARD SEWER CONNECTION PERMIT
—
DEVELOPMENT SERVICES PERMIT#: SWFz2002-00067
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
DATE ISSUED: 9/4102
PARCEL: 2S104DA-23000
SITE ADDRESS; 13035 SW PRINCETON LN
SUBDIVISION: QUAIL HOLLOW ,OUTH ZONING: R-4.5
BLOCK. LOT: 056 _ JURISDICTION: TIG
TENANT NAME:
USA. NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
i YPE OF USE: SFA NO OF BUILDINGS:
INSTALL "TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for SF rowhouse.
Owner: — --�– FEES -�-----'
BROWNSTONE QUAIL HOLLOW LLC Type By Date Amount Receipt
12670 SW 68TH PKWY
STE 200 PRMT CTR 9I4IO2 $2,300.00 27200200000
PORTLAND,OR 97223 INSP CTR 9/4102 _ - $35.00 27200200000
Phone: 503-5987565 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
i
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The Permit expiresires
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" Permit and the Agency will install a lateral. 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 rules or direct questions to OUNC by calling (501) 246-1987
Issued by: r/.�.�u-�.�.- Permittee Signature: >
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
wIlge Z10 02
BuildingPe � >I On ✓
City of Tigard Daterecelved: a Permltno.: -Uf
Address: 13125 S W Hall �'Y'i�,W Project/appL no.: Expire date: _
City nf7igard BULAINO TMM
Phone: (503) 639-4171 Date issued: By; _ Receipt no.:
Fax: (503) 598-1960 Case file no,: Payment type:
Land use approval: _ I&2 family:Simple Complex:
1
U I P-2 family dwelling or accessory U Commercial/industrial J Multi-family U New construction U Demolition
U Addition/alteration/replacement ❑'tenant improvement J Fire sprinkler/alarm ❑Other: _
li INFORMATION
Job address; S Lv f %ft-C C_ �� , I Bldg.no.: Suite no.:
Lot: BrAl Tax map/tax lot/accountno.:`;s;�1y�A-�� NCS
Project name:
Description and location of work on premises/special conditions:
INFORMATION,FOR SPECIAL
(Floodplain,tieptic capacilly,solar,etc.)
Name: ,r
Mailing address: n 1 &2 family dwelling:
City: ta jState:C lR ZIP: Valuation of work...... ................................. $_
Phone - Fax: E-mail: No.of bedrooms/baths•.........................•.... _
Owner's representative: " Total number of floors................................. —`
Phone: P Fax: 1 -mail: New dwelling area(sq.ft.
Garage/carport arca(sq.ft.)...............•.........
Name: f 0, L, _� , Covered porch area(sq.ft.) ............I............
Mailing address: S L" _ - Deck area(sq.ft.) .......................................•
City: 4(. _� State: ZII. 4 Other structure area(s .ft.).........•.........•..... _
I mail: Commercial/industrial/multi-family:
1 1 Valuation of work........................................ $
Existing bldc. area(sq,ft.) ..........................Businessname:mune: t_Q ,, - t
Address: g�- tre
� New bldg.area(sq, ft.) ............................... ----
City: r kA .F, State:p ZI
Number of atories........................................
Phone• - "' Fax:b�,o • -mail: Type of construction....................................
CCB no.: Occupancy group(s): Existing:
New:
City/metro lic.no.: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: ET LCA provisions of ORS 701 and may be required to be licensed in the
igvL _S4i jurisdiction where work is being performed.If the applicant is
Address:
� ��- -- exempt from licensing,the following reason applies:
City:_ c State 7.11
Contact person;A, Plan no.:
Phone: r: F.-mail
Name: i r„� e, Contact person: Fees due upon application ..............•............ $
Address: 69 S Uj rcc Date received: __
City: c-� talc: ZIP: 3 Amount received ......................................... $
Phone: ,j _ Fax: E-mail: Please refer to fee schedule.
