13770 SW 122ND AVENUE r
1: 770 5W 122"" Averme
C=I YY OF I A D 4-Haur
BUILDING Inspecti,7n Lite: (503) 639-4175
INSPECT;'": Di V-;SION
Business Line: (503)639-4171 - -- - ----
Received __ -. Date Hequested '� '-/ S _ AMp� BUIP
_ _
Location ___ � .� � 7 D / Z. Z � v Suite _ MEC
— - --
Contact Person f�_(� Ph( ) -1�(o�j'—��� PLM _-------
Contractor _ Ph(_) SWR
---
-FF
BUILDING Tenant/Owner ELC
Focting ---- -- - - --
Foundation Access: EL.0
--- -
tg Drain --
Crawl Drain _ ELR
Slab lnsecticn totes: SIT - ---- - .
Post& Ream �� Q Y\ -------. ------
Shear Anchors
Ext Sheath/Shear ..__� -------
Int
- _..Int Sheath/Sheaf
Framing
Insulation - --- -- - - -
Drywall Nailing -
----
Firewall - --- --- ---
--- -------
Fire Sprinkler
------------
Fire Alarm -- -- - --- --
Susp'd Ceiling _- .--- - -
Roof
Other: - -
r=nal -_--
PASS PART FAIL
--
IrLUMBING __-
- & B '
Post- E-eam
Under Slab
Rough-In ,------ — — - _ --
Water Survice
Sanitary Sewer - --- - -- -
Rain Drains
Catch Basin/Manhole T - -
Storm Draln
Shower Pan - ----- —
Other:
Final -
PASS PART FAIL
MECHANICAL
Post&Beam
Rough-In
Gas Line
smoke Dampers
Final _
PASS PART_ FAIL
ELECTRICAL —
Service
Rough-Ir _
U
0 01ta
Fire Alarm - -
S -PART FAIL U Reinspection fee of a__ required before next inspection. Pay at City Hall, 13525 SW Hall Blvd.
0 Please call for reinspection RE:
Fire Supply Line Unable to inspect--no acceso
ADA
Approach/Sidewalk iDab = �� � - Inspat{or .
Other: _ �'
Final - - DO NOT IZEMOVE this ir,$pection record from the Job site.
PASS PART FAIL
MASTE
ERMIT
CITY OF TIGARD PERMIT
: MST'2
PERMIT#: MST'2003-00003
DEVELOPMENT SERVICES DATE ISSUED: 1/29/03
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-41171
SITE ADDRESS: 13770 SW 122ND AVI_ PARCEL: 2S103CC-WWO36
SUBDIVISION: WHISTLER'S WALK ZONING: R-4.5
BLOCK: LOT: 0311 JURISDICTION: TIG
REMARKS: Const. new SF del,--oed residence.
PUII DING
REISSUE i JJ STORIES: 2 FLOOR AREAS RcOUIRED SETBACKS REQUIRED
CLASS OF WORK: NEIN HEIGHT: 24 FIRSr. 1,5?u sl BASEMENT: sl LEFT: Ili SMOKE DETFCTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND 1.F;n sl GARAGE; 406 sl FRONT. PARKING SPACES: ,-
TYPE OF CONST: 5N DWELLING UNITS: 1 1�41NU sI RIGHT
132 40
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL 3,IOU sl VALUE. 300, FEAR
PLUMBING
SINKS: I wr rER CLOSETS: 3 WASHING MACH. 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS; 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: IMI BCKFLW PREVNTR t GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 4 CLOTHES DRYER: I
FURN>■100K: 1 UNIT HEATERS: HOODS: I OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
_ RESIDENTIAL UNIT_ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTION?
