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12289 SW HOLLOW LANE N N 00 N N O O N cfl t 1 t 1 "i 12289 SW Hollow Lane CITY OF T I G A RD —_ PLUMBING PERMIT DEVELOPMENT SER'ViLES EISSUT#: P22101 00211 1312..5 SW Hall Blvd.,Tigard, OR 9722:1 (::():) 639-4171 DATE ISSUED: 5122101 PARCEL: 2S 1(13(:8-06400 SITE ADDRESS: 12289 SW HOLLOW LN SUBDIVISION: QUAIL HOLLON/ - EAST ZONING: P ^ 5 BLOCK: iLOT: 013_____ ___ JURISDICTION_1Ih CLASS OF WORK: ALT GAF BAGS 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOW''RS: SEWER LINE: ft WATER CLOSETS: WAl ER LINE: ft DISHWASHERS: RAIN DRAIN. ft Remarks: Irrigation backflow prevention device. Owner: — — Type By� Datc Amount Receipt DON MORisSETTE HOMES INC PRMT CTR ` 5122/C1 $36.25 27200100000 4230 SVb GALEVJOOD 5PCT CTR 5/22/01 $190 27200100000 LAKE OSWEGO, OR 97035 _— Total --=$39.15 Phone 1: Contractor: L PROGRASS LANDSCAPE_SEFVICES 29895 SW KINSMAN F.') WILSONVILLE, OR 97070 REQUIRED It,^FLECTIONS Phone 1: 682-6076 Final Inspection Reg #: LIC 6136 PLM 11558 This permit is issued subject to the regulationG contained in he Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laves. All work will be done in accordance with approved plans. This permit v ill expire if work is not started within 180 days of issuance, or if work is suspended for more than 1801 c;ays. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon linty Notification Center Those rules are set forth in OAR 952-0001-0010 thrcugh OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: t �_z r��= — Permittee Signatu,,:,,Z_e e, C?.II (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day ,i Plumbing Permit Application 7Sewcr eceived: �i7IBuildiitng o.:�>, Q/�01 City of Tigard permltno.: permitno.:Address: 13125 SW Hall Blvd,Tigard,OR 97223City of Tigard phone: (503) 639-4171 t/appl.no.: atc: Fax: (503) 598-1960 Date issued: By:. ' Reccipt no.: Land use approval: Case tilt no.: Payment type: an EVA U 1 &2 family dwelling r a:cessory U Commercial/industrial U Multi-family U Tenant improvement 0 New construction l7 Addition/Ateration/replacement U Food service U Otho: 1 { SITE INFORMATION Joh address: /.J, i, �; l /// /r" t.t' ('r/� n seri tlrrt _ qty. hie(ca.) Total Bldg.no.: Suite no.: New 1-And 2-family dwellings only: j (includes 100 It.for each utility connection) Tax map/tax lot/account nn,: (, ` ,� ` SFR(1)bath Lot: JBlock: Subdivision:Lj t t ti� /(a ) SFR(2)bath Project name t t it c C t'', k 1 3 SPI'(3)bath _ City/county: 11�tt ,( lC'!k,h_ ZIP: Each additional bath/kitchen Description arid locati n of work on premises: Siteutilltles: �I n�/q fy u .fJ i(� Catch basin/area drain Est.date o:completion/inspection: > , 1 F ting drain(sAcacg o.lin. ft.) drain PLUMBING 1 Fuuting drain(no.lin.Ct.) _ Manufactured home utilitha Business name: iP t)C-�/`C�5 LQ/Y.�SL".2 G Z/1 G, Manholes Address: qC175r.±U k'' IQQ Rain drain connector City: f) 1Yl G State:('r ZIP: 70Sanitary sewer(no.'in.ft.) Phone Fax:(d�'a- 7 },mail: Storm sewer(no.lin.ft.) Plumb.bus.reg.no: Water service(no.lin.ft. City/metro lic.no.: tqt?3a/ Fixture or Item: Contractor's representative signature: AN valve t name: / Date: r' Back flow preventer a7—SS Backwater valve Kim Basins/lavatory : Lllb-) SLI r/�J C.e U Clothes washer _ Dishwasher ess: 99*95' '.Sw 1 a Drinking fountains)y: 1 U State:C ZIP: 9'7U7Q E ectors/sum PhonLI ii I kt e: )q Fax:6&d r/ 7 E-mail: Expansion tank Fi-turelsewer cap — Name(print): ,Q� mQ-r i Sse� Z Moor:+rains/floor sinks/hub Mailin address: 3U SCU v vnG�. Sj-- Garbage •iisposal g Hose