11455 SW HAZELWOOD LOOP a
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1455 SW Hazelwood loop
CITY OF TIGARD BUILDING INSPECTION DIVISIGM
MST
24-11our Inspection Li ,e: 639-4175 Business Line: 63Fi-4'171 - --- -
BLIP
Cdte Requester ! a / AM_ Pti1 _—� BLD _ r
Locations_, PYi Suite •_ ,�1., , MEC
c1 l� -- .ADD
Contact Person Ph -3 36 PLM
_ i �y�� i_
T'
Contractor_— _ -_ -- Ph _ — SWR _
BUILDING Tenant/Owner EI-C
Retaining Wall _ —� ELR
Footing Access: ��, r lis ���/—
Foundation FPS S °'
IFtg Drain
Crawl Drain Inspection Notes:
Siab 0-" fog,.. —--- -----
Pof t& Beam — — SIT
Ext Sheath/Shear _
Int Shpath/Shear --
Framing
------------------ --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm — —
Susp'd Ceiling _
Roof —
Misc
Final
PASS PART FAIL
PLUMBING
Post& Beam —_ - --_---.1Z
Under Slab / ...
Top Out
Water Service
Sanitary Sewer
Rain Drains
4ASS )PART FAIL
11CRANICAL —
Post& Beam --— ---- —. --
Rough In
Gas Line — ------ —
Smoke Dampers
Final ----- — --
PASS PART FAIL
ELECTRICAL _ -- --- — —-�
Service
(Rough In -----• ---
UG/Slab
L ow Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading —
Sanitary Sewer
Storm Drain I Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
(Catch Basin Please call for reinspection RE:
ire Supply Line p- _ _ I I Unable to Inspect no access
ADA /�
coach/Sidewalk Date ! �
Oth 0/y inspector Pi / ��y--e , Ext
Other I , _ _
Final
PASS PART FAIL DO NOT RErviOVE this inispection record frc.m the job site.
yLlriTY OF TIGARD —_ ._ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00443
13125 SW Hall Blvd., i igard, OR 97223 (503) 639-4171 DATE ISSUED- 9/19/01
SITE ADDRESS: 11455 SW I-IAZELWOOD LP PARCEL: 1S134BD-00300
SUBDIVISr.:)N: ENGLEWOOD NO, 2 ZONING: R-4.5
BLOCK: LOT: 091 JURISDICTION: 1 IG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MAI'H. BACKFLOW PREVNTRS: 1
CCCI IPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_FIXTURES _ LAUNDRY TRA'M'S: SF RAIN DRAINS:
— SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINA: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of backflow device. (front SW corner of lot)
------
Owner: FEES --
- --- ----_
-- —�� Type By Date Amount P.eceipt
JACKSON, NITA,J AND RO 3ERT M
TRUSTEES PRMT CTR 9/19/01 $39.15 27200100000
11455 SW HAZELWOOD LOOP SPOT `CTR 9/19/01 $3.14 27200100000 1
TIGARD, OR 97273 Total $42.29— _�
Phone 1:
Contractor:
LIVING COLOR LANDSCAPE CO
PO BOX 514
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 678-3364 RP/Backflow Preventer
Reg #: LIC 7311 Final Inspe0on
This permit is issued subject to the regulations contained in the Tigan-( 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 requir-;s you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set Firth i~i OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules of direct questions to OUNC by calling (503) 246-1,987.
Issued By: _ =- .. — Permittee Signature:
Call (503) 639-1175 by 7:00 P.M. for an inspection needed the next business day
u9 .12/2001 17:0.0 FAZ 50359SL960 CITY OF TIGARL @100f
T" "
Plumbing Permit Application
l h i�lt, Iiaterecei,eed: & pYrrnitao.: - ✓U3
City of Tig FVt ' SM-urpertnitno. BuudinEpartriteo.: _
Ad1mss: 13125 SW Hall Blvd,Tigard,C+R 91223 oject/oppt.n —i— Expire date:
Cltv(#Mtard Phone: 003)639.4171
Fax: M)3)598.1960 �+rP U- �(lU� �
a7C. Dacelssued: la Race no.:
Cax file LO.. Payment typt;