1000 SF OR LESS: 1 U 200 amp 0 200 amp. WISVC OR FOR: PUMPIIRRIGATION: PER INSPECTION:
EAADD'L 500SF: 6 201 400 amp: 201 400 amp 1st W/O SVCA=DR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 -600 amp: 401 600 amp EAADDL SR CIR: SIGNAL/PANEL: IN PLANT:
MANII HWSVCIFDR: 601 1000 amp: 60i+8mpa•1000v: MINOR LABEL:
1000+amolvolt: PLAN REVIEW SECTION
Reconnect only: »4 RES UNITS: 9VCIFOR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
_ A.SF RESI9R!:i IAL i S.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNOSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLC,^.K: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Contractor: TOTAL FEES: $ 5,530.99
Owner: This permit Is subject to the regulations contained In the
DON MORISSETTE HOMCS DON MORISSETTE HOMLS Tigard Municipal Cede,Stale of OR. Specialty Codes and
4230 GALE WOOD ST 4230 GALE WOOD STREET all other applicable laws. All work will be done In
STE 100 SUITE 100 accordance with approved plans. This permit will expire H
LAKE OSWEGO OR 97035 LAKE OSWEGO,OR 97035 work Is not started within 180 days of Issuance,or If the
work is suspended for rTlorc than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone. 503-387-7538 Prone: Oregon Utility Notification Center. Those rules ate set
forth in OAR 952-001-0010 through 952-001-0080. You
Reg N, L9C'38737 may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp& Post/Beam Mechanlca Mechanical Insp Exterior Sheathing Insl Rain drain Insp Plumb Final
Sewer Inspection Underfloor insulation Plumb Top Out Low Voltage Watw Line Insp Final inspection
Footing Insp Crawl DralnlBackwater Electrical Service Gas Line Insp Appr/Sdwlk Insp
Foundation Insp Footing/Foundation Dr: Electrical Rough In Gas Fireplace Electrical Final
Po s am 5tru—'ROral PLM/Underfloor Framing Insp lnsularion Insp Mechanical Final
IsLed By �4"'IIiI,14� Perrnittee Signature
\�- Call (503) 639-4175 by 7:00 p.m for an inspection needed the next business day
CITY OF
TI Gid RD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES
PERMIT#: 1/'9/0200300004
DATE iSSUEQ: 1129/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103CC-WW03
SITE ADDRESS; 13770 SW 122ND AVE
SUBDIVISION: WHISTLER'S WALK ZONING: R--i.S
BLOCK. _ LOT: 036 _ JURISDICTION: "I I(J_
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection fo,new SF detached residence.
Owner: -- FEES
DON MORISSETTE HOMES Description Date Amount
4230 GALEWOOD ST -- -
STE 100 [SWUSA]Swr Connect 1/29/03 $2,300.00
LAKE OSWEGO, OR 97035 [SWUSA]Swr Connect 1/29/03 $0.00
Phone: 503-387-7538 [SWINSP]Swr Inspect 1/29/03 $35.00
ISWINSP] Swr Inspect 1/29/03 $0.00
Contractor: Total $2,335.00
Phone:
Reg#:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The 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
IssuAd b- Permittee Signature]
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
• • Date received: — (� Permit no.:
City of Tigard —
Address: 13125 SW Hall Blvd.Ti OR 97223 ProJecdappl.no.: Expircdale:
CitynjTigard ti , 2003 ,, , p
Phone: (503) 639-4171 314 �,1 � Date issued: By: l.ecei t no.:
Fax: (503) 598-1960 Case file no.: Payment type:
CITY OF TIGARD _
Land use approval: BUILDING DIVISION I&2 family:Simple Complex:
C1 I &2 family dwelling or accessory 0 Commercial/industrial U Multi-family ,&New,,. nstruction ❑ Demolition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other:
Job address: 7 \i _ Bldg. no.: Suite no.:
Int: = ame: Block: Subdivision: �,�,,j,Ll ��� I���( Tax map/tax lot/account no.:
Project nna
Description anti location of work on premises/special conditions:
Name:
Mailing address: ��' _ , 1 &2 family dwelling:
City: Stu >L) ZI
eP: ) Valuation of work........................................ $ 3e"",
Phone: "
Fax• --3444F-mail: No.of bedrooms/baths.................................
Owner's representative: I 6 Y I Total number of floors................................. _
Phone: ti. Fax: E-mail: New dwelling area(sq.ft.) ..........................
