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12176 SW HOLLOW LANE r� N J Q\ 5 A 1 A t�4 4 Rio f 1 ri i `I Hollow Lose � CITY OF TIOARD Residential Certificate o fOccupancy h,miit Nei.: Address: T 't tv -5 L4Z1LI o-AJ L-r, Owner/Contractor: Date of final Inspection: ''+I inspector: 1=dt.r tructure has been found to be in substantial compliance with the provisions of the State of Oregon Ont'& Two F'amilN l welling ('Hilt anti is hereby approved for eccupancy. i CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-H-)ur inspection Line: 639-4175 Business Line: 639-1171 BUP _Date Requested � L� �/ _AM PM BLD --- _ Location z �� S w l( ��� Suite _ MEC Contact Person Ph ( f -3� `. PLM Contractor QiTc, Ix c Ph SWR BUILDING Tenant/Owner ELC 2_c;0/ - eJc1Z.�T' Retaining Wall - ELR Footing Access: _ Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: --- - Slab _ �-' Lf/� ----- SIT Post& Beam -' Ext Sheath/Shear Int SheathiShear Fram6g Insulation Drywall Nailing Firewall - -_�-__----------_-- Fire Sprinkler Fire Alarm _--..- Susp'd Ceiling -- Roof Misc: - -- -- Final ,— PASS PART FAIL PLUMBING Post& Beam Under Slab Top Out Water Service Sanit,-,y Sewer - Rain Drains Final PASS PARI FAIL MECHANICAL. _ Post& Beam -- . ----- - - --- - Rough In Gas Line -- - - - Smoke Dampers iFinal - -- - -- -- _ — .. -- ----- - - - - -- PASS PART FAIL .rvtce Rough In UG/Slab _ Low Voltage Firs Alarm ---- --- �.. ,--- ---- AS ' PART FAIL Backfill/Grading -_— Sanitary Sewer Storm Drain ( J Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( ]Please call for reinspection RE: j Unable to inspect-no access Fire Supply Line ADA Approach/Sidewell; Date <" Other Inspector _ , Ext Final �-- PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITYOF TIG�4RD MAS'TERPLRMIT PERMIT#: MST2000-00212 DEVELOPMENT SERVICES DATE ISSUED: 10/31/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12176 SW HOLLOW LN PARCEL: 2S103CB-12201 ' SUBDIVISION: QUAIL HOLLOW- EAST ZONING: R-4.5 BLOCK: LOT: 080 JURISDICTION: TIG REMARKS: path I S/F Attach BUILDING REISSUF STORIES: FLOOR AREAS REQUIRED SEI BACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 18 FIRST. 2,110 sf BASEMENT at LEFT 11 SMOKE DETECTORS. v TYPE OF USE: SF FLOOR LOAD: 4o SECOND. 1,070 of GARAGE, 004 sf FRONT ,0 PARKING SPACES , TYPE OF CONST: 5N DWELLING UNITS: 1 FINB£MENT: of RIGHT: VALUE.: $Z40 PQ 17 OCCUPANCY GRP: R3 BDRM: I BATH: TOTAL: 3,18000 of REAR. PLUMBING SINKS. WATER CLOSETS: 4 WASMNG MACH: t LAUND,Y TRAYS 1 RAIN DRAIN. Inti TRAPS. LAVATORIES 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER.LINES: 100 SF RAIN DRAINS 1 CATCH BASINS: TUDISHOWERS GARBAGE DISP: I WATER.HEATERS. I WATER LINES: 1U9 BCKFLW PREVNTR: I GREASE-TRAPS: R , MECHANICAL OTHER FIXTURES' FUEL TYPES FURN<100K BOIL/CMP<3HP: VENT FANS: 7 CLOTHES DRYER: I ns FURN—190K: t UNIT HEATERS HOODS: I OTHER UNITS I MAX INP. lila FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS _ ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp. W/SVC OR FOR: I PUMPIIRRIGATION: PER INSPECTION EA ADD'L 500SF. r, 201 400 amp: 201 400 amp1st WIO SVCIFDR: 0f, SIGNIOUT LIN LT: PER i!OUR: LIMITED ENERGY: 401 600 amp: 401 - 600 amo: EA ADDL BR CIR: SIGNALIPANEL• IN PLANT MANU HMISVCIFDR: 601 - 1000 amp, 601-amps•t000v: MINOR LABEL: 1000.amplvolt PLAN REVIEW SECTION Reconnect only: -- -4 RES UNITS: SVCIFDR-225 A.: >600 V NOMINAL. CLS AREA/SPC OCC ELECTRICAL-RESTRICTED ENERGY A SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO R STEREO. FIRE ALARM. INTERCOM/PAGING. OUTDOOR LNDSC LT: BURGLAR ALARM: OTH. BOILER: HVAC: LANDSCAPEIIRRIG PROTECTIVE SIGNL GARAGE OPENER CLOCK: INSTRUMENTATION MEDICAL: OTHR: HVAC. DATAITELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 4,477.82 00 This permit is subject to the regulations contained in the 4230 GALEWOOD ST 4230 DON MORISSITE HOMES DON AILEW E fTE HOMES Tigard Municipal Code,Stste of OR Specialty Codes and SUITE 100 SUITE 110OOD STREET all other applicable laws All work will be done in LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 accordance with approved plans This permit will expire if work Is not started within 160 days of issuance,or if the work IS Suspended for more than 180 days