Land uie a.pproval:;r+ AAf)._ ----- --
1 At 2 family dwtalling or.Ceoerory U Ceamercial/Industnal D Witi-farrW5 ❑Tenant 1.npt7 vemalt.
7'lzw construction U Addidon/alteraizoNmVIACcntent U Food iavice
MINE
lob uldtess; v .a'I';MMY .N
Suite no.: ---- (bKi rdet to n.r r rads rruty col-rct►on)
Tax run x 1pt/ac antral r.+• SFP(1)bath----
Lot;
ath _Lot; _ �Bloct: I Subdivisiur:
pro•eot name: --
��—"� -
na
ramTinoiZhWonTba�ilk
--
acri in+Ind l jtian of wont an p�ptniae:a: ' c 81te ntiiitlaes
l c�C.'OCatch baein/araa drain - -
-
wo Il�eac7i line/ enc
Fst,date of ootuoleti(•tL'ia cdon: u�.. . n no�,1-n --
RnuttChSCe.�bPit1C nQIICEr --
BU"neba na tte; ���;�• r,. ..ty w- ani er_ �_
Addeeer: '�") i �" in rain connector __--
clty t State Z J t) lin t�
txm sewer no,lin. )
Phone: Fut ,2 5 __ ❑tcr Setvtoo nom) -- —
CCB nom- Plumb,boa rob.no:
ity/metro Absa ;�,%Iv,.
Con7actol"e repreeentusive el�ratstte: -- 13eclt fN reventcr
punt nolle: Dote; $glee vale
�iiwns/l-ava
o es wa ' --
Nam r. .
Addrasa: r _
_ n ouetarn a _
Gtv. �1"'
( C Sttaa Z1P: 'Vector sunt
Tlwne: (ri 7�• 3i ax: N:� 5y timall: x en—on tan
x se --
crnt c;ait�sl�jprvr�ab._ ..
ore erCit cM
Phone: o /
nas
trop
Owns m
IetioNresidentia! ait0erttnct only: Tht octuel anon Mime r�_
will re made by me cw the maintenmioe and repair made by my Mgular .00f drain con fl&el I _
em;toyee on the ptKTerty I own ns pet ORS Chapter 44'7, 1 a µ it�(a) __
Qvrrler's aturr. Darr u�_�m
Tlshower atrower pan
L _
None: alar clnaa� -
Addrear. _ etaTiruer _ ,�
City — tate: Zlp` r.
Phone: Pax: B mail: _ _ _" _.._ _. __
MTMinimum fee....... ......f
'Nm 61jWAcna+cn&,0—�l!wW+�(W°101t�'""cl'i 'ioUce Thieperm` aprlicauon Plantevlea (at %) $
O Viva M"tc'CW 14 T— exptrea Its permit is not obWod State ourche rge(896)..•.$
CM&;xe atiatbet ^__. __--—.-_-�__ � � within 180 days d w h has boon TOTAL'—!ami»aToi�a dt*v—�xie a ciotfi G��—
aeceptad ar oemt'ate. ..................,.....S
$ a AC-le l a(ss1a+COM
/ \ CITY OF T!G A R a MECHANICAL PERMIT
\\\ DEVELOPMENT SERVICES PER!'dT#: MEC2001-00372
13125 SW Hwll Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/25/01
P -kRCEL: 1S13413D-003n0
SITE ADDRESS: 11455 SW HAZELWOOD LP
SUBDIVISION: f NGLEWOOD NO. 2 ZONING: R-4 5
BLOCK: LOT: 091 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HE.A1 ERS: VENT FANS:
OCCUPANCY GRP: P3 VENTS W/O ADPL: VEN1 SYSTEMS:
STORIES: BOILERSICOM_PRESSORS HOOD:
_
FUELTYPES _
_ ES _ 0 3 HP: DOMES. INCIN:
LPG i 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP:
REPAIR UNITS:
FIP,E DAMPERS?: 30 - 50 HP: WOODSTOVES.
GAS PRFSSURE: 150 + HP:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS _ OTHER UNITS: 1
FURN 100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfrn.
Remarks: Installation of gas piping and gas fireplace insert
Owner: _...__ FEES �-- --------�.
JA_KSON, NITA J AND POBER f M Type B,r Date Amount Receipt
TRUSTEES -PRMT CTR 10/25/01 $72.50 2720010000
1 145 SW HAZELWOOD LOOP 5PCT CTR 10/2-101 $5 80 2720010000
TIGARD, OR 97223
Total $78.30
Phone: t — - -- --
Contractor:
RICKS HEATING & COOLING
RICK STICKA
696 25TH COURT REQUIRED INSPECTIONS�__�� _
COhNcI_IUS. OR 97113-7273 �
Gas Line insp
Phc ne:503-648-4466 Mechanical Insp
Reg #:LIC 57068 Final Inspection
This permit is issued subje-6, to the regulati )ns contained ;n the Tigard Municipal Code, &.nte of Ore.
Specialty Codes and all ether applicable laws. All work will be done in ac�;xdance with approved
plans. This permit will expire if work is n-)t stated within 180 days Of issuance, or if work is suspended
fo; more than 130 days. .ATTENTION. Or�gcn law requires you to follow cules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OA 952-0 `1-0011; Through OAR 952-001-0080.