bibb City: LIL (��t t<? State:[ ZIP. x763 Ice maker Phone: I Fax: E-mail: Interco for/grease trap Owner instailation/resldential maintenance only: The actual installation Primer(s) will be made by me or die maintenance and repair made by my regular Roof drain(commercial) _ employee on the property I own as per ORS Chapter 447. Sink(s), asin(s), ays(s) Owner's signature: Date: Sur - bs/shower/shower pan_� Urinal Name: —Writer closet Address: Weter heater _ City: State: ZIP_ Other Phone: _ Fax: E-mail: Total _ Not at(—jurisdictions accept credit cords,please call Jurisdiction for rmte lKortraion. Notice:Ills permit application Minimum fee................$ Plan review(at _� %) $ o Visa to MasterCard expires if a permit is not obtained — _ Credit card number. ____ _ within 180 days after it has been State surcharge(891')....$ _L—L Expiresaccepted as complete. TOTAL .......................$ 39. Name of e o der u shown on credit card— $ cardholaefsignature —mount 40-4616(S WCOM) PLUMBING PERMIT FEES: PRICE TOTAL New i and 2 family dwellings only: - FIXTURES {individual) _Q I Y ea AMOUNT (includes all plumbing fi ures In PRICE TOTAL Sink 18.60 - the dwelling arid the first100 ft. G�TY (ea) AMOUNT for each utility connection Lavatory One(1)bath - 16.60 $249.20 Tub or TublShower Comb. 16.60 Two 2 bath $350.00 Shower Only 16.60 Three(31 bath $399.00 Water Closet 16.60 Urinal 16.60 6%STATE SURCHARGE Dishwasher 16.60 _ PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal TOTAL Laundry Tray 16.60 Washing Machine 16.60 _ Floor Drain/Floor Sink 2" lsso PLtEASE COMPLETE: 3" 13.60 q• 16.60 -- - _ Quantity b Work Performed Water Heater o conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed/ Gas piping requires a separate mechanical Capped arm I. Sink MFG Horne New Water Service 46.40 Lavatory MFG Home New SaNStorm Sewer _ 46.40 Tub or Tub/Shower Hose Bibs 18.60 Combination Roof Drains 16.60 Shower Onl 1R.ri0 Water Closet Drinking Fountain Urinal Other F',xtures(Specify) 16.61 Dishwasher _ Garbe a Dls oral _ Lsund Room Tra Washing Machine Floor Oraln/Sfnk: 2" _ - Sewer-1st 100' 55.00 3' Sewer-each edditlonal 100' 46.40 4" - - $5.00 Water Heater Water Service 1st 100' Other Fixtures Water Service-each additional 200' 46.40 (Specify) Storm 6 Rain Drain-1st 100' 55.00 - - £torm& aln 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 erRtr _ COMMENTS REGARDING ABOVE: Rain Drain,single farnRy dwelling 65.25 Grease Traps 16.60 -- - -_ QUANTITY TOTAL n [C� -- - - Isometric or Hier diagram is required It / p�7. SS p� /• J J 01-nt!!X Total 1s >9 - *SUBTOTALS+ _ 8%STATE SURCHARGE . U -- --- ----- -- - --- -- "PLAN REVIEW 25°/s OF SUBTOTAL Required only it fixture qty total is>9 TOTAL S 3c7 I r 'Minimum permit fee is$15a 1:state surcharge,except Residential Backflow Prevention Device,which Is$36 25• %state surcharge "All New Commercial Buildings require plans with isometric or Hierdlagram and plan review i 1'idstskformsiplm-fees.doc 10/10/00 d ("Y OF TIGARD BUILDING INSPECTION DIVISION MST 24410ar inspection Line: 639-4175 Business Line- 639-4171 BLIP _ Date Requested - AM yi _�'M .----___ BLD Location. L Z y 3 State MEC Contact Person Ph Z y' j PLM �^ Contractor— Ph SWR _ y BUILDING Tenant/Ov.,ter LLC Retaining Wall r' _-� ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: --- -- - - - - Slah — _- ------ -- --_ - - ----- - — SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation -- -- --�--� _--- Drywall Nailing Firewall � Fire Sprinkler Fire Alarm Susp'd Ceiling Roof MiEC: - Final - ----�- PASS PART FAIL -- -- - --- PLUMBING ._ Post& Beam Under Slab Top Out `-- Water Service Sanitary Sewer - Rain Drains -----.