ATTENTION Phone Phone Oregon,law requires you`o follow rules adopted by the Oregon Utility Notification Center Those rules am set Reg e: TIC o)03!,531 forth in OAR 952-001-0010 through 952-001-0080 Ycu may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987 REQUIRED INSPECTIONS Erosion 844.8444 PLM/Underfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Building Final Footing Insp Mechanical Insp Framing Insp Gas Fireplace Electrical Final Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Post/Beam Structural Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final PosUBeam Mechanica Electrical Service Low Voltage Water Line Insp Final inspection Issued Bf __ K_l - 1 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#: SWR2000-00172 13125 SW Hail Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/31/00 SITE ADDRESS; 12176 SW HOLLOW LN PARCEL: 2S103C13-12200 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 _BLOCK: LOT: 080 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Owner: - -- ----- - `-- FEES DOIJ MORISSTTE HOMES 4230 GAL.EWOOD ST Type By — Date __ Amount Receipt SLPTL 1r0 PRMT CTR 10/31/00 $2,300.00 27200000000 LAKE OSWEGO, OR 97035 INSP CTR 10/31/00 $35.00 27200000000 Phone: Total $2,335.00 Contractor: Phone: Red #: Required Inspections Sewer Inspection This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires 180 days from the date issued. The total amount paid will 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" Pen-nit 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(503) 246 .,s7 Issued by: �' 11�� Permittee Signature:\ _ Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day GITY OF TIGARD Residential Building Permit Application Plan Che - 131t.5 SW HALL BLVD. New Construction Rec'd13yc Date Red TIGARD, OR 97223 Single Family Detached Date to P E (S .z g coy V 503-639-4171 / Dale to DST -00 F 503-684-7297 Permit#tA'7`20Q0.00 ZI Z Print or Type Called 7-/7- ©c' Incomplete or illegible applications will not be accepted Pe-- J m -(G - Name of Project Name Job Site t l.� r Address i Ads1 s Architect dins DIM ! —_� It,.--, i ILQ OK ity/s me I , a OI �- Name Owner LyAlingAdd ess ity/S' to one I Engineer Mailing Address "✓ City/State �7� o General Name Contractor * ( Describe work New Addition O Alteration O Repair O I�aajling Address to be done: Prior to permit P CL Additional Description of Work: issuance,a copy City/State Zip Phone of all licenses are required If Oregon Const.Cont.Board E .Date PROJECT ' expired in COT uc.# j3 11�I0� VALUATIONS�y~ database - Mechanical Name NEW CONSTRUCTION ONLY: Sub- 1 CLUtAIIA (?. Sq. Ft.Fill"z l Sq. Ft.Garage Contractor Mailing Address 3 Prior to permrt �i[,� Indicate the restricted energy Installati3n by the electrical T ,�fc� �-Y V subcontractor in the following areas issuance,a copy Cit /Qtate of all licen e 0l� � - Restricted Audio/Stet eo are required if Oregon Const.Ceaf. Board Ex .Date Energy System Alarms expired In COT Lic.# --1 I n Installations Vacuum Irrigation database _ / �" `'�`-' S stem System Plumbing Name (check all that Other: Sub- 1( r l� l.1NY� a I Contractor Mailing A ess Number of Units in Building Unit Number Designation 1 I I - P�(rYl L l 1r Has the Subdivision Plat recorded? N/A Y NO Prior to permit ity/State Zip Phone issuance,a copy ? 4 a"- _ of all licenses are Oregon Const.Cont. Board Exp Date required K Lic.# / _ �)/� C11I I I/)' _ expired in COT lD CJ f L'�-J V database Plumbing Lic.# Ex .Date I hearby acknowledge that I have read this application,that the � Information given is correct,that I am the owner or authorized agent ll 1�T of the owner,and that plans submitted are in compliance with Name re on State laws Electrical eell:A f✓ -� Si ature of wne Age t� �p e Sub- Mailing Address AI 1- 1r' tact Pe��kkon Name one Contractor �(� �JI,V/ Cl r • F4 l - �j- City/State Zip Phone Prior to permit issuance,a copy FOR OFFICE USE ONLY: of all licenses are Oregon Const.Cont. Board Exp Date plat#: Map/TL#: required if Lic.