12225 SW HOLLOW LANE J
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12225 :3W Hollow Lane
Building;Permit Application
City of Tigard Datereceived: Q R Permit no.:
Address: 13125 SW Hall lilvd. 1'i g aid,OR 9721-3 Prolecdappl.no Expiredatc: y
CitynjTigard k� - -----
Phone: (503) 639-4171 /�:- Date issued: _ tiy., Pe; ,,�no.:
Fax: (503) 598-1960 //) Case file.io..: ^_ Payment type.
Land use approval: 1&2 family:Simply Complex:
;Jb
&2 family dwellh g or accessory Q Commercial/industnal U Multi-family Vew construction O Demolition
dition/a!teration/replacement J Tenant impiO NICmCnl 0 Fire sprinkler/alarm U Other:
dress: \ v V-1 Bldg.no.: Suite no.:
Block: Subdivision: !
rV" 7'a,;map/U,x loti�:^.Dunt no.:
Project name: k e ,- —
Description and location of work on premises/special conditions:
Name: �(
Mailing address: , LV 1&2 fatnlly dweWog: 21 A-)/City:
City: % State_ ZIP: ). Valuation of work............ y.'(.�-�....,. tTTI
Phone: - Fax: -7 -snail: No,of bedrooms/baths...
.............................
Owner's representative: tii, Total number of floors.................................
Phone: irax. IE-mail: New dweiling area(sq. ft.) ... ......................
Garage/carport area(sq.ft.).........................
lNa!,er��A_Ilcllly j Covered porch,,rea(sq. ft.) ......... ...............
Mailing address: Z �. Deck area(sr,.ft.) ........................................
City _ State- 'LIP: Other structure area(sq.ft.)......................... _ -
Phone: f,tx: E-mail: 1.�.tmercir•U:nduatrhl/tnultl-fam
Valuation of work................... ................... $
business name: - Existing bldg.area(sq ft.) ......... ... ...........
Address: Z New bldg.area(sq.t't.) ..............
City: _ State: I ZIP: Number of stories...................✓.:... ............
Phone:
Fax Email: TyK of construction..........................1........
CCB no.: Occupancy group(s): Existing:
City/metro lic.no.
--------- New:
Notl,.e:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: ( `l /1 V Y , /tv provisions of ORS 7C I and may be required to be licensed in the
Address: �� �G-}- jurisdiction where work is being performed.If the applicant is
City: III_ IAe: ZIP: exempt from licensing,the following reason applies:
Contact person: _ Plan no.: - —
Phone: i,t FE-mail-
Name:
—
Name: Contact person: Fees due upon application
Address: _ _ Date received:
City: ^ State: JZII. Atuount received .............. .......................... S _
Phone: - Fax: I E-mail: Please refer to fee schedule. —�
hereby certify I have read and examined.his application and the Not all jtutidktiom Wcapr credit cwds.ptew call jurisdiction for m(rr tnf,mmumn
attached checklist.AlLprovisions of laws and o inznces governing this U Visa o MasterCard
work will be comp) til wl , whether cif) e or nod! Cred+t�md number __ ,__.L._1_
\ r.xp rrs
Authorized s�aturnCySA, ate: --
1
e �---� � , � , Name of cardholder u Mown on credit eW =
Pent name:,,,_ � L. r Cardholder sipulure Amount
Notice:This permit application expires if a permit is not obtained within 180 days alter it has been accepted as complete. +40-4e13(6 WOM)
Ogre-and'Two-Family Dwelling
& Building Permit Application Checklist Reference no.: r—
Associated permits:
City o;Ttgurd City of Tigard J Electrical J Plumbing G Mechanical
Address: 131'-5 SW Hal,' Blvd,Tigard,OR 97223 J Other. _
Phone: (503) 639-4171 -----'
Fax: (503) 598-1960
01.1,01VING ITENIS ARE REQUIREDAo NIA I Oil PLAN REVIEW %'es
I Land use actions corn.fileted.See jurisdiction criteria for concurrent reviews. _
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plottlot.
4 Fire district —arproval required.
5 Septic system permit or authorization for remouel.Existing system capacity
6 Sewer permit. —
7 Water district approval.
s SolLr report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑plan ❑permit required.Include drainage-way protection,silt fence design and location of
C tch-basin protection,etc r _
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state
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 copyright violations exist _
I I I Site/plot plan drawn to scale.The plan must show lot and building sethack dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2A intervals);location of easements and
driveway,footprint of structure(including decks);location of weils/sepdc systems;utility locations;direction indicator,lot
area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surfcc. drainage.
12 Foundation plan.Show dime-tsions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location.
13 Floor plans.Show a:l dimensions,rcom identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fire lace construction, thermal insulation,etc. _
15 Elevation views.Pro- ,de elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must 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 referencr.,am acceptable. _
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indir ate deter is and locations;for
nonprescriptive 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 and retaining walls.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 floor/roof truss design detalls.