Garage/carport area(sq. ft.).................. ......
Name: j Covered porch area(sq.ft.) ........................ _
Mailing address: Deck area(sq.ft.) ............... ..................
City: State: ZIP: Other structure area(sq. ft.l.. ...................... _
Phone: Fax: E-mail: CommerciaUfndurtrial/multi-family:
Valuationof work........................................ $
Business name: Existing bldg.area(sq.ft.) .... ..........I........
Address: _� Z � � New bldg.area(sq. R.) ........ ....... — —
City: _ Suite: 7_IP: - -- Number of stories...... ..........................
Phone: Fax:_ E-mail: Type of constr on .................................. _-
-�-- Occupancy roti
CCB no.: 2� - P Y g P(s): Existing: _
- --- - ---- New:
City/metro tic.no.: Nodee:All contractors and subconu:tctors are required to be
licensed with the Oregon Construction Contractors Board under
Name: V � Y' �� provisions of ORS 701 and may be required to be licensed in the
Address: ��,, jurisdiction where work is being performed. If the applicant L
Cit : State: ZIP: exempt from licensing,the following reason applies:
Contact person: Plan no.: —
Phone: Fax_ E-mail: —
Name: Contact person: Fees due upon application ...........................
Address: Date received:
City: State: ZIP: Amount received .................................. $ _
Phone: Fax: I E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Na all luriWicuorn axe q ctedii came.please call)uriwrictlon fix more inin nsuoo.
attached checklist.Alprovisions of I ws and o�inances governing this ❑Visa U MasterCanl
work will be com it wi , whether. cified illcreA t. C"l card number
�j �j/�� H�p,r•e
Authorized si aIU C- q,J f 1y Name of cardholder u shown on ctafir cwt
—.. s
Pent pante: '4.Z2tT (L.}`._ Cardholder fipalun ._'Amount
Notice:This permit application expires If a permit is not obtained within ISO days after it has been accepted as compl,te. 6/04613(W1000M)
Once-and Two-Fainnily Dwelling
Building Permit Application +Checklist
IR,femn=ao.�
CiryofTigordCl, , of Tigard Associated permits: ----
Add,css: 13125 SW Hall Blvd,Til;ard,OR 97223 Electrical Q Plumbing p Mechanical
Plmne: (503) 6394171 0 Other: _^
Fax: (503) 598-1960
� t s
1 _Laud use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc
3 Verification of approved plat/lot. �—
4 Fire district— approval required. —
5 Septic system permit or authorization for remodel. Existing system canacity
6 Sewer permit. - _
7 Water district approval_ -
8 Soils report, Must carry original applicable stamp and signature on file or with application. —
9 Erosion control ❑plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 J Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local Tnj_;t_ate __k/�
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed t/
if co yri ht violations exist. J`
I I Site/plot plan drawn to scale.The plan roust show lot and building setback dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);location of welWseptic systems;utility locations;direction indicator,lot
area;building coverage:area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
112 Foundations plan.Show dimensions,anchor bolts,any hold-downs and reirforcing pads,connection details,vent
size and location.
13 Floor plans.Show all dimensions,room identification,window size,locwton of smoke detectors,water heater, -
furnace,ventilation fans,plumbing fixtures,balconies raid decks 30 inches above grade,etc.
14 Cross section(q)and details.Show all frarning-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show
details if all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc. X
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations roust reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
15 Wall bracing(prey,riptive path)and/or lateral aualyele plane.Must indicate details and locations;for
non- res�tivc path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation.
18 Basement anti refaininR wa11e.Provide cross sections and details showing placement of rebar. For engineered
..systems,see item 22, 'Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured if truss design details. -
21 Energy Code compliance. Identify the prescriptive path or provide calculations.A gas-piping schematic is required
for rnur or more appliances, i
22 Emglneer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to he applicable to rile project under review.
23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1%2"x 1 l"or 1 l"x 17"
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons.