# (I �I I I jl(� f 2 �( - lhra `f 2 sl 0 C0- 122C)a expired in COT database ectrical Li �l xpl D t�' Setback: / Zone: Elefr' Su or Lic.p Exp D to EngineerJtg Approval: Planning Approval: TIF: t t lJ i i O l'- i klstslforms\sfd-new doc 11120/98 r UNITED ENGINEERING, INC. Consulting Engineers * Civil * Structural * Environmental 922 N. Killingsworth, Suite IA Tel:503-283-6060 Portland, Oregon 97217 Fax:503-283-4445 U S A e-m":jaimelim&uno.com -L--- Leer 7 A-11� L�S� 5 PROJECT NAME t oT PROJECT LOCATION -7/ (z� ,�Q,U PR�F£Sn C� *. G l I Ui J I,y- n; r 14 1)104E J. EXCLUSION OF LIABILITIES 1. DISCLAIMER AND RELEASE Buyer hereby waives, releases and reg-,ounces all warranties(express or implied), obligations and liabilities of United Eigic:eering, Inc. and all other rights and claims and all other remedies a,,ainst United Engineering, Inc. with respect to any nonconformity, improper installation, workmanship or material. 11 EXCLUSION OF CONSEQUENTIAL AND OTHER DAMAGES United Engineering, Inc. shall have no obligation of liability, whether arising in contract (including warranty), Tort (including active, passive, or imputed negligence) or otherwise, for loss or use, revenue or profit, or for any other incidental or consequential damage DON - MORISSETTE OBE : 2035 HOMES INCORPORATED LOT: 80 4 3 0 G A L E W 0 CD S TRE E E T 3 U I T I t 0 0 LAKE 0 S W 8 GO0RE G0 N 9 7 0 3 5 PATE: 06-13-2000 (5 0 3) 3 8 7 7 5 3 8 PAX (503) 387 - 7615 PROPERTY. QUAIL-HOLLOW CITY: TIGARD SCALE: I"=20' OPTIONAL ELEVATION 1 PLAN-.No.: 169B mig v"l L, ;)5 1() - Q tl c--"ix,) 26Y)e- 51U, �OLLOUJ L ,4NE rW �� Ull E P.U.E. 284.00, 2'so., ............. -7 21a .3 r-.r- 2ec 4 bath h \B, bdrm, 31 2132., 6080 LOT 08A • Ft. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE HARRY + SON PLUMBING INC 7117 NORTH ARMOUR PORTLAND, OR 97203 PI:Im,pin(, Signature Form Pcr mit #: MST2000.t?921" Date Issued: 10131100 Parcel: 2S103CB-12200 Site Address: 12176 S17 HOLLOW LN Subdivision: QUAIL_ HOLLOW - EAST Block: Lot: 080 Jurisdiction: TIG Zoning. R-4.5 Remarks: path I S/F Attach 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 Piumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will I-)e authorized until this completed form is received OWNER. PLUMBING CONTRACTOR: DON MORISSTTE HOMES HARRY + SON PLUMBING INC 4230 GALEWOOD ST. 7117 NORTH ARMOUR 5Ul'I E 1 UU PORTLAND, OR 9720.3 LAKE OSWEGO, OR 97035 Phone #: Phone #: Reg ##: I Ir 00068900 PI M 26,-448Db AN INK SIGNATURE IS REQUIRED ON THIS FORM Signatu05 of Authorized Plumber If you have any questions, please call (503) 539-4171, ext. # 310 ELECTRIGA' CITY OF TIGARD RESTRICTS PERMIT- RESTRICTEn ENERGY DEVELOPMENT SERVICES PERMIT ELR2000-00309 13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 12./19/00 SITE ADDRESS: 12176 SW HOLLOW LN PAP.CEL: 2S103CB-12200 SUBDIVISION: QUAIL HOLLOW EAST ZONING: R-4.5 BLOCK: LOT: O80 JURISDICTION: TIG Proiect Description: A. RESIDENTIAL B.COMMERCIAL _ ____�� _ AUDIO & STEREO: AUDIO & STEREO INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELF COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTc)nOR LANDSC LITE: U FHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL# OF SYSTEMS: Owner: � Contractor: DON MORISSTTE HOMES GARY'S VACUFLO INC 4230 GALEWOOD ST. 9015 SE FLAVEL SUITE 100 PORTLAND, OR 97266 LAKE OSWEGO, OR 97035 Phone: Phone: 775-2042 Reg #: LIC 69047 ELE 26-728CLE FEES _ Required Inspections Type_ By Date Amouni Receipt _ Low Voltage Inspection PRMT CTR 12/19/00 $75.00 2720000000 Elect'I Final 5PC r CTR 12/19/00 $6.00 2720000000 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws All work will be done in accordance with approved plans This permit will expire if 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 Ltility 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 at (503) 246-1987 - Issued by —� -- ? kd_ �- Permittee Signature^ OWNER INSTALLATION GNLY The installation is being made on property I own which is not intinded for sale. lease, or rent. OWNER'S SIGNATURE. DATE: CONTRACTOR INS T A'_'.ATION ONLY SIGNATURE OF SUPR. ELEC'N _ DATE: LICEINSE NO: Call 639-4175 by 7:00 P.M. for an inspection needed the next business day 12/14/2000 09:17 5037880633 GARY'S VACUFLO PAUL rl Electrical Permit Application - 1 r Date received: �Fem-jl n , f City of Tigard Projeel/appl.no.: Expire date: CifyQ/7lgarrr Addre.s: 13125 SW Hall Blvd,Tigao,QR 9722 1t1oGl Date issued: By, Receipt