You may obtain copies of these rules or direct questions i ) OU NC (50,3)2-46-9189
Is!tie R Paemittee Sic nature: -
Cad (:;03) 639-4175 by 7:00 P.M. for inspecti ins needed the next business day
Mechanical Permit Application
-� ��J� Date received:/D ?S 0 Permit no. E[�q�/�1� �
City of Tigard ProJect/eppI no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd,Tigard.O 9 - pate issued: By: /'. I..... it no..
Phone: (503) 639-4171 --
Fax: (503) 598-19f+0 Car,file no.: Payment type:
Land use approval: _i Building permit na
X1 &2 family dwelling or accessory U Commercial/industrial U Multi-fainily U Tenant improvement
U New construction U Addition/alteratiotVreplacement U Other:
Joh address: //!y53` L,pgi . Indicate equipment quanti!ies in boxes helow. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax IoVaccowtt nc,.: profit. Value$
Lot: — Block: Subdivision: *See checklist for important application ,nformation and
_Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP:
Description and location of work on premises: ' 1 ' !
jL
�S �`ht'fC/T .�i+�S TA-� l erica.► dotal
Est date of completion/inspection: Z0 •--,aS _.� -_ _ Descrlptiun qty. Res-only Res.only
Tenant impr�tvcment or change of us,:
1s existing space heated or conditioned? es U No Air handling:mit ____CFM
' Air conditioning(site plan reGu re )
X _
is existing space insulated'.1 Yes J No Alteration of cxi%Tin-gsystem
o er compressors
Business prints: % State boiler permit no.:
tic r k sT� �_c r L , n!, HP Tons B11,1/
Address: _"dl Sr .2 29 . - _ Fir�i.smo ere dampers uct smoke detectors -
City: Cc r,,"i State:pe- `!_I P: t 7 / eat-T{-pump(stle plan required) -
Phone: - (� Fax: . >/wF-marl: nsta rep ace furnace burner
CCB no.: �y Including ductwork/vent liner U Yes U No
�] nsta rep accrre ocatT e ealers suspen e
City/metro lic.no.: _.r� > - / wall,or floor mounted -
Name(please print): Vent for aapFianceother than furnace
ONRefrigeration,-
CONTA(I PERS
_ Absorption units BTU/H _
Name: �i` 4. 77%C,CA` Chillers HP
Address: C_1 Compressors - HP
.n ronmenta ex au,l an veM at on:
City: State:0/24- 7//3 Appliance vent
Phone. y�� Fax: (09 �7/v' F.-trail ryerex aunt
r s,Type res. its en/hazmat
hood fire suppres.-.inn system
Nt+me: / , /y! '��c, L/w Exhaust fan with magie duct(beth Taus)
�-
Wiling addn ss: P 1? ,xhaust systema art from isatin or AC
ce S / ��[u�rxi� � .� ,
City: - �/T Slate: OF Z,IP: •aeTpipTng end dlstrau(qo to 4 outlets)
Type: LPG _ NG Oil _
Phone: Fax: E-maihI ve piliing ea h ad uio aur ets
Process r p ng(schematicrequir��
Numher of outlets
Name: _ ter Itited app aace or eq_v pment:
Address: Decoiativetircplace
City: State: 7.1P: Insert-type _
Phone: -- - Fax: E-mail: oo stov pc et stave
Applicant's signature: 77 .7� , Date: x, .is--, 1 t --
Name (print): )R,
Nm nil Judsdlctions accept credo rartls,please call jurisdicda+for more Inknn+ntom Permit fee.....................$
J Visa U jurisdiction,
pt eF Notice:This permit application
Minimum fee................$ _
expires if a permit is
+'mdn card number within igU days ager it has been-,�.________. not as been
nplan review(al , %) $ v -_
State surcharge(8%)....$
m
Nae ut carrdholder as shown on cmdit cod--- F ptrl accepted as complete. TOTAL
•*AL $ '22� 3
S
-- Cardholdn signature Amount-�
_.___ 4404617(NOOtCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEF SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to 55,000.00 _ _ Minimum fee$72.5G Table 1A Mechanical Code _ Qt (Ea) Amt
$5,001'.00 to$10,r')0.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 DTL'
$1.52 for each additional$100.00 or inJuding ducts&vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00. Including ducts&vents_ - 17.40
$10,_001.00 to$25,000.(;0 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or including vent 14.00
fraction thereof,to and Including 4) Suspended heater,wall heater
_ $25 U00.00 or floor mounted heater 14.00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance pal nlit