26 No rolled, reversed or mirrored building plans will be ac,-.e cl
27 -
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only, 4101614tlrOWOMI
Mechanical Permit Application
Date received: Permit no.:061 i -Ca;6 4/
City of Tigard P:oject/appl.no.. Expire date:
CiryajTi mard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone- (503) 639-4171
Fax: (503) 598-1960 Case file no.: I Payment type:
Land use approval: Building permit no.:
TYPEoF
O I &2 family dwelling or accessory 0 Commercial/industrial O Multi-family 0 Tenant improvement
I!CNew construction 0 Addition/alteration replacement ❑Other:
e ; I 121 hap)� t t t
Job address: % ►� c�-� ^ c> Indicate equipment quwiLities in boxes below. Indicate the dollar
Bldg. no.: Suite — value of all mechanical materials,equipment,labor,overhead,
Tax ma /tax lot/account no.: profit Value$
Lot; Block: Subdivision: '7 'See checklist for important application information and
Project name: �,+�fl� fr jurisdiction's fee schedule for residential permit fee.
City/county: Lit 9-
ZIP: t t t H 31tr r
Description and location of work on premises:
l t tr r
Fee(ea.) Total
Est.date of completion/inspection: i Description Qty. Res.only Res.onl
H AC:
'Tenant improvement or change of use: Air handling unit CFM---
Is existing space heated or conditioned?0 Yes 0 No Air conditioning(site p an rcq r )
Is existing space insulated?O Yes 0 No Alteration of existing HVAC system
Boiler/compressors
State boiler permit no.:
Business name: HP HP Tons BTU/H
Address: (� FLr smoke ampere/ uct smo a erectors _
City: LI Start;' ZIP: eatpump(site plan required)
Install/replace urnac urner
Phone: Fax: F-mail: —�_ Including ductwork/vent liner 0 Yes O Nu -
CCB no.: ns a- rep ac relocate heaters-suspende .
City/metro lic. no.:N/A wall,or floor mounted
Vent orappliance other than urnace
Name(please print): - �-' a emt ua:
Absorption units_ BTU/H
__L
_ Chillers_ _ HP _
Name: jT ���'` C�t-� Cum rcssurs HP
Address'
�C'C V G C_L nr onmenta a tier an rent at on:
City: State: ZIP: Appliance vent
Phone: i'ax: E-mail: ryerex aust
Hoods,Type res. itc a azmat
hood'ire suppression system -
Name: _ ) Exhaust fan with single duct(bath fans)
time: address: aust system apart from caun Gr_
Mailing ) 61.' 1
tie p p g an7 distr ut on(up to out ets)
Cit)• State LIP ,rJ -Type LPG NO Oil
Phone 7' Fax: Email: Fuel tin each additions over 4 outlets
rocesspiping(schematicrequired)
Number of outlets
Name: t er iG e�app ance or egqu-pmmh
Address: D- alive fireplace
City - State: _ ZIP: -type — ----
stovelpe let stove
Phone:--- - __— Fa.� � 'mail: .cher: --
Applicant's signaru other.
Name(print)print): 4 l�GiiC't.11
Permit fee.....................$ — -
Not all)uriuktlaru accept crerht c",pleats call wrisdicuon roc more trdormMian. Notice:Thisrmit application PP lication
Minimum fee................S _—.—
O Visa 0 MasterCard � expires if a permit is not obtained Plan review,(at _ *) $
Credh cud number — Aptft1 within 180 days after it has been
accepted as complete. State surcharge(8°6) ...•$ _
-- Nrtrtx of cardholder u An—on c u cu = TOTAL .......................$ --
Cardholdertlptuure Amount 41(fJGt1 t60r�lOM)
Plumbing Perinit Application
Daterecnved: Permit no.
City of Tigard Sewer permit no.. Building permit no.:
Address: 13125 SW Hall Blvd.Tiinrd, OR `l 3 (}U�ecdappl.no.: - Expire date:
City of Tig,.rd Phone: (503) 639.4171
Fax: (503) 598-196-- Date issued. By: _ Receipt no.:
Case file no. Payment type:
Land use approval:
1 �
i &2 family dwelling or accessory U t:.,lnmercial/indusui 0 Multi-family 0 Tenant improvement
ew construction ❑Addition/a�teradon/replacement 0 Food service 0 Other.