no,; Phone: (503) 6394171 Fax: (503) 598-1960 WMMUNITY DFVF(1JpMf r' Cele rile net,: Payment type: Land use approval: .. "2, y dwelling or aceesfieny U CoiarnerciaUindustrial 0 Multi-family Q Tenantimprovement uction U Additiort/altmation/rt, °mcnl O Other- U Partial .lob address: )iNEMU t L,a[�L��_1F!1JdlU0q;ite no.: Tim map/tax lottaccount no.: Lot: : subdiviaztoon� _ Project name: Description and location of work on premises: Estimated date of com letion/ins tion: Job swt taint CENTRAL VAC INSTALLATION Dvacrlptlon (A (ea.) Total no.Imp New reatslmlW•destle or wdrl 4a nilly per (GARY 'S VACUFLO, INC: 775-2042 � drrdl4rgenitfeclorbattnchedprW.. 9015 S E F L A V E L, 97266 C B: 5 8 0 4 7 s•rrtoe irtcMsdeab C`.E: 25728 _ 4 0 P 7— Gch addidal 100 thereof� ---._-.-------�. - -_ Uinlled energy,residential2 C FtyTrieUtpIc.nt1,: Umltedenergy,non�residealial 2 t3ach manufactured hnme or modu:nr 6millnQ 3aturo of a - bin eIt:Wlclan requited Dote Service and/or feeder 2 Sup elr.t nalor..(pt;,tt). L,kensennc t9aedcesorf -laidal"gat. ali eratloa or raincalieo: 200 amps or lett: Name(print), 201 amps to 400 antps — 2 Mmung addrees: 1- sol amps tr.600 ami 2 601 sn a to 100n amps 2 -C1ry: SIaV': ZIP � � Over 1 tgr usor volts 2 Phone: Fax: mail' Reconrim only I Chimer msWiarion•The installation is being made on property I own Temporary wr*marf . which is not intended for sale,lease,n-ru,or exch;m,-according to htoxilati'n.dlorn"un.ofmiewllon: ORS 447,455, 479,670. 701. 100 amps or loss l Owner's signature: _ln i arrtl�s tr)acm amFe z —-- - _ Date: _ •10 1 In 600 amp Womb elreaw-aew,illerptles, Name: or extrosim per pwigh —..� A. Fee for branch circuits with purchase of Address: service or reader fee,each branch eirriiit City: S te: Z1p: ~' A Fee for hronah clroult�without pure;,s Phone: Fax: B-mail: _ of eel-vies nr reader fall,nrst branch dtr,4tit: 1 NUMMIMMM L'ach Mdidonsl�rertch rlrruh. - Mtac.McMee or fesaller not Its )t Q9rvicaovn2i5an+pa.ooteltraets) 0Realth-ewrfacilrty Nash umporirrigationcircle 11 service over 320 amps-nUna of 1 U U Hioardout location Each aipn or outllne Ilahting-- - 2 family dwellings U Huildioe over I0,000 square feat fou;or Signal circurt($)ora lirnhed enerfty panel. --- O System over 600 volts nominal rru,rr renidential,nits in one sutx-.,rte alteration,or"tcl.ion' 2 U Building over three ornries U Fredem 400 amps or more O P..erea✓llehtlnpplm t,dter �paaai lion. - - U Occupant Iced over v9 persona U Manufactured structures or RV park Each 'I--nal kup*ctlm n.wr tl>r alloteabk hr any o►r dere '_I Per inspection �-�'-�'r-t-- i9abtalt- gets of plarut with any of the aborta. a - ---- - - _-J Invan adonfix The above err,Not applicable to temporary coerlrvcUoa aetfite. cr NA all)taLtrllyd�e,s rept emah crM,ptaasn call halsdkUm fm a,are Mfonrrdar Notice:This permit application Pertlit fee..................... S• / t Vl+a ct Mnuerf ad expires if•permit is not obtained Flan review,(vet _ %) s �-- c"d"rartl ran"r.s, L� within 180 days after it has been State.qurrh"e 0%) ....S -. 7rirrir;7e • Wn all 1 e accepted as eornplete. TOTAL ................•......S - S --' 4404615 teAMWOst) DEC-28-2000 THU 11 :48 AM PHOENIX ELECTRIC CO FAX NO, 15036843611 P. 01 CITY OF ]IGARD 13126 S.W. HALL BLVD. -rIGARD, OR 97223 IMPORTANT PERMIT NOTICE PHOENIX. ELECTRIC CO 7379 SAV TECH CENTER DR Ir3ARD, OR 97223 Electrical Signature Form Permit 4: M,ST2000-00212 Dnto Issued: 1013;100 Parcel: 2S`I 3XB-12200 Sit(, Addross: 12176 SW HOLLOW LN Subdivision: QUAIL HOLLOW - EAST Block: L.ot: 080 Jurisdiction: TIG Zoning: R-4.5 Remarks: path I SIF Attach Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid,the signature of the supervising electrician Is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No elentrical inspections will be authorized until this completed form is received OWNF R: ELECTRICAL CONTRACTOR: DON MORISSTTE HOMES PHOENIX ELECTRIC CO 4230 GAL.EWOOD ST. 7371 SW TECH CENTER DR. SUITE 100 TIGARD, OR 97223 L,AKE USWEGO, OR 97035 phony #t; 684-3600 Phone#. fit- LIC OOOS7298 SLIP 41405 LIF 344470 AN INK SIGNATURE IS REQUIRED (JN �THIS FORM J __ Vj 'T�_ Signature of Supervising Electrician If you have any questions, please call (503; 639 4171, ext.. At 310 �00(A gxVD11 30 .