$1.45 for each additional$100.00 or 6.80 _
fraction thereof,to and Including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fract ..r thereof. footnotes below. C6;1p
Minimum Permit Fee$72.50 SUBTOTAL: 7)<3HP;absorb unit
E l0 100K BTU 14.00 _
8%State Surcharge $ 8)3.15 HP;absorb 25.60
unit 100k to 500k BTU
25%Plan Review Fee(of subtotal) a 9)15-30 HP;absorb 35.00
Reguired for ALL commercial onlyunit.5 1 mil BTU ___ IN
TOTAL COMMERCIAL PERMIT FEE: :6 uni 30-50 HP;absorb
unit 1••1.75 mil BTU 52.20
11)>50HP;absorb - - -
unit>1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM _ 10.00
Value Total 13)Air handling unit 10,000 CFM+
Descrt on: Qt Ea Amount 17.20
Furnace to 100,000 BTU,InrJuding 955 14)Non-portable evaporate cooler
ducts&vents _ _ _ 10.00
Furnace>100,000 BTU Including 1.170 15)Vent fan connet:ted to a singly duct
ducts&vents _ _ - _ 8.80 _
Floor furnace inclugAn _vent - _ 955 16}Ver lila"nn system not Inclu.'eJ in
Suspended heeter,wall heater or 955 r
floopmounted treater appliance permit 10.00
17)Hoed served b
Vent not included In applicance 445 y mechanical exhaust
10.00
rmit 18)Domestic incinerators
Repair units 805 17.40
<3 h absorb.unit, 955 - - -
10)Commer'al or industrial type Inrnerator
to i 00 BTU
69.95 _
3-15 hp:absorb.unit, 1,700 20)Othdr units,including wood stoves
101k to 500k BTU 10.00
I(-15-30 hp;absorb,unit,801k to 1 2,310 21)Gari piping one to ir outlets
mil.BTU 5.40
30-50 hp;absorb.unit_ 3.400 22)More than 4-per outlet(each)
1-1.75 mil.BTU _ 1.00
>50 hp;absorb.unit. 5,72.5
>1.75 mil.BTU Minimum Permit Fee$72.50 SUBTOTAL:
__
Alr handy unit to 10,000 Nrh 656 --__ - - - --
All handlingunit>10,000 cfm 1,176 _ I 8°/.State Surchargd $
Non- ortable ev.pperzie cooler 656 - - -
VPat fau connected to a single duct 446 _ II i�1/"L RESIDENTIAL PERMIT FEE: $
Vent system not Included In 656 `_________ __ _- _
appliance permit
Hood sewed b mech-,n)t,al exhaust t70
Other Inj_&L ns and Feta:
1 Inspecilons outside of nortnal business hours(minimum charge-two hours)
Domestic incinerator _ 1, $72 50 per hour
Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
Other unit,Including wood stoves, $72 50 per hour
Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum
Gas piping 1-4 outlets _ 360 charge.-jne-half hour)$72:•0 per hour
Each additional ouft +� 63 'State Contractor Boller Certification required for units>200k BTU.
TOTAL COMM_FF CIAL $ -Residential A/C requires+site plan showing placement of unit.
VALUATION: _ All Ww Commorciai Buildlags require 2 sets of plans.
I:wistsVormiMmech-fees.doc 08/29/01
rsaa:-
ss r�
CITY OF TIGARD BUil_DING INSPECTION DIVISION MST
24-Hour Inspection Line: 63: 175 Business Line: 639-4 —
z BUP
Date Requested_ _AM-L/ Z PM Bt_D
Location Suite
—TJ—
Contact Person �.�c c--,�. Ph '_
Contractor Ph SWR
BUILDING - Tenant/Owner ELC
Retaining Wall - ELR
Footing -
r•
Foundation FPS _
Fig Drain SGN
Crawl Drain [71ns� ion Notes ---- --
Slab '� -2 SIT
Posta Beam
Ext Sheath/Shear
Int SheathlShear � 4 ` - / _ � ,l / 1O -•��
Framing _ _ 4? l✓ / !�
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Erre Alarm --_--- --
Susp'd railing
Roof
Misc: --
Final --- ------ -------.._._.�
PASS PART FAIL - -- ----- -----
PLUMBING
Post a Beam -----
Under Slab
Top Out - ..-_.-
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL,
MECHANIC
Post& BearnAil
-- - -- --
Rough In f- F'• - -- --
CA - - -- -- ------
1 e Dampma
S PART FAIL /
CTRICAL - - -- -- - --- -- .0
Service
Rough In -
UG/Slab — -- - --------- —
Low Voltage
Fire Alarm
Final
PASS PART FAIL _
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ )Reinspention fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ )Please call for ietnspection RE. [ )Unable to Inspect-no access
Fire Supply line
ADA
Approach/Sidewalk D1
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REhIOVE this inspection record from the job site.