I hereby certify 1 have read and examined this application and die Not all jurisdictions accept credit cud,,Please rAll jtuisdiceon for mom information
attached checklist All provisions of laws and ordinances governing this 13 Visa U MasterCard
work will be complied whethu ' ed herein or not. radir card aombet —
-1�11rJ=� D�
Authorized sl re: amt of c Ides u abown oo t card
S
Print name: --_---_— der atpwtae momi
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4/04613(6nX)OM,
l lambing Permit lication
--�"--� Lj Datc reoeivud: Permit no./%I,_n( ,_
City of Tigard Sewer permit no.: Building permit no.:
Addnv•;,- 13125 SW Tigard.OR 97223 -
C�ryol 111uie: (5(3) o9-4171 Project/appl.no.: Expire date:
Fax (.,)W099 19N) CITY Y Uf IIUAKD Date issued: By: Receipt no.:
1,and um- approval: _ BITILDING�7IV S1 C'ascfileno.: Payment type:
TVPE OF PERMIT
U 1 &2 family dwelling or accessory U Commerciattindustrial U Multi-family U Tenant improvement
U New construction U Addition/altemtion/replaccn•ent U I"«x1 service U Other:
SCHEDULE3011 SITL INFORI%IATION FEE,
]ob address: Ucscri tion Qt
Y. Fee(ca. Total
30 b New 1-and 2-family dwellings only:
Bldg.no,: Suite no.: (Includes 100 fl.for each utility connection)
Tax mapitax lot/account no.: SIR(1)bath
L,ot• 6 Block: Subdivision: SIR(2)bath
Project name: __ SFR(3)bath
City/county: ZIP. Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain _
Est date of completion/inspection: Drywells/leach Iine/trcncn drain
Food^g drain(no.lin.ft.)
PLUM PING CONTRACTOR Manufactured home utilities
:- - - Manholes _
Wolcott I'lumbwg 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.)
(VB:23847 PLM#:26-20,�,I Fixture or item:
Absorpon valve
Contractor's representative signature- Back flow pmvcnter
Print name: Data: [Backwater valve
t t Basinsllavaiory
Clothes washer
Name: Dishwasher --
Addmss: - _ -- Drinking fountain(s) --
City: tate: L[P: Ejcctors/sum
Phone: Pax: E-mail: Expansion tank
Fixture/sever ca
Floor drains/floor sink-s/hub
Name(print) ----- -Garbage disposal _
Mailing address: _ Hose bibb _
City: ___t�tatc: I.IP: ice maker --
Phone: Fax: I-mail: Intcrceptodgmase trap
Owner instal ladon/residential maintenance only: The actual installation Primers)
will be made by me or die maintenance and repair made by my regular Roof drain(commercial) _
employee on the property 1 own as per ORS Chapter 447. Si (s),basin(s), ays(s)
Owner's signature: _ Date: Sum
Tubs/shower/shower pan
Urinal
Name: __ _J _ Water closet
Address: _-� Water heater
City: _ State: 1 other.Phone: — - Fax: �E=rnaiL Total
Nor of}�i�ticuau. aell cad.+,p�evt)WI&ction for mate wonsel01 Notice:This permit application Minimum fee................$ _
U Yw U MaswCw d expires if a permit is not obtained S $
State
review(it 9t.)
�1 cad number--�----, within 1130 days after it has been State surcharge(896) $
....
accepted as compl�'e 1'OTAI. .......................S
Nude d cad"du u daMo 00 m&cad $
440 4616(6WA)O Q
MechanicalPcr '�,A► � _
Uateroceived: f'crmitno.:�Sf�01��00b .