�.LIO 096T 8i5S COS YVA 9(-:60 f1H1 00/92i7.T I CITYOF TIGARD —__ PLUMF3ING PERMIT — DEVELOPMENT SERVICES PERMIT ft: 2/5/01 01 00037 DATE ISSUED: 2!5/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCrL: 2S103CB-12200 SITE ADDRESS: 12176 SW HOLLOW LN SUBDIVISION: (QUAIL HOLLOW - E=AST ZONING: R-4.5 BLOCK: LOT: 080 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF 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: J URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUBiSHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residential backflow prevention device for irrigation system. _ _FEE_S_ _ Owner: Type By Date Amount Receipt DICK PACHOLL PRMT CTR 2/5/01 $36.25 27200100000 5255 SW 50TH CT 5PCT CTR 2/5/01 $2.90 27200100000 Total $39.15 Phone 1: 503-526-1799 Contractor: TRYON CREEK LANDSCAPE INC 11400 SW NORTH DAKOTA ST TIGARD, OR 97223 REQUIRED INSPECTIONS RP/Backflow Preventer Phone 1: 624-2174 Final Inspection Reg #: LIC 1152.5 PLM 6296 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. phis 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 952-0001-0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. C� u2 Permittee signature:(/\ Issued By: i -- l , Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application 7,Mroject/aprd. : 9-5-0-V Permitno.: flit of Tigard and - y no.: Building permit no.: Audress: 13125 SW Hall Blvd,'pigard,Cid 97223 ---- — --- C(ryojTigard phone: (503) 639-4171 no.: _ Expire date: Fax: (503) 598-1960 Date issued: - By: l?eccipt no. Land use approval: — -_ Case file no.: Payment type: U I &2 family dwelling or accessory U Commercial/industrial U Multi-f lli ily U Tenant improvement }ANew construction U Addition/alteration/replacemcnt U Food w,lvice U Other: Job address: -4 �I -� Description Qt Fee(ea.) Total -Bldg.no.: Suite no.: New 1-and 2-family dwellings only: — (includes 100 ft.for each utility connection) Tax map/lax lot/account no.: SFR(1)bath Lot: Block: JSubdiisiow. - SFR(2)bathProject name:name: SFR(.3)bath _ City/county. n t tl7.IP: Z Each additional bath/kitchen Description and loc tion of wo.k on premises: Siteutilitles: N At?(h � Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain. Footing drain(no.lin..11.) Manufactured home utilities _ Business name:TV_\jvr) CQ--�_-tL (_AYg0eS(1}K yr1C. Manholes _ Address: t\ V V o 9 T N •- ItD-rIlt a, Rain drain connector City; '-1'; a p State: ZIP: 17 Sanitary sewer(no.lin. ft.) Phone: o3 9�'(6cj E-mail: Storm sewer(no.lin.ft.) CCB no: 1 G,'Z C, P teg.pro: Zd Water service(no.lin.ft.) City/metro lic.no.: Fixture or Item: Contractor's representative signa�tyy' bsorpown valve Print name: 11 c ,� ry ��, z z -1 r Date: 2 y o I ack flow preventer- Backwater valve Basins/la,atory Name: �-T A L, y e.t��11-N t l� Clothes v asher Dishww-ner Address: I I `t au -,LA-) N orcr o i� r.oT�s Drinking fountalu(s) — -- -- - City: ---�'yam Ln State:C Z'P: �l Z-Z 3 Ejectors/sump Phonc:r . ; u. ta I z I ax t.Z ( 9OU F.-mail: Expansion tank 111111141111 Fixture/sewer cap Name(print): LCL i 'Iq LT O r tFloor drains/floor siRVhub Mailing address: S Z a^,,v aT Garbage disposal �— Huse oibb City 84.2,12,t.(o State: ZIP: Ice-m-a ker -_ Phone: le(,p Fax: _ E-mail: Interceptor/grease trap Owner Installation/residential maintenance only: The actual installation Ptimer(s) will be made by me or the maintenance and repair made by my.-gular Roof drain(commercial) _ employee on the property I own as per CRS Chapter 447. Sink(s),hasin(s),lays(s) _ Owner's signature: Date. Sump Tubs/shower/shower pan Name: Urinal --- — - -- Water closet _ Address: Water heater - — City: --__—I_State: ZIP: Other: — -- Phone: Fuse: _ Email_+ Total Not all jurisdictions accept credit cards,please call jurisdiction for rmxe inimm.uiext Minimum fee................ Notice:flus penntt application U visa U MasterCard Plan review(al _ %1) $ _ cxthin it'a perndit is not obtained Credit card number__ _.-_-f.-_1 vithin 180 dflvs atter it has been State surcharge(13%) ....