21 Energy Code complisn*.Identify the prescriptive path or provide.calculations. A gas-piping schematic is required
for four or more appliances.
22 Engineer'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 be applicable to the project under review.
23 Five(5)site plans are required for Item 1 I above. Site plans must be 8 '-Or.]1' x17". _
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 mirrom I building plans will be accepted.
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. 4404614(NAIK (Ali
Mechanical Permit Applicatian
-- �Datt:!T"===eived�: PnA (� Pertnitno.: f �L-
City Of 'Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no. Payment type:
Land use approval: _ Building permit no.:
TYPE OF PERNUT
O 1 &2 family dwelling or accesst ry O Commercial/industrial U Multi-fimily U Tenant improvement
XNew construction U A(I(lition/altcmtion/mplacement U Other: ,V
It SI'MINFORNIATION1 1SCHEDULE
Job address: Indicate equipment quantities in boxes below. Indicate the dollar
S` value of all mechanical materials, ui ment,labor,overhead,
Bldg. no.: Suite no.: W P
Tax map/tax lot/account no.: profit. Value$
Lot: Block: SubdivisL"L.-K-4k, i •See checklist ivy:mnortant application information and
Project name: C jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: t N t
Description and location of work on premises:_ t 1 I r 1 r
Fee(ea.) Total
Est.date of completion/inspection: Description Qty. Rcs.only Res.only
Tenant impiuvement or change of use: _ han
Is existing space heated or conditioned)O Yes O No Air handling unit CFM
Air condiuoning(site plan required) _
Is existing space insulated?U Yc% f] \Jo A ter:anof existing A systemoilempressors
Business name: Stater permit no.:
la���' HP Tons BTU/H
Address: Fire/ a ampers/ uctsmo edetectors
City: Ll State ZIP: eat p(site p an requucd)7Phone: Fax: E-mai nsta ace rnac urnet
Including ductwork/vent liner O Yes 0 No
CCB no.: ,jr��-j(�- _ Instal rep ace/relocate heaters-suspended,
City/metro lic. no.: N/A _ _ wall,or floor mounted _
Name(please print): _ t Vent fora liance other than furnace
e erat on:
Absorption units BTU/H
IName: `VACLL Chillers HP
Address: C" (l r _ Com ressors HP
a onmental exhaust an rent lar on:
City — State: ZIP_ _ Appliance vent
Phone: Fac E-mail: ere aust
foods,Type res. tc en/hazmat
hood fire suppression system --
Name. \ ' ' Exhaust fan with single duct(bath fans)
Mailing address ) �,' -x aust s stem a art from heatin or C
- tie
piping asdistribution(up to 4 outlets)
City: State ZIP ) Type: LPG NG Oil
Phone: 7- lug F mail Fuel piping each additional over outlets
Process piping(schematicrequired)
Number of outlets
Name: ter appliance or equipment:
Address: Decorative fireplace
CitN State: ZIP: nsert-type
Phony -I --,---- F•mail: oodstoveJpcllctstovc
Other. _ --
Applit:unr's signuru � Date:' other.
Name(print)
all jurisdictions acacceptcredit cards,please call ituiulicum
on for more inftxatlm Permit fee.....................$
Na
NVisa D MasterCard expires
This permit application Minimum fee................$
expires if a permit is not obtained
Credit cud number //, Plan review(at _ %) $ —
-- Expires within 180 days after it has been
State surcharge(8%)....S
Name of cudholder as shown on credit cud accepted as complete.
: TOTAL .......................S —
Cardholder signature Amount Iaa-4617(&OWOM)
Plumbing Perinit Application
IDatercmccived: %�4)q, Permit no.:)-+)rdVj-C,6rc/f
City of Tigard Sewer permit no.: Building pertnit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 —— ---
City of Tigard Phone: (503) 639-4171 I'rujccdappL no: Expire date:
Fax: (503)598-1960 Date is-ucd: By: Receipt no.:
Land use approval: Case file no.: Payment type �—
TYPF,13F PERMIT
O l &2 family dwelling or accessory O Commercial/industrial U Multi-family U Tenant improvement
ew construction O Addiuon/alternfiori/replacement O Food service CI Other.
FEE SCIIEDULE
lob address: - c� �' �l V y� Description _ Qty. ll-ee(e:0 Total
Bldg.no.: Suite no.: New 1.and 2-family dwellings only:
(includes 100 it.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot Block: Subdivision: 'l.t SFR(2)bath --
Project name: - l_ SFR(3)bath —�
City/county: ZIP: Each additional bath/kitchen
Description and location of work on premises:_,_ Siteutllities:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain
�Mi Footing drain(no.lin. ft.)
Manufactured home utilities
Business name N �I�t ' .I �L Manholes
Address: Rain drain connector
City: State ZIP: Sanitary sewer(no. in.ft.)