Job address
(� -t ` Description Qty. Fee(ea.) Total_
New I-and 2-family dwellings only: 1
Bldg. no.: Suite not- (includes 100 it.for each utility connection)
Tax mapitax lot/account no.: SFR(1)bath _j
Lot: Block: I Subdivision: t 1 J SFR(2)bath
Project name: v( SFR 13)hath
City/county: ZIP: Each additional battv'kuch n
Descrpuon and location of work on premises: `__ Siteutilities:
_ Catch basin/area drain
Drywells/leach line/trench drain------.,
Est.date of completionAnspection: Footing drain(no.lin. ft.) _
Manufactured home utilities
Business nam e: � � _L'l_ 1"�$I Manholes _.
Address: '� Rain drain connector
State ZIP Sanitary sewer(no. lin. ft.)
Clty: Storm sewer(no,lin ft.)
Phone: �'- Fax: E-mail: _ wafer service(no.lin.ft.)
CCB no.: CZ l- Plumb. bus. reg. no: F•L�tture or item:
City/metro lic. no.:N/A Absorption valve
Contractor's representative signatures /� Back clow preventer
Print name: I k' -rE= U Backwater valve
IN
Basins/lavatory
Clothes washer
Name: c � I _ Dishwasher
Address: IC V Dnnkinc fountainls)
City State: ZIP: _ Elr.ctors/sump
Phone: Fax: E-mail: Expansion tank
Fixturelsewer cap
Floor druns/tloor sinks/hub
Name(printf: r` Garbage disposal —
Mailing address: Hose blbb
City- l State ZIP.G Ice maker
Phone: Farr: /"-)o E-mail: Interceptor/grease trap
Owner instaUadowi esidenda/maintenance only: The actual installation Pnmens)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the propem I own as per ORS Chapter 447 Sink(sl,basin(s), lays(s)
Uvvner's si nature. Date: Sump
Tubs/shower/shower an —_
Unnal _
Name: — water closet —
Address: �V'P �k ater heater
City. State: Other.
Phone: Fax E Total
Minimum fee................$
Na W1 iunubcuons accept cnida cards,please call lunuLcuan to mon mfu"eusuon Notice-This permit application �) $
O Visa O PlssterCard expires if a permit is not obtained plan review(at _
CtWn card number within 180 days ager it has been State surcharge(8%)....S
P TOTAL ...............f
accepted is complete. """'
Hank tit urJholikr v stwrn M ctedn card
$
l Cardholder rilnature Am-wnt 4W-1616160dCOM1
Electrical Permit Application_
Date received: _ Perrrmit no.: al�" '
City of Tigard Project/appl.no.: Expire date:
CiryofTigard Address; 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Rec-rpt no.:
Phone: (503) 639-4171 •� — ------
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
1
❑ I ,4c 2 family dwelling or accessory 0 Commercial/industrial ❑Multi-family 0 Tenant improvement
New construction U Addition/alteration/replacement ❑Other:._ ❑Partial
11 SITE INFOktMATION
Job address: j ( y Bldg.no.: suite no.: I Tax map/tax lot/account no.:
Lor. Block: Subdivision: +� {_ —
Project name: Description and location of work on premises:
F orated date of completion/inspection: —
t
"b1no: _ Fee �x
Descriplion Oty. (ea.) Total no.lnsp
me: _ 1 —
- New residential•singleor muni-family per
Address: 7 dwelling unit.Includes attached rArage.