$ Eapire. TOTA1, . -- -m- acre led as CPm late. ""'-""""-" ""$ Name of cardholder u shown rnr credit card I p p — S JI cardholder signature Amount f 440-4616(6M"M) PLUMBING PERMIT FEES: �— PRICE TOTAL New 1 and 2-famlly dwellings only: FIXTURES Individual _ QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the flrst100 ft. QTY (ea) AMOUNT 16 60 — for each utility connection Lavatory _ One(l)bath $249.20 I ub or Tub/Shower Comb 1660 Two 2 bath $350.00 -Shower only 16.60 Three bath _ $399.00 Water Closet 16.60- - -- _ SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbcgo Disposal 16,60 -,-- TOTAL Laundry Tray 16.60 _ Washing Machine 16.60 Floor Drain/Floor Sink F 16.60 — 16.60 PLEASE COMPLETE: 4.. --� 16.60 Weater O conversion O like kind 16.60 Quandt b Work Performed ater N Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ Capped MFG Home New Nater Service 46.40 Sink _ Lavato MFG Home New.San/Storm Sewer 4640 ---- - - 16 60 — Tub or Tub/Shower Hose Bibs _ Combination _ Roof Drains 16.60 Shower Only [Drinking Fountain - 16 60 Water Closet _ ^ Urinal Other Fixtures(Specify) 1660 _ _ Dishwasher Garbage Disposal Laundry Room Tray -- - Washing Machine Floor Drain/Sink: 2" - �— Sewer-1 st 100' 5500 3„ Sewer-each addiDe.tal 100' - 4640 4" Water Service-list 100' 55.00 Water Heater_- Water Service-each additional 200' 46,40 Other Fixtures Storm 8 Rain Drain-list 100' 55.00 Storm 6 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Devise 46.40 Res dential Backflow Prevention Device' 27.55 — Calch Basin 1660 — — Inspection of Existing Plumbing or Specially 72 50 Requested Inspections perthr COMMENTS REGARDING ABOVE: Rain Drain.single family dwelling 6525 Grease Traps 1660 --- -- - - - - QUANTITY TOTAL -- Isometric or riser diagram is required if Ouantlty Total is >9 __ -- *SUBTOTAL ---- --- --- -- - 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL TOTAL a *Minimum permit fee is$72 50+8%stale surcharge,except Residential Backflow Prevention Device,which is$36 25-8%slate surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan revrew LWsLa\forms\plm-fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 \ MST -- C�BUP _ Date Requested_ �" Z j .-AM ---PM BLD _ Location Ar, MEC — Contact Berson Ph -3,PLM Contractor Ph SWR BUIL LDING —� Tenant/Owner ELC _ Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes ----- Slab -_-- .. SIT Post& Beam —�---_-- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkle, Fire Alarm Susp'd Ceiling Roof - -- ------------ Misc Final _...------- PASS PART FAIL -_---. _ `------- -_�—... PLU Post tG Bea -,e"'�.� — --- - Under Slab Top Out --- Water Servi Sanitary Se - Rain Drains �.. W;kRT FAILCHAL � Y Post i3 Beam - - --- ---- — E Rough In l/ Gas gine - -- Smoke Dampers Final PASS PART FAII ELECTRICAL -------� �— — Servir..e Rough In — T� UG/Slab _ Low Voltage Fire Alarm - --- ---- - — - -- Final PASS PART FAIL SITE Bark fit I/Grading - -- --_ -'� Sanitary Sewer Storni Drain [ Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Fiall Blvd Catch Basin Fire Supply Line [ ) Prase call for reinspection RE _ [ Unable to inspect-no access ADA Approach/Sidewalk Other Date L' Inspectors` L -- _ Ext -+ -(j Final — PASS PART - FAIL DO NOT REMOVE this inspection record from the job site. CITYOF TIGARD ELECTRICAL PERMIT PERMIT#: ELC2001-00129 DEVELOPMENT SERVICES DATE ISSUED: 3/2/01 13125 SW Hall Blvd.,Tigard. OR 97223 (503) 639-4171 PARCEL: 2S103CB-12200 SITE ADDRESS: 12176 SW HOLLOW LN SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 BLOCK: LOT : 080 JURISCICTION: TIG Prolect Description: I lot Tub RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): _ SERVICE/FEEDER _ BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1 st W/O SRVG OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ _ PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMIN_AL7� Reconnect only: SVC/FDR>=225 AMPS: _ CLASS AREA/SPEC OCC: Owner: Contractor: DON MORISSTTE HOMES PHOENIX ELECTRIC CO 4230 GALEWOOD ST. DBA/ENCOMPASS ELECTRICAL TECH SUITE 100 7379 SW TECH CENTER DRIVE LAKE OSWEGO, OR 97035 TIGARD, OR 97223 Phone: Phone: 684-3600 Reg #: LIC 00052288 SUN 4140S ELE 34-2470 _ FEES Required Inspections_____ Type By Date Amount Receipt Rough-in PRMT CTR 3/2/01 $46.85 2720010000( Elect'I Final 5PCT CTR 3/2/01 $3.74 2720010000( Total $50.59 [his Permit is issued subject to the regulations contained in the Tigard Municipal