Phone: -�" Fax: E-mail: Storm sewer(no.lin.ft.)
CCB no.: Z L Plumb.bus. reg.no: - Water service( lin.ft.)
Future or item::
City/metro lic. no.: N/AAbsorption valve
Contractor's representative signature _ Back flow preventer
Print name. Qt V Backwater valve _
Basins/lavatory _
N_t ��' 0 Clothes washer
Name: _
�� �� Dishwasher
Address: �:Crrje, Jj�,� CLV,_1,1Vr Dritrking fountains)
City; state: ZIP: Ejectors/sump
Phone: Fax: I E-mail: Expansion tank
Fi aure/sewer ca
Moor drains/floor sinks/hub
Name(print): ��E'�� Carbage disposal
Mailing address: Hose bihb
City; L 4__* State ZIP: C Ice maker
Phone - Fax: 7 71ei Email: Interceptor/grease trap
Owner installatfon/residendal maintenance only:The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si nature: Date: Sum
Tubs/shower/shower pan
Urinal
Name.: _ Water closet
Address: Water heater _
City: State: ZIP: Other.
Phone: Fax: E-mail: Total
Not all junsdictiosn accept credit cards,please call jurisdiction for more infor.mijon Notice:This permit application Minimum fee............ ) S
O Visa O MasterCard expires if a permit is not obtained Plan review(at _ 96) S _-----•
Credit cud number �_@sprees� within I80 day s after it has been r to surcharge(896) $
Nurse of urttholdrr u shown on credit cud
accepted as complete. TOTAL .......................E _
S _
Cardholder sip siure Amount 440.4614(ISMOiC.'OM)
Electrical Perinit A►pp➢(cation
Date receives: a2 I 0 t Permit no.:Y15r _,141.
City of 'Tigard 2, 3je.Y ! no.: Expire date:
City afTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Dale issued: By: Receipt no.:
Phone: (50 ) 539-4171 -- --
Fax: (503)'i98-1960 Case file no.: Paymen(type:
Land use approval:
7Newly dwelling or accessory 0 Commercial/industrial U Multi-family G Tenant improvement
ruction U Addition/alicration/replarerii-w J Other: U Partial
JOR SITE INFORNIATION
Job address: , =, . I31dg. no.: Suite no.: Tax map=lot/account no.:
Lot: Block: Subdivision: 1 %k —
Project name: Description and location of work on premises: _
Estimated date of (umpletion/ins ction:
1 1
Job no: Fee Mie
Ikxcri tion . (ea.) Total no.lns
Business name: New realdential sint k�or rmsuTrarssilr PeT
Address: 8900 SW BURNHAM ST F27 dwelling unit-Includes aRachedKara".
City: TIGARD I State: OR ZIP: 97223 Servicehicludesi:
Phone: 503-443-1092 Fax533-625-305 E-mail: 1000 sq It.or less t
CCB no.: 42422 Elec.bus,tic.no: 26-289C
Each additional 500 sq.ft.or portion thereof
Limited energy,residential 2
City/met .no. 02604 Limited energy,non-residential 2
Each manufactured home or modular dwelling
Sign tore of (sing ectrician(required) Due +�ice and/or feeder 2
Sup.elect.name(print). CHARLES FRIESEN License no: Servicesorreaders-Installallon,
allerallon or relocation:
:rro je s(y less
Name(print): 201 amps to 400 amps 2
401 amps to 600 amps 2
[EMailing address: 601 amps to 1000 amps 2
ty: State: ZIP: Ov_r 1000 amps or volts 2
Phone: Fax: E-mail: Reconnectonly I
Owner installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 200&nips or less 2201 amps to 400 amps---- -
Owner's signature: Date: 401 to 600 snips - 2
Rtanch circuits-new,rlterallon,
orexleation per panel:
Name: _- _ K Fee for branch circuits with purchase of
Address: servir a or feeder fee,each branch circuit 2
Cit T lc: ZIP B. Fee for branch circuits without purchase
ti mail of service or feeder fee,first branch circuit: 2
Each additional branch circuit:
Misc.(Service or feeder not Included):
UServi.cover 225amps-commercial UHealthcarefaciht} Each pump or irrigation circle _ 2
O Service over 320 amps-rating of 1&2 Cl Hazardous location Each signor outline lighting 2
fondly dwellings O Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
O System over 600 volts nonunal more residential units in one structure alteration,or extension* _ 2
O Building over three stones O Feeders.400&trips or more aDescri tion:
O Occupant load over 99 persons O Manufactured structures or RV park Fich additional Inspection over the allowable In any of the above:
O Egress/lighungplan 0 Other — — Per inspection r—
Submit__sets of plans with any or the above. Investigation fee
The above are not applicable to temporary construction service. Other
Na all jurisdictions rcept credit rants,pleise call jurisdiction for mac Infomwwn. Notice:This permit application Permit fee.....................$
O visa O MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number _ / within 180 days after it has been State surcharge(8%)....$
Expires accepted as complete. TOTAL . $
Name of cardholder ss shown on credit cid
Cardholder upurure —Amount 440-1615 WOO/COM)
i
- I
DON , MORISSETTE
HOUNHINCUMP ONATED
4830 0AI. 1W00D 9T. 9 U I T 3 1o0
I. A [ 3 0 9 1l t o O. 0 1 1 0 0 N 9 7 0 3 5
(503) 307 - 7538 FAX (go a) ae7 - 7o1a
OBE : 160
5TANDARD ELEVATION LOT: 7
DATE: 9/9/01
�J PROPEM: QUAIL—HOLLOW
R CITY: TIGARD
SCALE: i 20'
/D ' PLAN No.: 133A
30 Y_ r_24
300 29B
1 _
1 ,
1 i
�� I 105(10
99 _ -
`y�»�j(( 2l' 4
0 2ABo eq. rt.