city: State: ZIP: Seth«inclutkd
1000 sq.ft.or less 4
Phone: ,j- I � Fax: E-mail: -- -----
Each additional 500 sq.ft.or portion thereof
CCB no.: Elec. bus. lic. no: Urniterlenergy,residential 2�
C'�J�dlur
f-;\ -� Limited manuf manufactured
-t home or
_ _- _— 1
Foch manufactured home or modular dwelling
rupervising r(eetrielan(required) Uate
Service and/or feeder 2 _
Sup elect nnmeiprrnu s Li�enseno a� Serrvicesorfeeders-Installation,
alteration or relocation:
200 amps or less _ 2
Name (print):
201 amps to 4l)n amps 2
40I amps l0 600 amps 2
Mailing address: 601 amps to 1000 amps _ 2
City: i 0, State ZIP: over 1000 amps or volts _ 2
Phone: - Fax:=--7-� -mail: Reeonnectonly t
Owner installation: Me installation is being made on property I own Temporary services orfeeder-
%%hich is not intended for sale, lease,rent,or exchange according to btstallation,slteralion,orrelocation:
200 .nps or less 2
ORS dal,455,479,670,701, 201 amps to 400 amps 2
Owner's signature: Date: 401 in W)ams 2
Branch cir:vlts new,alteration.
or extension per panel:
Name: — a Fee for branch circuits with purchase of
Address: service or fader fee,each branch circuit
City: State: ZIP: B. Fee for branch circ.;+%without purchase
pit m
Email' of service or fader fee,first branch circuit
I'ax: Each additional branch circuit:
V
Me.(Service or feeder nt(dacurded):
Q Service ovet 215 amps•cornmercial ❑ Hecdth .are facility Each pump or irrigation circle — _ 2
UService over 320amps-rating ofIA2 UHazardous lxauon Each sign or oudine lighting _ 2
family dwellings O Building over 10.000 square feet four or Signal circuit(s)or s limited energy panel,
U System over 600 volts norrunal more residential units in one structure alteration,or extension' 2 _
U Building over three s:enes U Feeders,400 amps or more 'Description
O Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
U Egress/lighungplan 0 Other - Perinspecuon F_ T
Submit_sets of plans with any of the stove. Invests auon fee
The above are not applicablr to temporary construction service. Other -
- — Permit fee.................. -- __
Not all)unsrbcrrons accept credit cards.plea+e call pti,khcuon ra more Infsrmstion Notice:This permit application
U Visa O MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit cud number -- •- within 180 days after it has been State surcharge(8%)....$
accepted as complete. TOTALS
None of t:anatnl r u shown on credit cad
1<
Cardholder si store Amount 440-4611 I& COM)
DON • MORISSETTE OBE : 2806
a 0 m 2 6 INCORPORATZD LOT: 36
LAKE oswaa0. 0 2 9 G 0 N e7oaa • 12/31/2002
@ o 3) 'Ie 7 - 7 a a e -VAX (a o a) a 8 ? - 7 0 i a pROPNRrf'• WELSTLER'S-11AIX
31' 1 CITY: TIGAW
SCM Z: 1"=20'
S o PLAN No.: 170
OP71ON 2 ELEVATION
78
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LUT' COVERAGE
LOT AREA: 8,040 9Q. Pt. 348'
BUILDING AREA: 2,146 60. PT. \
F-ERCE1,!TAGE: 2'1.5% t 11 � AA A
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'RED MAPLE' SgEalrt- ,
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION, DIVISION Business Line: (503)639-4171 MST - _ - --
- J AM PM
Received Date Requested � `
_-_-_ --1�
Location � 7 BUP
BUP —
-- �
Contact Person MEC
�_p h PLM
( -) � �je2,. - �cf �.�_
- __-_-
Contractor _-_ - Ph( ) --
SWR
BUILDING TenanUOwn%r _ ----
Footing - - — ELC
Foundation ELC
Ftg Drain Access: _—
Crawl Drain ELR _
Stab Inspection - --
Post$Beam SIT
Shear Anchors -- _
Ext Sheath/Shear ---- -____
Int Sheath/Shear
Framing ---
Insulation ------
Drywall Nailing
1•irewall
Fire Sprinkler
Fire Alarm '
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL —
PLUMBING
Post$Beam — ---
Under Slab _
Rough-In
Water Service
anitory Sower
Hain Drains
etch Basin/Manhole
Storm Urain
Shower Pan ---_`
Othe _ ---- -
PART FAIL _ ---------
_ CHANICAL -
Post& Beam -- - _.----_---
Rough-In —
Gas Line —— - ----- _
Smoke Dampers -
Final -----------------_---
PASS PART FAIL ------
ELEC RT ICAL�- -- —'—
Service - - -- _
Rough-In
UG/slab
Low Voltage -' -
Fire Alarm -- - --
Final —
PASS PART FAIL C7 Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd.