Code.State of OR Specialty Codes and all other applicable laws All work will be done in accordance with approved plans This permit will expire if 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 adapted by the Oregon Utility Notification Center Those rules atim- set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at 15031 246-1987 PERMITTEE'S SIGNATURE ISSUED BY: OWNER INSTALLATION ONLY _ The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: �- DATE: LICENSE NO: Call 639.4175 by 7:00pm for an Inspection the next business day MPf'-01 -2001 THU 01 :45 PM PHOENIX ELECTRIC CO FAX N0, 15036843611 P. 02 1 Electrical Permit Application — _ Dnteroeeived: p P Rf�C'FIVED City of Tigard ProjacVappl.no.: Expiredatc: Cllyof 1-jeard Address: 13125 SW Holl Blvd,Tigard,OR 97223 Date issued. by: _ Rcceiptno.: Phone: (503) 639-4171 41 '+ 1. 2001 Fall: (503) 598-1960 Cane file no,: _ Payinent type, Land use approval- COMMUNNY UEYELJPMEN1 PLO] 2.f roily dwelling or accessary U Coni nserciaUindustrial ❑Multi-family U Tenant improvement TNtew cunalnlction U Addiliotl/alcerntion/replacenient U Other: U Partial JOB SITE mrORMATION lob nddreas: flt ij�ANA ASuiie no.: I Tax map/tour IoUnccount no.: Lot: jBiock, _ Subdivision: F'rojert name_ Ut•ncviption and location of work on pismises: Estimated date of eom leliort/inxpeet9nn: Job no: M _ — IFar Max —{`—,���� _Description Qty. (ea) Total no,Imp Business name: i Ut - Aw rcudrnlul•aingk artrwjd fanilly per Address: �< <�' dwrWagrnit.ItrtlotlesarUrttedgnnge. ;cx ZIP: � !inia(ncludrd: Fide - E-mail: 1000 sq,p,or leas — - 4 EICe,bus,li0. ��- F^1eh nddidonW 500 sq.ft.or potjon dicreof CCB no,: ���_. _ Limited energy,residential _. 2 Cit /me41•o tr.,no.: Untiedenr , ,nnn-tsssidentlal _ 2 Etch manufactured home or modular dwelling ^� �'i�—`"• --`— Service anNor feeder 2 signature of rupervixin elec-u-icciaann—(reguiired) Urate Sup,elect,name(print): ('t,<ti"-j- v-e-'(Lt, r i,-rose no-3 Y'�3S• Services orfee rs-Insullallon, allersulon or relocation- a 200 Amps or less 2 Nerve(print) ��L`—_�2 tot amps to aW amps -- -- — --_2 401 unpA 10 600 amps 2 Mulling 0 rim v: ,,,o ( _ 601 ampi to 1000 amps 2 City; •_ SL7le: ZIP: Over I Mo Amps or volts -- 2 1'Itnnr�cj' 1"a%: &mail Rccnrureunn 1 Owner instalIdtion:TI►e installadon is being made on property 1 own Tenrpanry Knicelr ll feeders• _ which is not intended for bale,(ease,rent,or exchange according to 2noindamps m,altrntion,arrelararlon: OIt,S 447.455,479,670,701. 201 amps nr less _ 2 2n1 utrpa to 400 amps i Owner's signature: _ Date: 401 to 600 A _ ' — 2 ► lrsnch c rcuil -new,alteration. or cetendon per panet: _Name: A. Fre for branch circuits with purchase or Address: service or fecAcr roe,each branch circuit 2 r_ily: stale: ZIP! B Fee,fnthrancheircullstaidinutpurchase ---_ — — of service or feeder fee,firm branch circuit: i } a Phone: t°aCj z: E m9il: - - ch additional brunch circuit: PLAN REVIEW(I'llease check all that appliMlac.( rvice or feeder not Included): OServieeover 225amp4-mmmercial UWilth-care facility Each pumpor irrigation circle 2 UService over 32tiamps-rating of1&2 U144aywdnuslocadan Cjchsi ioroullinelil.hiinr 2_. ramily dwellings Q Building over 10,000 square feet four or Signal eircuil(s)or a limited energy panel, GSyvtennvurMAI v(ihanorninal nstrerrvidentialuniL%inouenruclure alteration,orettrn•inn• 2 U Building over tltrw rindrs Q Fcedrm.400 mnps or enure •Aeac�don. _ U Mcol'im 1113d taver 99 persona 0 Manufactured structures nr RV perk Each additional Inspection over lite allowable ill any of the abort U Urmsallighringplutt 0 Otter. _ -�-- Pcrinspcction - Bubmi,_,sets of plant with any of the above. Invrsllgulon fee— -- Ille above are not applicable to ternporuy eomtructlou service. other —mall j,ainlictinns acu1N CmEt tank,piety call)utiaticuon for mwe iN,vnwtnn. Notice: pais permit epplieellou Permit fee...................... 0 Visa o Ma_.tcrCard expires if pertrrit Is not obtained flan review(at _- malt rwri number: T _— within 190 days after it has been Slate surcharge (8%)...