3 bdrm.
2 Irl bath
FF.E. 301' ,
Q I
"✓,!dl eq. Pt.
e5.h.
300' 2 r Cgar. 5,
RRE -
9'
71' 12a�
29 79
o Co►icrete I �� a
298 - n ry
29r'• j 98. 298 «q�%.°error err to ZW
L____ �ppraech 31dawa Ik -
------.-
01
12225 S.UJ, HOLLOW 01. LOT 1
5�02� eq. ft.
CITUOF TACARD MASTER PERMIT___
PERMIT#: MST2001-00196
DEVELOPMENT SERVICES DATE ISSUED: 4/27/01
13125 SW Hall B'vd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12225 SW HOLLOW LN PARCEL: 2S103CB-05800
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: Construction of new single family detached residence.Path 1
BUILDING
REISSUE STORIES: 2 FLOOR AREAS _REQUIRED SEI BACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,160 of BASEMENT: of LEFT, 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,430 of GARAGE: 501 of FRONT 25 PARK'NG SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 5
VALUE: S 236,435.00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAI.: 2.540 00 at REAR: 32
PLUMBING _
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: IOU TRAPS.
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS.
TUBISHOWERS! 3 GARBAGE DISP: I WATER HEATERS: I WATER LINES: 100 BCKFLW PCFVNTR, I GREASE TRAPS
MECHANICAL OTHER FIXTURES,
FUEL TYPES FURN<100K: 130IUCMP<3HP: VENT FANS: 5 CLOTHES DRYER: I
GAS FURN-100K: I UNIT HEA"ERS: HOODS: I OTHER UNITS: 1
MAX INP: blu FLOOR F ^LACES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL _
RESIDENTIAL UNIT SERVICE FL TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADU'L INSPECTIONS
1000 SF OR LES';: 1 0 - 200 amp: 0 - 200 amp: WISVC OR FDR, 1 PUMPIIRRIGATI-)N: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 400 amp: tat W/O SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANLI HM/SVC/FDR: 601 • 1000 amp: 601+ampo•1000v: MINOR LABEL:
1000♦amplvolt
PLAN REVIEW SECTION
Reconnect only: '—
>•4 RES UNITS: SVCIFDR>a225 A.: a 600 V NOMINAL: CLS AREAISPC UCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING, OU7000R LNDSC LT
BURGLAR ALARM. 0TH: BOILER. HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER. CLOCK: INSTRUMENTATION: MEDICAL: OTHR.
HVAC'. DATAITELE COMM: NI IRSF CALLS: TOTAL 4 SYSTEMS:
Owner: Contractor: TOTAL_ FEES: $ 4,430.24
DON MORISSETTE HOMES INC DON MORISSETTE HOMES This permit is subject to the regulations contained in the
Tigard Municipal Code,State of OR. Specialty Codes and
4230 GAt EWOOD ST#100 4230 GALEWOOD STREET all other applicable laws. All work will be done in
LAKE OSWEGO,OR 97035 SUITE 100 accordance with approved plans. This permit will eanire If
LAKE OSWEGO,( t 97035 work is not started wii.lin 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION:
Phone: Phone Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rep N: LIC 35533 forth in OAR 952-001-0010 through 952.001-0080, You
may obtain copies of these rules or dirr;ct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion Control Insp& Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Foundation Insp Footing/Foundation Dr, Electrical Rough In Gas Llne!^4a Appr/Sdwlk Insp Building Final
Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
1
Issued By : 6 - GL Permittee Signature : ,�( G %� I^ Awl/►�ti� U
Call (501) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF °T'IGARD —SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: 3WR2001-00134
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: '1/27/01
SITE ADDRESS; 12225 SW HOLLOW LN PARCEL: 2S103CB-05800
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 007 JURISDICTIDN: TIC
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 permit for new single family residence
Owner: - _ --
FELS
DON MORISSETTE HOMES INC
4230 GALEWOOD ST#100 Type.By Date - Amount Receipt
— -- --
LAKE OSWEGO, OR 97035 PRMT CTR 4/27/01 $2.300.00 2720C100000
INSP CTR 4/27/01 $35.00 27200100000
Phone: 503-387-7538 Total $2,335.00
Co-itractor:
Phone:
Red#:
Required Inspections
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 1 he 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 CLINC by calling (503) 246-1987 I
Issued b �` ��-•� --— Permittee Signature: LV
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 RCC IVf=D
MAY ; „ ?0011
IMPORTANT PERMIT NOTICE
COMMtlN1T°r Ol'.vEl�}FrG�!