SITE_ Please 11 for reinspection RE: �,_
Fire Supply Line I n - Unable to Inspect-no access
ADA 1 f ,
Approach/Sidewalk pobl-- LT_ UInspsetor
Other:
^-
Othe - �►
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
d
CITYOF °T I G A R D — PLUMBING PERMIT
DEVELOPMENT SERVICES PFKIviiT#: FLM2003-00126
DATE ISSUED: 4/7103
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103CC 08900
31TE ADDRESS: 13770 SW 122ND AVE
SUBDIVISION: WHISTLER'S WALK ZONING: R 4.5
BLOCK: LOT: 036 _ JURISDICTION: T-IG
_CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE Or USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_FIXTURES _ _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWAS!;ERS: RAIN DRAIN: ft
Remarks: Installation residential backflow preventer. _FEES
Owner:
Owner: Description Date Amount
DON MORISSETV' HOMES [PLUMB] Permit t-ee 4/7/03 $36.25
4230 GALEVV001 ST [TAX] 8%,State'I'ax 4/7/03 $2.90
STE 100 -- '--' —
LAKE OSWEGO, OR 97035 Total $39.15
Phone : 503-387-7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
1UALAVIN, OR 97062 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : 503-692-5945 Final Inspection
Reg #: I'LM 7804
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 accoruance 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 952-0001-0010 through OAR 952-0001-0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699.
Issued By: / t Permittee Signature:
Call (503) 639-4175 by 7:t'., P.M. for an inspection needed the next business day
Hpr 0? 03 03: 48p dan edmonds
503-692-0768 p. 3
Plumbing Permit Application
-- +- Received ,/ . Plumbing'
Date/By: /` `� ¢. Permit No. L/))do-Z
RECEIVED �aQ/NO
City of Tigard Planning Approval Sewer
Date/BY: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 APR 0 3 200 Oatc/B Pct.,it No.:
Phone: 503-639-4171 Fax: 50T259164960 Post-Review Land Use
Internet: www.ci.tigardor.us ,;1 T Y O F T I G A I Date/By: Case No.:
Contact Jttris.: 5cc Pa 2 far
24-hour Inspection Request: rS)pAti4�>><d43�31��1` s'
Jame/Method: Supelementitl information.
TYPE OF WORK FEE"SCHEDULE ffor s ecial Information Cae checklist
_New construction Demolition Description Qty. I Fee(ca.) I Total
_LJ Addition/alteration/replacement (]Other: New I-&2.11hmily dwellings
CATEGORY OF CONSTRUCTION includes 100 R.for each u 111ty connection
1 &2-Family dwelling _Commercial/Industrial SFR ! bath 249.20
SFR 2 bath 350.00
Accessory Building [Multi-)gamily SFR 3 bath 399.00
Master Builder F1 Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Firesprinkler-sq.ft.: Page 2
Job site addressSite Utilities
Suite#: Bid ./A .#: Catch basin/area drain 16.60
Project Name:U h drS 1,1:1 Lel• 3f� D ell/leach line/trcnch drain 16.60
Cross street/I)irections to0o site:
-Footing drain no. linear ft• Page 2
�� t_ Manufactured home utilities 110.00
Manholes - 16.60 _
Rain drain connector 16.60
Sanitary sewer no.linear ft. Page 2 .__
Subdivision:
_Subdivision: i�; (-'Gl•CG Lot -:-%7 Storni sewer no,linear ft. Page 2
Tax ma / arcel#: Water service no. linear ft. pat 2
DESCRIPTION OF WORK Fixture or Item