$ scccpted as complete, TOTAL ....................... None o rJ ho r u�i owa on eraiit c 7 -' S ' L'Iddholdel ateinalu,e Amount _tr ( d l �,5� W-4A15(&&COM) CITY OF TIGA,RD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- l BUP ----- —Date Requested 2� Z —__ AM PM/� — BLD _ Location�Z / 5�� /�z����✓ ( �- Suite _ MEP Contact Person Ph PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall — — ELR Footing ACCeS.ri: Foundation FPS Fig Drain — SGN —_ — Crawl Drain Inspection Notes: — — Slab __ SIT Post& Beam -- Fxt Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Nailing Firewall Fire Sprinkler ----_.___..____ ------_.— ---_-----__—__-_---- Fire Alarm -•--_-- - ----L-4_ Susp'd Ceiling --.- --.-- Roof MISC. --- Final —.----_---------------- PASS PART FAIL ---.------.._ __-_- — --_—_— `__--- Inst& Beam _ ---- — ----- ----_---.—._.— —_ ----- ._— Under Slab Top Out Water Service --- Sarritary Se �—�- Rajp I)rains �`" Fina SS PART TAIL MPCfiANICAL Post& Beam ---------.___._..--- ----- --_— Rough In ---- -----__—..._ GasLine -----.------------____—___�—__—__---- Smoke Dampers Final _-- --------------- ---- --------- PASS PART FAIL ELECTRICAL --_-----� Service Rough In UG/Slab Low Voltage --�._._.------_._-------- Fire Alarm Final PASS PART FAIL ------ --- --- ----- ..--- --- -- ---- —SITE Backfill/Srading — ----------- - -- ------------ ----- -- Sanitary Sewer Storm Drain ( )Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin I Please call for reinspection RE: Unable to inspect no access Fire Supply Line --- i P ADA ..� Approach/Sidewalk , ����"�" Other 4 - Date - Inspector CCCJJJ111 Ext,. 1 Final PASS PART FAIL 00 NOT REMOVE this irnspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION f ) MST c G' 24-Hour Inspection Line: 639-4175 business Line: 639-4171 - � BUP Date Requested j'� AM PM �� BLD Location / Z l 7G ��� /mac I�� r Suite MEC t,intact Person __.--.__-- Ph f= '-�� 3 PLM Contractor Ph SWR IL Tenant/Owner ELC Retaining Wall o_LR Footing Access: Foundation FPS Fig Drain SGN Y �� Crawl Drain inspection Notes: --- SlabSIT Post& Beam - Ext Sheath/Shear Int Sheath/Shear �— Framing - ------------- -----.- --- -- ---_ _ Insulation Drywall Nailing Firewall ------------------_---_-__ Fire Sprinkler Fire Alarm Susp'd Ceiling ---_--------.--------.-----_ _._..�___-._ Roof Mi-,c: A9$ PART FAIL— PLUMBING AIL .--� - -------.__ _.. U BING Post& Beam Under Slab Top Out ------------------ Water Service Sanitary Sewer - -�-- -- —- Rain Drains Final -- ------------- --------- P PART FAIL. ECHANIC P J A-Ream --- - --- .. _ Rough In Gas Line -- -- - .._.-.------ ----- Smoke Dampers eASSPART FAIL ELECTRICAL —_ __�___. Service _ Rough In - UG/Slab Low Voltage ---- ---------___ _ Fire Alarm F inal - PASS PART FAIL SITE Backfill/Grading -- --- -- -- — -- - -'-- Sanitary Sewer Storm Drain [ J Reinspection fee of$ — _—required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ J Please call for reinspection RF _ _ _� _ [ J Unable to inspect no accass ADA Approach/Sidewalk Date Other _ — —_- Inspector^— Ext -- Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION ,�,u �� t, 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST --�_ BLIP Date Requested__ -2- ' z AM PM BLD I-ocatIon�2. ?�r' S w ��rl�.�✓ G Suite _ MEC Curllaut Pel�url Ph Y q y 3✓ _ PLM —_-- Contractor Ph SWR Tenant/Owner ELC -- — R etaining Wall ELR FootingAccess _____—_---------.--.._ - Foundation FPS Ftg Drain Crawl Drain Inspection Notes _ SGN Slab -------- - _ - ---- ------ _ ------- SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear --�Framing Insulation Drywall Nailing Firewall - Fire Sprinkler -----_-- Fire Alarm / Susp'd Ceiling Moor - -e ASS PART FAIL ��— PLUMBING Post& Beam - --` — -- -- — Under Slab Top Out -- -- — —__ �— Water Service Sanitary Sewer Rain Drains _ Final PASS PART FAIL - __—w— -- — MECHANICAL Post& Beam _--__-- Rough In Gas Line - _ _-- --- -- Smoke Dampers Final - ---- --- -- PASS PART FAIL Rough In ---- UG/Slab _ to e, Alarm PASS 'P RT FAIL Back fill/Grading - - -- -- — ----- Sanitary Sewer Stone Drain ( J Reinspection fee of$ _ _required before nextjgspection. Pay at City Hall, 13125 SW Hall Bled Catch Basin Fire Supply Line ( ] Please call for reinspection RE-y [ ] Unable to inspect- no access ADA 7 Approach/Sidewalk Other Date -� —__— Inspector / Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.