City of Tigard projo t/appl.no. Gxpirr.date:
Ciryof"17gard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued:
fly Recciptno.:
('hone: (503) 639-4171
Fax: (503) 598-1960 iffy OF I IUAKD Case file no.: Payment type:
")MMING Building permit no.:
Land use approval: --
U I &2 family dwelling or accessory U CommerciaU'industrial U Mulli•family U Tenan impr(wcrncnt
U New construction ❑Addition/alteratiun/rn:placemcnt U Other: _ —
� �
lob address:r ()" W Indicate equipment quantities in boxes below.lndic:a!e the dollar
Bldg no Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: _ _ profit.Value$
Lot; Block: Subdivision: *See checklist for important application information and
jurisdiction's fee schedule for residential permit fee
Project name: .
tr
City/county: ZIP: _ s a1
Description and location of work on premises:
1
Fee(C2.) total
[
Est.date of complction/inspection: �Y Res.only Itcc.only
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned?U Yes U No Tir con illcnrng(sue p an required)
Is existing space insulated?O Yes U No Alteration ofexrsung VAC system
AIMIANICAL ` t a compressors
State boiler permit no.:
HP Tons BTU/({
Four Seasons heating& A/C Service Inc -rr smo a am ictstno a detectors
PO Box 66409 eat pump(site Tan requ
Portland OR 97290-6409 Install/rr{rlacefurace/burer_BTU/14
503-775-5919 Including ductwotWvent liner U Yes U No
CC'13: 48283 nslelUrep Redeeorate eaters-sus�eF
wall,or floor mounted
enl(ora lian�ce ter an urnace
Name(please print): ch era on:
t Absorption units_ — BTU/H
Chillers—.__ HP _
Name: Com ressors HP
Address: _ �t ZIP:
wt Tea ton:
city:-- Slate: __ Appliance vent
Piton-: Fax: C-mail: -- T)ryerex Rust--
t tM Hoods,Type res. tc a lazmat —
hood fire suppression system
Name: Gxhaust fan with single duct(bath fans)
Mailing address: _ _ - F must a stem seam rom eaten or C
el pTp�a ton up to ou els
City: _ State: 7.11— _- TyPc. U� NG Oil
Phone: Fax: G mail: Fuelr ea-cTi a3diuona ovu MRS
°ro"sspiping schematicrequirre )
Number of outlets _
Nano. other applWn-ce or eq pmenl:
Address: Decorative fireplace
-__ State: ZIP: nsert-type --
City
Phone: Fax: E-mail: er. -- -
Applicant's signature: - Date: oth,
Name (print)c—
- -- Permit fee.....................$ ---
Na w hutretcuau.00W cmdr cads,0 cat)'°{'a`d""r«"New°`" ` Notice:This permit application Minimum fee................$
O Vie U MasterCard expires if a permit is not obtained Plan review(at _%) $
r_"l cad anmt>tr _ ---- — �� within 180 days after P has been State surcharge(8%)....$ —_
an<or — — ted as complete.
u m card = accepted TOTAL .......................$
da stpurore AUWW 440-017(60MM"
,qLAAAA AAAAAAAAAAAAAAAAAAAAAAAA AAAAAA AAAAAAAAAAAAA,AAAAAAAAI j
ii (�
A� 10
C TIFICATI ►I S �EET TREER
►
NO.
oil.
l � ,
`4 i j, � ��- , Owner/Agent for
.I (PLEASEPRI'�r`
(PF-&If T HOLDER)
S, Do hereby certify, that the following location ►
I ►
it meets City of Tigard/Washington County
a ►
land use and development standards for street tree installation.
zj
ADDRESS: �' v +►
S 1 �
T O . SUBDIVISION: ����` ►
A _ �T. ►
A BY; __ DATE: ►
.
� 0.= —� `{ / �' � _ 101.