--------- Final - PASS PART FAIL _ MECHANICAL _ Post& Beam -- Rough In Gas Line _- Smoke Dampers Final - - -- P PART FAIL ELECTR Service Rough In ----- -----,- ,-�_- UG/Slab Low Voltage P I Alarm §AESRT FAIL Backfill/Grading - Sanitary Sewer Storm Drain ( )Reinspection fee of$ _ _required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ p -.______ ,� __ [ ) l.!nable to inspect nn access ADA Approach/Sidewalk Other Date '.7 - C.. InspectorftEx- Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION y MST 24-Hour Inspection Line: 6s9-4175 --Business Line: 639-4171 k J, �,,- -- BUP — Date Requested_ ;'Am P,-1 EILD Location�2 S�� v/�Gc✓ �,..- Suite _ _ MEC Contact Person Y /dPh J-7',3 G v�'L PLM Contractor Pf•I Z SWR UIL_j-NG -- Tenant/Owner _�— _ ELC �! Retaining Wall �1 EI.R Fo fing .Access / �C > ►L. �/ /y S F nation, L FPS F Drain awl Dr n Inspectio Notes. SGN SIT17 P st& eam - _—� 1 F Sh ath/Shear, � 4 - Int 'h ath/Sheaf I Fra ng Ins tion D II Nailing t Fi a Sp nkler ---,.- ---_------- F re Aland I� usp'd Ceiling -------- ----- --- - -- - - -- - o I j k17— SASS PART FAIL U I ost& Beam ^- -- - Under Slab �� - _- Top Out Water Se ,e U Sanitary SeRain Drains Drains AS§ PART FAIL CHANICAL - - Post& Beam -------..--.___----------__-�______-__-- Fough In Gas Line -- Smoke Dampers Final ---- .�- - --- - - ------_- --- ---- — - PASS PART FAIL ELECTRICAL - -- __--_-----��_� Service Rough In --_- _-...-----.- UGISlab Low Voltage - Fire Alarm Final PASS PART FAIL SITE Backfill/Grading -- --- ----------- ---------- Sanitary Sewer Storm Drain [ ] Reinspection foe of$_ - -_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Bisin Fire Supply Line I ] Please cal!for reinspQction RE -� - [ ] Unable to inspect- no access ADA (LAI Approach/Sidewalk ( / ,I Other Date _L , l U --- Inspector. 1..,J` .m� ----Ext Final PASS -PART FAIL 00 NOT REMOVE this Inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - BUP mate Requested_) —AM�PM BLD Location Z 2 fry s ��'' /��l�G �v c Suite MEC Contact Person Ph ! PLM Contractor Ph SWR _ iqgpl Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FNS _ Fig Drain( SGN Crawl Drain Inspection Notes -- --- Slab _._ - - SIT Post&Beam ------ - Ext Sheath/Sheat Int Sheath/Shear Framing (moi.% ��r' r'c..,�u ` � '_�z ` ,�As��. Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ---.--�.-_--- ___ Roof / S.) PART FAIL — PLUMBING Post& Beam Under Slab Top OutWater Servise Servi:e Sanitary Sewer Rain Drains Final - -�-�-- - PASS PART NAIL MECHANICAL -�-------�._v-`_ [lost& Beam Rough In Gas Line _ ----- - --- ---- Smoke Dampers Final -- -- -- - — PASS PART FAIL ELECTRICAL Service _ Rough In UG/Slab --.-- Low Voltage Fire Alarm Final PASS _PART FAILSITE BackfilUGrading - Sanitaiy Sewer Storm Drain I ]Reinspection fee of$ required before next Inspection. Pay at City Hall, 13175`:W Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ ] P _-_ [ ]Unable to inspect-no access ADA Apprnach/Sidewalk Date l� r �/ _.__ Inspector Ext 4_ Final PASS PART _FAIL_ DO NOT REMOVE this inspection record from the job site. ►AAAAAAAAAAAAAAAAAAAAAAAAAAAAAs IAAAAAAAAAAAA � m � o a i rTi poll t, cn r' p- CD O ► t d n v ► ► -+ 2 ► O °, ► 4 ► r ► �:r o r O O �' ' ct CD - ► o' -- ' ► / O_ ��' ► !