CITY ELECTRIC + SUPPLY CO
8900 SW BURNHAM F-27
TIGARD, OR 97223
Electrical Signature Form
Permit #: MST2nn1-00196
mate Issued: 4/27/01
Parcel. 2S103CB-0j'800
Site Address: 12225 SW HOLLOW LN
Subdivision: QUAIL HOLLOW - EAST
Block: Lot: 007
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Construction of new single family detached residence.Path 1
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 electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
DON MORISSETTE HOMES INC CITY ELECTRIC + SUPPLY CO
4230 GALEWOOD ST #100 8900 SW BURNHAM F-27
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
Phone #: 503-387-7538 Phone # 641-8012
Req #: SUP 3592S
LIC 42422
ELF_ 26-289C
AN INK SIGNATURE IS REQUIRED ON TFVS FORM
X �
Signature of Supervising E trician/
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BLIP
Date Requested �2'r/ —CJ �AM _PM __ BLD
Location / Z 7 l ��//� Suite _ MEC
Contact Person _ Ph _ _ PLM ZOO /_ GG 2 y�-
Contractor Ph SWIR _
BUILDING Tenant/Owner ELC _
Retaining Wall ELIR
Footing Access FPS
Ftg Drain �— -- SGN
Crawl Drain Inspection Notes. -------
Slab SIT
Post& Beam -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ----_--- ----------—-
Drywgll Nailing
Firewall
Fire Sprinkler -- -
Fire Alarm
Susp'd Ceiling
Roof
Misc
Final
PASS PART FAIL — ---
PLUMBING
Post Beam /
Under Slab
Top Out / - -
Water Service
Sanitary Sewer
rains
Final
PART FAIL
M CHANICAL
Post& Beam
Rough In
Gas Line - ---
Smoke Dampers
Final - ---- -- - - --
PASS PART FAIL
ELECTRICAL
Service
Rough In — - - -- -
UG/Slab
Low Voltage
Fire Alarm
----- ----------------
Final
PASS PART FA:L -
sin _
Backfill/Grading — —
Sanitary Sewer
Storm Drain [ j Retrospection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ j Please call for reinspection RE:--___ [ [Unable to inspect no access
ADA ------
Approach/Sidewalk
Other Date 7'' 7 —U J -__® Inspector s_�m Ext -_
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST ?,�i_�u/%�
24-Hour Inspection Line: 639-4975 Business Line: 639-4171
r...7 BUP _
Date Requested`.1= AM______+PM BLD
Location Z Z 5 Sw, ���� �^ _ _ Suite _ MEC
Contact Person -„� Ph Sof- G X13 z_ PLM
Contractor -� Ph -_ Y SWR
BUP-DING - Tenant/OwnerCLC -- - -- ---_-
Retaining Wall — ELR
Footing Access: —
Foundation FPS --_--____--�
Ftg Drain SGN
Crawl Drain Inspection Notes: -
Slab ---- --.---- -------- - SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Sheaf �—
Framing
Insulation ------Drywall Nailing
Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof _
Mise.
Final — — -
PASS PART FAIL -- -- -- -- -- —
PLUMBING
Post& Eiearn ------ -- l--- -- — -----
Under Slab
Top Out -- —_—�— — —_.
Water Service
Sanitary Sewer
Rain Drains —---—- --_.---—---------- --- —
Final
PASS PART FAIL
MECHANICAL �-
Post& Beam --- — — -
Rough In
Gas Line -- — ------ -- — - ----------
Smoke Dampers
PART FAIL
�. -------- ----- -- ----- ---
Service _
Rough In
UG/Slab
Low Voltage
Fire Alarm
ASS TIART FAIL _-__— -- ---------- __ —
Backfill/Grading --
Sanitary Sewer
Sturm Drain ( j Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE _— [ ]Unable to inspect no access
ADA
Approach/Sidewalk
Other Date / __- Inspector Ext _
Final
PASS PART FAIL DA NOT REMOVE this inspection reco: it :he joh site.
I
n —
CITYOF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES DATE
#. PLM2001-00298
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 1339-4171 DATE ISSUED: 7/16/01
SITE ADDRESS: 12'225 SW HOLLOW LN PARCEL: 2S103CB-05800
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
W SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of(1) back flow preventer valve.