RECEIVED By: DATE:
L
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CITY OF TIGARD 24-Baur
BUl-DING Inspection Line: (503) 631%175
MST -_
INSPECTION DIVISION Business Line: (503) 71
BUP --
Received Date fequested —3 r �"2 _-._ AM PM -_____ BUP
Location _____���,5— Suite___ MEC
Contact Person _. _ Ph( ) - PLM
Contractor __ _ __ Ph( —) _ _ SWR
BUILDING Tenant/Owner — — ELC _
Footing ELC
Foundation Access: --
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 1 , 1 S 11 � (� � SIT
Post 1£Beam
Shear Anchors -'--
Ext Sheath/Shear
Int Sheath/Shear �-
Framing ---
Insulation �-
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling -- -- --- --- - -
Roof
Other: _--.- __-.-..--.- ----• --- -
F'f
AS PART FAIL ---_------- -- ----
Post 6 Beam
Under Slab ------- -- -— - -----
Rough-In
Water Service
---- -----__--.- - - _-_ _--
Sanitary Sewer •
Rain Drains -- ---- _ -- -
Catch Basin/Manhole
Ak
Storm Drain - ----- --- - —
Shower Pan _
Other: ---- --
Final ---. -----
PASS PART _FAIL -
MECHANIC_AL
Post 6 Beam —
Rough-In ---- ----- ----- --- ---- -
Gas Line
Smoke Dampers -------- - —---- -- --- -- -
21ZOPART 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 Fj Please call for reinspection RE:-._ Unable to inspect-no access
Fire Supply Line
ADA /�-7 ( U �/ c
Approach/Sidewalk DEW ---- ---- ..'Pector � - xt
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD
Residential Certificate of Occil pancv
t No.:
Permit No.: Z - o o Qc -2 -- Address: F�6- r--✓� C
(honer/Contractor:
Date of Final Inspection: 3 Z7 w Inspector: I
r
This structure has been found to be in substant d compliance with the provisions of the State of Oregon One& Two Family Dxvellitm
Specialty Code and is hereby approved for occupancy.
CITY OF TI^ARD RESTRICTS PERMIT-
\ V RESTRICTED ENERGY
DEVELOPMENT SERVICES � PERMIT#: ELR2002-00296
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639-4171 DATE ISSUED: 12/16/02
SITE ADDRESS: 13035 SW PRINCETON LN PARCEL: 2S104DA-23000
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT: 056 JURISDICTION: TIG
Proiect Description: All encompassing low voltage
A._RESIDENTIAL R.COMMERCIAL
AUDIO & STEREO: X 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:
01 HER: ALL ENCOMP X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL# OF SYSTEMS_:
Owner: Contractor:
BROWNSTONE QUAIL HOLLOW LLC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY P.O. BOX 508
STE 200 WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: 503-59x-7565 Phone: Sita-639-0110
Reg#: I 1 1 36-940_1
I'll 1' 2312LEA
I Ic 145828
_ FEES Required Inspections--
Description Date Amount Low Voltage Inspection
[ELPRM'I'l F1 R Permit 12/16/02 $75.00 Elect'I Final
(TAXI P.,Mate Tax 12/16/02 $6.00
Total $81.00
This Penrit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. Ail work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance,or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throuc
Issue by Permittee Signature . 1Z
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ _ _ PATE:
CONTRACTOR INSTALLATION ONLY
SIGNATORE OF SUPR. ELEC'N ,_ —„ DATE:
LICENSE NO:
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
R EC E{!/E�
PDatcreceived• "0,3 � Permit no.•�ye��M-00,Xg 9�
i4�Acyal"MCity Of Tigard Project/appl.no.: pin date:
CiryojTigard Address: 13125 SW Nall Blvd,Tigard,OR 97223 Date issued: By. Receipt no.:
Phone: (503) 639-4171 DEC 13 2002
Fax: (503) 598-1960 CITY OF TIGAFiD Case file no. Paymen type:
Land use approval: 13W169141" P401191=1
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family 0 Tenant improvement
0,New construction U Addition/alteration/replacement U Other: ❑Partial
- -- E=EXM III 11111011111111 —1
lob address: , k., a "VC4- i}✓ LA.1 I Bldg.no.: JA I Suite no.. ITax map/tax lot/account no.:
Lot: 6L, I Block: Subdivision; k6ii- SauTpf
Project name: 47AL4jz- SvuT Description and location of work on premises:
Estimated date of completion/ins ction:
UON'11 RACI Oil All"I'LICA]ION 1111,11-1, SCHEDULE,
Job no: Fee Max
Z�M tti TFt CQ&'-j1 u�i eA rv,t1 Description Qty. (ea.) 1'0421 no. US
Business name: S —
Address: New r+esldentlal-shtgk urmultl-family per
c.�• � OA dwelling unit.Includes atlaclwdgarage.