► LA ► a; ► CITY OF TIGARD BUILDING INSPECTION DIVISION 7 24-Hour InspeLtion Line: 639--4175 Business Line: 639.4171 MST a_ __ f,. BUP Daated Requeste -- S- Z �� AM PPA SU Location-4? Ls_—`',-, L'^' 3,Ate — _ MEC --- -- - --- Contact Pei.3on Ph Ze, �- PLM --- Contractor Ph SWR BUILDING - 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 Sprinkler Fire Alarm -- --- - __ -_ Susp'd Ceiling _ Roof _—.�---- Misc. PASS PART FAIL -- -- -- __ PLUMBING [lost& Beam - ------------- _-- ---- — — -- Under Slab TopOut -- --- . ._-- --_ _------_-------------- -�___ Water Service Sanitary Sewer -- Rain Drains Final _------__-------_.._—�--------------- PASS PART FAIL ECH QU> Post& Be-im Rough In Gas[.'ne I -- -- --- - ake Uarnpers Fin AS 5 -)PART FAIL atIMICAC -----____— Service Rough In UG/Slat, _ Low Voltage — — — Fire Alprrn Final -- PASS PART FAIL -------- --_ �- - ..__.---- -- --SITE Backfill/Grading Sanitary Sewer Storm Drain ( ]Reinspection fee of$ - required before r,ext 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 r7'Z Other Date _- _ ----.- Inspector_- `Ext Final PASS PART FAIL DO NOT REMOVE this inspection recoto from the job site. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERT NOTICE HARRY + SON PLUMBING INC 7117 NORTH ARMOUR PORTLAND, OR 97203 Plumbing Signateire Form Permit #: MST2000-00571 Date Issued: 2126101 Parcel: 2S103CB-•06400 Site Address: 12289 SW HOLLOW LN Subdivision: QUAIL HOLLOW - EAST Block: Lot-. 013 Jurisdiction: TIG Zoning: R-4.5 Remarks: S1F Path 1 Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No Plumbing inspections will be authorized until this completed form is received OWNED PLUMBING CONTRACTOR. DON MORISSETTE HOMES INC HARRY + SON PLUMBING INC 4230 SW GALEWOOD 7117 NORTH ARMOUR LAKE OSWEGO, OR 970:5 PORTLAND, OR 97 203 Phone #: Phone #: Reg #: I sn 00068900 Pi M 26-448Db AN INK SIGNATURE IS REQUIRED ON THIS FORM ignatwe of Authorized Plumber If yo!i have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE R� CITY ELECTRIC + SUPPLY CO 8900 SW BURNHAM F-27 TIGARD, OR 97223 cotF"��i Electrical Signature Form Permit #: NIST2000-00571 Date Issued: 2126/01 Parcel: 2S 103CB-06400 Site Address: 12289 SW HOLLOW Lid Subdivision: QUAIL HOLLOW - BAST Block: Lot: 013 Jurisdiction: 1'IG Zoning: R-4.5 Remarks: S/F 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 10 the address above, ATTN: Building Dept No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: DCN MORISSETTE HOMES INC CITY ELECTRIC + SUPPLY CO 4230 SW GALEWOOD 8900 SW BURNHAM F-27 LADE OSWEGO, OR 97035 TIGARD, OR 97223 Phone #. Phone #: 641-8012 Req #: SUP 3592s LIC 42422 ELE 28-289C AN INK SIGNATURE IS REQUIRED ON T'-,:S FORM Signa�e of Supervising ec ncian If you have any questions, please call (503) 639-4171, ext. # 310 A MASTER PERMIT CITYOF T I G A R D PERMIT#: MST2000-00571 DEVELOPMENT SERVICES DATE ISSUED: 2/26/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12280 SW I I0IA-0W LN PARCEL: 2S103CB-06400 SUBDIVISION: 00A11_ HOLLOW - LAST ZONING: R-4.5 BLOCK: LOT: 613 JURISDICTION: TIG REMARKS: S/F" Path 1 BUILDING _ REISSUE: STORIES: 2 FLOOR AFEAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST 1'rn of BASEMENT. of LEFT: 11 SMOKE DETEC'ORS: Y TYPE OF USE: SF FLOOR LOAD: 40 :SECOND: 1 50" of GARAGE: 421 of FRONT: 20 PARWNG SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINDSMENT: el RIGHT: 5 VALLE: S 242,587 00 OCCUPANCY GRP: R3 BORM 4 BATH: 1 TOTAL ?w'I n of REAR 31 PLUMBING _ SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNURY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES. WO SF RAIN DRAINS: I CATCH BASINS. TUBISHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLIV PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN c 100K: BOIL/CMP<AHP: VENT FANS: 5 CLOTHES DRYER: I GAS FURN>-100K: I UNIT HEATERS: HOODS: OTI IER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: t 0 200 amp: 0 -200 amp: WISVC OR FDR: 1 PUMPARRIGATION: PER INSPECTION: LA ADD'L 5008F: 5 201 400 amp: 201 •400 amp: tat WIO SVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENEkGY: 401 600 amp: 401 000 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFDR: 601 1000 amp: 601+ampa•1C90V: MINOR LABEL: T 1D0�amplvrylt PLAN REVIEW SECTION Reconnect only: >600 V NOMINAL: CLS AREAMPC OCC: >*4 RES UNITS: SVGFDR>=215 A.: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL _ B.COMMERCIAL T AUDIO&STEREO: VACUUM SYSTEM: AUD,O f1 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTW BOILER: HVAC- LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENEn CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL M SYSTEMS: Owner: Contractor: TOTAL FEES: $ 4,406.79 DON MORISSETTE HOMES INC DON MOPISSETTE HOMES This permit is subject to the regulations contained in the 4230 SW GALEWOOD 4230 GALEWOOD STREET Tigard Municipal Coda,State Specialty Coxes and IAKE OSWEGO,OR 97035 SHITE 100 all other appllcabte!awe. All work w will be done In LAKE OSWEGO,OR 97035 accordance with approved plans This permit will expire if work is not started within 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 Reg#: LIC 35x33 forth in OAR 952-001-0010 through 952-001-008.. You may obtain copies of these rules or direct questions to JUNC by calling(503)246-1 WIT REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Framing Insp Gas Fireplace Mechanical Final Sewer Inspection Underfloor insulation Mechanical Insp Shear Wall Insp Rain drain Insp Plumb Final Footing Insp Crawl Drain/Backwater Plumb Top Out Low Voltage Water Line Insp Finai Inspecticn Foundatlon Insp F,)oting/Foundation On Electrical Service Gas Line Insp Appr/Sdwtk tnsp Building Final Post/Beam Structural PLAI/Underfloor Electrical Rough In Gas Fireplace Electrical Final Issued By : _ Permittee Signature 1 Ca}f(5 639-4175 by 7:00 p.m. for an inspection needed the next business day CITY OF TIOARD Residential Certificate Of Occupancy Permit No.: �j�yj_�-,� , 7 Address: zz Owner/Contractor: Date of Final Inspection: -_ / _ Inspc,ctor: 'i'his structure has been found to be in substantial compliance with the provisions of the Strive of'Oregon One& Two Fancily Dwelling S ecialr y Cade and is hereb a roved for occup�ty_ ' CITYOF TiGARD ^ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2000-00390 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: '!/26/01 SITE ADDRESS; 12289 SVb'HOLLOW LN PARCEL: 2S103CB-06400 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 BLOCK: LOT•. 013 .JURISDIt, 'ION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: I_TPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF detached residence. Owner: -- FEES DON MORISSETTE HOMES INC Type By Date Amount Receipt 4230 SW GALEWOOD _ ! AKE OSWEGO, OR 97035 PRMT CTR 2/26/01 $2,300.00 27200100000 INSP CTR 2/26/01 $35.00 27200100000 Phone: _ To.al $2,335.00 Contractor: Phone: Reg #: 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 he forfeited if the permit expires The Agency does not guarantee the accuracy of the side :ewer 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 Viese rules or direct questions to OUNC by calling (503) 246-1987. Issued by:� T �� t;�n.