Owner: - -- --FEES
-- - — Type By Date Amount Receipt
DON MORISSETTE HOMES INC -- -- —
4230 GALEWOOD ST#100 PRMT CTR 7/16/01 $36.25 27200100000
LAKE OSWEGO, OR 97035 5PCT CTR 7/16/0' $2.90 27200100000
Total $39.15
Phone 1: 503-387-7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682-6076 RP/Backflow Preventer
Reg #: LIC 6136
Final Inspection
PLM 11558
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 Al TENTION 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 CAR 952-0001-0080.
You may obtain copies cf these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: ! , /�' , '. (�/ Permittee Signature: C�C.14. ' �? ,
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
.Plumbing Permit Application
Date received: Permit no._
City of Tigard C'I -AQI
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Illvu,Tigard,O 3 -
City ojTigard phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 j (� Date issued: By: Re^-'.,:no.:
Land use approval: -- Case file no.: Payment type:
1Ad I
7;U; &2 family dwelling or accessury LI Commercial/indust ial U Multi-family U Tenant improveaenc, w construction U Addition/alteration replace me fit U Food s:rvice U Other:
JOR SITE INrORNIATIqN
Job address: o2,1 s SLA- 116-W Total
Bldg.no.: _ Suite ro.: - New I-and 2-family dwellings only:
-- (includes 100 n.for each uti;lty connection)
Tax map/tax lot/account no.: a j315 SFR(1)bath
Lot: f f Block: —�bdivisionatt SFR(2)bath -
Project name: i ut'e. 14yllow (t'-' __ SFR(3)bath --
City/county cLA ('2- I ZtP:C/r7a Each additional bath/kitchen -
Description and focativin of work or,premises:_ Site rttWtles:
NqurtlOu-) LV-du lc.6 _—_ Catch basin/area drain
Est date of complelion/inspection: 17 -„�r i`/ Drywells/leach linWt_i nch drain
1 Footing drain(no.lin.ft.) �- --
ivlanuf:ctured home utilities —
Business name: P QCom/Q S�5' L e2fY�S(''LtA zfl C,
�L _ Manholes
Address: 9 $ /QQ Rain drain connector
CijState:C) ZIP: 7Q Sanitary sewer(no.lin.ft.)
Phone _ Fax:64A- W764 E-mail: Storm sewer(no.lin.ft.) _ —
CC13 no.: /3 tePlumb.bus,reg.no: Water set-vice(no.lin,ft.) —
City/metro lic.oro.: DG3a/ )F7xture or Item:
Contractors representative signature: -t Absorption valve
' — � — Back flow revente_r
t rirrt Warne: //� Zt t I tate: , �1/ Backwater valveCONTACT -- -
1 Basins/lavatory
Name: L C Clothes washer
Address: Q �a Dishwasher
�-)- Drinking fountain(s)
City: rY t��e'� ate:C ZIP_9?U'�C —
Ejectors/sump
Phone: _ Fax:baa-A7 E-mail: Expansion tank --- — -
1 Fixture/sewer cap
Name(orinQ: /J)'I s, -e_ Floor drains/floor sinks/hub —
Garbage disposal
Mailing address: 3C) S.W uod_ Sr Hose bibb
City:_ (��(t State:C. ZIP. r]63,7( Ice maker
Phone: ax: I F_mai!: Interceptor/grease trap
Owner installation/residential maintenance only: The actual install..ttion Primer(s)
will be made by me or the maintenance and repair made by my regular Roof dra;n(commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: Date: Sum
Mom 11:1 N a Tubs/shu.ver/shower pan
Name: Urinal ----
- close
Address: t_— Water heater
City: State: ZIP: Other. --
Phone: Fax: E-mail.. Total
Not all Jurisdictions accept etedit cards,please call jurisdiction for more Information. Minimum fee................$ = ��
Notice:This permit application , 1
u Visa ❑MasterCard expires if a permit is not obtaine(' plan review(at „ %) $ r —
Credit card number: / / State surcharge (8%)....$
Expires •>7. 90
J within 180 days atter it has been
-- accepted as com Iete. TOTAL ............. .........$ —_
Nune of cardholder as shown on credit cad p P
_ S
Cardholder signature Amount
- 4404616(lwlla/COM)
Plumbing Permit Application
Date received: Permit no.: Vr,
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,03 - �-
City ojTigard phone: (503) 639-4171 Project/appl.r,o.: _ Expire date.