City: f i-S ,U1/I LLL— State:O/Z I ZIP: 77n76 Serviceincluded:
Phone ,3 L.3rj- o i/u Fax$ _e.39 p/ Vj E-mail: 1000 sq.ft.or leas 4
Each additional 500 sq.ft or union thereof
CCB no.: /4.5V,?g- Elec.hue.tic.no; 6-c) CE Limitedenergy,residential 2
City/metrolic.no.: 4�1 9 Limited energy,non-residential 2
- __ _ 1.2-/p Z Each manufactured home or modular dwelling
Signature of su ryisin cleclrici (req.ired) _ Date Service and/or feeder 2
Sup.elect.name(print): 77-' r t License no:�3i1 t�
Services or feeders-Installation,
alteration or relocation:
200 am s or less 2
Name(print): 3gY,) J 97W)C — !1201 am s to 400 amps 2
Mailing address: 401 amps to 600 amps _ 2
601 amps to 1000 amps 2
City: State: ZIP; Over 1000 amps or volts 2
Phone: I-ax: E-mail: Reconnectonl _ I
Owner installation:The installation is being made on property I own Temponryservices orfeeders-
which is not intended for sale,lease,rent,or exchange according to blstallatlon,altention,orreloceilon:
ORS 447,455,479,670,'101. 200 amps or leas _ 2
201 em s to 400 ams 2
Owner's signature: Date: 401 l0 600 am s 2
Branch circuits-new,attention,
or extension per panel:
NRme: _ A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit _ 2
City: )tate: ZIP: S. Fee for branch circuits without purchase
--Phone: �Fax. E-mail- of service or feeder fee,first branch circuit: _ 2
Each additional branch circuit
Misc.(Service or feeder not Included):
O Service over 225 amps-commercial O Health-care fac 11, Foch pump or irrigation circle_!_ _ 2
❑Service over 320amps-rstingof1&2 0Hawdouslocation Fechsi noroutliuelighting 2
familydwellings O Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration,or extension* _ 2
O Building over three stories ❑Feeders,400 amps m nlore *Description:
O Occupant load over 99 persons ❑Manufactured structures or RV park Each addlllona)Inspection over the allowable in any orthe above:
O F.grecs/lightingplan ❑Other: ___ Perins ection
Submit--sets of plans with any of the above. Investigation fee _
The above are not applicable to temporary construction service. Other
Na all judsdktions accept credit cants,please call jurisdiction for more informarion. Notice:This permit application Permit fee. .....................$
❑Visa O MasterCard expires if a permil is not obtained Plan review(at
Credit card number:_ _ / / within 180 days after it has been State surcharge(8%)....$ -
Expires accepted as complete. 7 OTAI, $
Name of c o r u •— ...........•.........
,vn m Ic�c�—
_ S _
Cardholder signature— ---- Amount a su u.i 5 c✓.xrt .t
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 #: MST2002-00092
Date Issued: 914102
Parcel: 2S104DA•23000
Site Address: 13035 SW PRINCETON LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot. 056
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse,Unit 56, BIdg12, BS plan with deck. STRUCTURAL FILL, REQUIRES
GEO-TECH INSPECTIONS AND REPORTS
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
UWNLNt PLUMBING CONTRACTOR:
BROWNSTONE QUAIL HOLLOW LLC WOLCOTT PLUMBING CONTRACTOR!
12670 SW 68TH PKWY NO BC.., 7007
STE 200 CRES!-t.` M7 OR 97030
PORTLAND OR. 97223
Phone #: 50'3-598.7565 Phone #: 667-1781
Reg #: t ir. 23847
PI M 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X r �
Signatu Au rued Plumber
If you have any questions, please call (503) 639-4171, ext # 310