Ab�o tinn valve 16.60
lluT_2�'yL /y..��'f/e l:: Backflow preventei Page 2 -
GC�'�= Backwater valve 16.60
Cl,••.hes washer 16.60
Dishwasher 16.60
PROPERTY OWNER TENANT Drinkingfountain 16.60
Ejectors/sum 16.60
Name: 16.60
Expansion tank
Address: ''!-, ` Sl.t� t.'Gl(�.c�xY.CI` ,y� Fixture/sewer cap 16.jC
Cit�+/State/Zip_lit i C: c er r;, �;/y e77L13t_ Floor drain/floor sink1hub 16.60
Phone: Fax:
Garbage disposal _ 16.60 _
Hose bib I u.GO
APDL_ ICAN'f CONTACT PERSOCI Ice maker 16.60
Name: Elcrl Interceptor/greasetr_�r 16.60
Address: /.�,L:. s Sal.: rY1t.e 5%LmU C6 Medical gas-value: S Pae 2
Cit /State/Zl t� (✓� /7G�. Primer 16.60
Roof drain 'commercial 16.60
Phon tj.) via- S9 Fax:yt?3 LOA- (NA sink/besin/lavato 16.60
E-mail_ Tub/shower/shower pan 16.60
rONTRACTOR Urinal - 16.60
Business Name: Water closet 16.60
Address: J L C' eviij Water heater 16.60
Uthcr:
city/state/zip: other: --
Phone:1JD3 -rc`iQ-S9 IVSFax_: .Sis Ic5i2-y7b Plumbing Permit Fe e*
CCB Lie. ft: '" - Plumb. Lic* Subtotal s
Authorized '� Minimum Permit Fee$7 S
Residential Backflow Minimum Fe 36.2 5f nature � [tiL Date:r
r Plan Review 25%otPermt ee S
. CZI �_� State Surcharge 8%of Permit Fee S .2 , n
(Please print name) _ __ 'TOTAL PERMIT FEE
Notice:
This permit application expires Ira permit Ir not obtained within All new commerclal buildings require 2 sets of plans with Isometric or
180 days after It has bten accepted a complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service hoard.
i:thstaTermit Po"MPIMPermltApp.duc 01/03
1
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (5(")639-4175 cid du 3
INSPECTION DIVISION Business Line: (SOL, 639-4171 MST —
BLIP
Received —____ —Date Requested - AM.-- PM BUP
Location _ 3 7 20 ��� _ Suite — MEC —_-- --_ _
Contact Person —_ — -'� _. Ph ( ) 5 � �� q 5 PLM �—
Contractor __ __— _ Ph( ) _— — SWR
BUILDING Tenant/')wner _ _ ELC
Footing
Foundation �- ELIC
Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors - ----- --
Ext Sheath/Shea
Int Sheath/Shear
Framing - — ------ -----�._. __
Insulation
Drywal!(Jailing ---
Firewall
Fire Sprinkler --- ----- - - - - - -------
Fire Alarm
Susp'd Ceiling
Roof
Other: -- - ---- -
rina
-W1pT FAIL - --------- - -- ----- ----- ---____- __ _....___
�• am
Under Slab --- -
Rough-In
Water Service --- ----- - - - - -- -- ------ ----
Sanitary Sewer
Rain Drains -- - - --- - - -- - -
Catch Basin/Manhole
Storm Drain - - -
Shower Pan L'
Fi ---- -----
PART FAIL -- - -- -- -- ----�--------
MECHANICAL _--
Post& Beam
Rough-In - -
Gas Line
Smoke Dampers - - ------- -
na ,
PART FAILELECTRICAL
Service - -------- - --
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$_-_ _-_ required before next inspection Pay at City Hall, 13125 SW Hall 1310.
PASS ;ART FAIL
-M—TE F] Please call for reinspection HE._ _.__ Unable to inspect- no access
Fire Supply Line
ADA rz1 3
Approach/Sidewalk fiats � - inspector 1 _ Ext_—
Other:
Final DO NOT REMOVE this Inspection record from the,fob site.
PASS PART FAIL
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