Fax: (503) 598-1960 1 ( C�, Date issued: Y By: Receipt no.:
Land use approval: _ _ Case rile no.: Payment type:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
gl`lew c:onstntction L7 Addition/alteration/replacetnent U Food service U Other: _
JORSITFINFORMATION FEE SCHEDULE(for special Information use checklist)
Description Q. Fee(ea.) Total
Job address:1AAA 5 S,Com) l�Qw - ---
Bldg.no.: Suite no.: New 1.and 2-family dwellings only:
(includes 100 ft.for each utility connection)
Tax map/tax lot/account no., a Q SFR(1`bath J _
Lot: of Brock: Subdivision t t,Ue jr-1/ U10 --SER(2)bath'— --- — —
project name: (Ioclll l(}Zc <', SFR(3)bath
City/county: eO U 00-- ZIP: ( Each additional bath%kitchen
Description and oca n of work on prorptses: Siteutiiitles:
Catch basin/area drain_ -
Fst.date of comptetiort/insrrection: - r`f _ Drywells/leach line/trench drain
Footing drain no.
Manufactured home utilities
Business name: PL,0_6,/CtS,S LU C 7n G' _ Manholes
Address: q J �_ R.O Rain drain connector
City: ct);j G Sta(e:C) ZIP-27'r _ Sanitary sewer no.lin.ft.)
Phone Fax: $off- 'I E-mail: Storm sewer(no.lin.ft.)
CCB no.: �/ Plumb.bus.reg.no: _ Water service no. in.ft.)
City/metro tic.no.: Sal Fixture or valy
Absorption valve
Contractors representative signature: /( Back clow preventer
Print name: /(V t ) Dave:rj 3 U/ Backwater valve
CONTACT PERSON Basinstlayatory —
Name: �I t°I� .�/�LLI /J(lLy ---,--^ Cishw waste
.ZW"I k�!/1 0 Dias er _
Address: Drinkin fountains)
City: 1"01116. State: ZIP_ c? N" Ejector sum
Phone: q' I Fax:hhr� y E-mail: Expansion _
Fixturelsewer cap
Name(print):[0071 mor f sse H-e- H��r drains/Aosinks/hub _
Garbage d.is saall _
Mailing address:IM,30 Sw U00(- St-- }lose Bibb
City: State:CY2— ZIP. 703 Ice maker _
Phone: Fax: E-mail: lnterce tor/ rease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on the property I own m tier ORS Chapter 447. Sink(s),basin(s),tays(s) _
Owner's si nature: Date: Sum _
Tubs/shower/shower pan
Urinal _
Name: _ _ Water closet
Address: _ Water heater
City: State: ZIP: Other:
Phone: Fax: I E-mail: Total
' r
lease call urisdiction for more Informstion. Minimum fee................$
Not all)uriatlictions accept credit cards,p ) Notice:This pelma application pian review(at cRo) $
o visa U MasterCard ard expires if a permit is not obtained 90
credi!card number. within 180 days after it has been State surcharge(8%)....$
-- —Name of cardholder u shown on credit card s
accepted as complete. TOTAL .......................$
-_-- Cardholder signature—— v Amount f 410-1616(MCONn
PLUMBING PERMIT FEES:
_----- PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES fir 'IvlduaQ QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the ftrst100 ft. QTY (ea) AMOUNT
16.60 for each utility connection
Lavatory _ _ One�1�bath ^V $249.20
Tub orTub/Shower Comb. 16.60 _ Two 2 bath _$350.00
Shower On:y 16.60 Three(3)bath_ $399.00
Water Closet 16.60 -- SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE _
Dishwasher 16.60 PLAN REVIEW 25'!.OF SUBTOTAL
Garbage Disposal 16.60 _ _TOTAL
laundry Tray 16.60
Washing Machine _ 16.60 _
Floor Drain/FioorSink z" 16.6° PLEASE COMPLETE:
3" 16.60
4" 16.60 __ M
Water Heater O conversion 0 like kind 16.60 QuantltY b Work Performed _
Gas piping requires a separate mechanical Fixture Type: Naw Moved Replaced P loved/
permit. _ - - - -- - Fped
MFG Home New or Service 46.40
MFG Home New-San/Storm Sewer 46.40 T - Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only _
Drinking Fountain 16,60 Water Closet
16.60 Urinal
Other Fixtures(Specify) Dishwasher
Garbage Disposal_ _
-- Laundry Room Tra
Wash�Machine _ -
_ -- Floor Drain/Sink: 2" _
Sewer-1st 100' 55.00 -31,
Sewer•each additional 100' _ 46.40 _ _ 4"
Water Service-1st 10055.00 Water Heater
Other Fixtures
Water Service-each additional 200' 46.40 (Specify)
Storm i1 Rain Drain-1st 100' i 55.00
Storm&Rain Drain-each additional 100' 46.40 _ _ ---
Commercial Back.Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 17.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested inspections er/hr COMMENTS REGARDING ABOVE:
Rain Draln,single family dwelling 65.25 -
Grease Traps 16.60 - -
QUANTITY TOTAL _
e'e- e'
Isometric or riser diagram is required if �7 ->�
"SUBTOTAL
J
------8°i.STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Rejuired only if fixture qty total is_>ft
TOTAL
`Minimum permit fee is 11?2.50 .state surcharge,except Residential Backflow
Prevention Device,which Is$31, °6 state surcharge
'All New Commercial Buildings require rlans with Isometric or riser diagram and
plan review
i\dsts\formslplm-fees.doc 1000/00
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CITY OF TIGARD BUILDING INSPECTION DIVISION MSTu�-�
24-Hour Inspection Line: 639-4176 Business Line: 639-4171 ----
_ BLIP
_ _Date Requested __ AM PM — BLD
Location-f-_Z Z 5�✓ ��, �� L-r� _ Suite MEC _
Contact Person Ph 51 — S�,�L PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall —y— ELR
Footing Access
Foundation FPS _
Fig Drain SGN _
Crawl Drain Inspection Notes: ---
Slab —�-- — -- ------ SIT
Post& Beam —
Ext Sheath/Shear
Int Sheath/Shear _ —
Framing O S >^ i_^'ea o7 f _.—
Insulation
Drywall Nailing ----_-___^---
Firewall
Fire Sprinkler
--------- -- - -
--
FireAlarm ---- ---�,------�_�
Susp'd Ceiling
Roof
Final —
PASS PART FAIL
PLUMBING
Post& Beam
Under Slab
Top Out ------ —
Water Service
Sanitary Sewer — —� --'
Rain Drains
Final —
PASS PART FAIL
Post&Beam - —---
Rough In
Gas Line
Smoke Dampers
rMSSJ PART FAIL
ELITCTRICAL
Service
Rough In ---__ -- _.._--- --- --- -
UG/Slab
Low Voltage
Fire Alarm
Final -
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire 9ippiy line ( ]Please call for reinspection RE: — ( ] Unable to inspect no access
ADA
Ire
Approach/Sidewalk -
/ 1
�
Other Date Z1�� —�Inspector / Ext .Sc
Final
PASS PART_ FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —--
BUP
— Date Requested -'f ;7 _ AMPM BLD _
Location Z Z Z SG✓ .�oI%w G,--- Suite MEC �—
Contact f-ersor, � —__ ^--_M Ph aJV 7 PLM , moo cc) Z��
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: -
Foundationi _ F� FPS
Ftg Drain ( "� SGN
Crawl Drain Inspection Notes:
Slab
Post 8 Beam _ _ _ - --------- -_-- —_ SIT
Ext Sheath/Shear
Int Sheath/Shear i -
Framing _ -- ---- -
Insulation -
Drywall Nailing --— _. ----- --- --- -----..-. -____ -- - --- ----
Firewall
Fire Sprinkler
_..._._
Fire Alarm -�
Susp'd Ceiling -- ._._-
Roof
Misc: -- --- ---
Final
PASS PART FAIL
Post& Beam - -- -------- -
Under Slab
Top Out
Water Service
Sanitary Sewer_ft __------ ---- -------- - --- - ---------
n Drains
PASS PART FAIL
ANICAL -
Post B Beam —- --
Rough In — v
Gas Line -- ---- ---- .._ .. - -----
Smoke Dampers
Final ----- - -----�- _ - ------- ----
PASS PART FAIL
ELECTRICAL --
Service
-------------..._----
Rough In
UG/Slab
Low Voltage ---- ----------- _-
--
FireAlarm -
Final
PASS PART FAIT_ ---- - -.- - --- -- - --- --------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 I ]Please call for reinspection RE Unable to inspect no access
Fire Supply Line -------.------- —_-. _-__ I 1 P
ADA
Approach/Sidewalk
Other Date _ -- — Inspector_ ✓ T i —Ext _ Y
Final
PASS PART FAIL 00 NOT REMOVE this Inspection record from the job site.
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST zaC Gv/J�'
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 �'�------�
SUP
Date Requested 7-17 AM_T__-PM BLn
Location -I"-'22S- S c,,, &aI/c w Lh . _ Suite MEC
:,ontact Person Ph — PLM
Contractor _ — Ph _ SWR
8i11L—DI kG Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Fig Drain -- SGN
Crawl Drain Inspection Notes. —
Slab --_ -- ---- - ___— ---- SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing ------_ _------ - ----- --
Insulation
Drywall Nailing -----
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ------ -- - - - ----
Roof
M„i - - ---- - — �T-- -
Fi
ASS,) PART FAIL
PLUMBING
Post& Beam -
Under Slab
Top Out -- - ..- ------- --
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post&Beam - ---- -
Rough in
Gas Line - - - --- -- -- -
Smoke Dampers
Final - -- -- -
PASS PART FAIL
ELECTRICAL. _
Service
Rough In
UG/Slab --
Low Voltage
Fire Alarm
Final __.--�_- -.-.------ - --
Final
PASS PART FAIL - --- - ---- ---- ---
SI'TE
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 RE' _ [ J Unable to inspect no access
ADA
Approach/Sidewalk Date Inspector /'"'`� L EXt
Other — _— --- — —
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site,