- _ Permittee Signature: Z��`�`- C X03) 639-4175 by 7:00 P.M. for an inspection needed the next business day ,!),P_ ?c:fin; Building Permit Application Date received: L nit City of Tigard Address: 13125 SW Hall Blvd,Ti ard,OR 9723 I'rojecUappl.no.: Expire date: City of Tigard L Phone: (503) 639-4171 j t �A � - Date issued: By: Receipt no.: Fax: (303) 598-1960 -J t /' Case file no.: Paymenttype: 1 L) Land use approval: 1&2 family:Simple Complex: TYPE OF PERMIT O 1 &2 family dwelling or accessory U Contmcrcial/industrial U Multi-family ew construction U Demolition O Addition/alteration/replacernent 0 Tenant improvement U Fire sprinkler/alum U Other: _ JOB SITE INFORMATION Job ddress: �; "� Bldg.no.: Suirc no.: Lot F— lock: Subdivision: _ t �� Tax map/tax lot/account no.: Prof ct amc: _ C" � gyDescription and location of work on premises/special conditions: 17, Ll 6, OWNER FOR ORMATION, Name: ��; fflltseptic Mailing address: l � *No. 2 family dweWngr �„ City: .(3% State: Z(P: '7 Cation of work........................................ 5 Phone: Far.,, - E-mail: of bedrooms/baths............... Owner's representative: Total number of floors................................. �- Phone: Fax: E-mail: New dwelling area(sq.ft.) .......................... r Garage/carport area(sq.ft.)......................... Name: Y I Covered porch arca(sq. ft.)......................... N !r — Mailing address: Deck area(sq.ft.) ........................................ City: State: 7.1 P: Other structure area(sq.ft.).................... .... Phone: Fax: Email: CommerciaUindustriallmulti-family: 1 , Valuation of work........................................ $ 1 — Existing bldg.area(sq.ft.) .......................... Business name: Y1 New bldg.arca(sq.ft.) Address Y� — ZIP: Number of stories ...............�....•............. — City: Type of construction.............................. Phone: I ax: E-mail: Occupancy group(s): Existing: CCB no.: -- --- - New: City/me,-f)tic.no.: Nruce;All contractors and subcontractors are required to be ARCUntevotsIGNER licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in the Address: �� _ ,jurisdiction where work is being performed.If the applicant is City: Vte: ZIP: u exempt from licensing,the following reason applies: Contact person: Plaut no.: Phone: Fax: Email: — "e: -r•`� L t Contact person: Fees clue upon application ........................... $ addr- t � Date received: . City: � i —ite �� ZIP_: Amount received ......................................... S _ Phone:] Fax: E-mail: Please refer to fee schedule. I hereby certify 1 have read -id examined this application and the Not all jurisdictions accept credit cards,please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this d visa O Mastercard work will b��ig�naturw omp d t idh,whether pecifitid1here�tt or no Credit card number _ _ /Exp. Authorized � �Oat-: 44 [ L Name of cardholder at rhown on credit cardPrint nameCardholder aipature $ Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4A0-%13 t6MCo"tt Electrical Permit Application Dateieceived_� J Permit no.: Y�j( 4CI ck-�-•• 11 City of Tigard fh_oiect/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd,]il,md,OR 10221 Date issued: Ily: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no. Payment type: Land use approval: 1 U I &2 family dwelling or accessory U Commercial1industrial U Multi-family U Tenant improvement New construction U Addition/al teration/replaccrnen( U Other: _. ___ U Partial It SITE INFORMATION _Job address: v '!,f Suite no.: Tax map/tax l ot/account no.: Loi:�r Block: Subdivision: ) t Project name: Description and location of work on premises: Estimated date of completion/inspection. CONTRACTOR 1SCHEDULE Job no: _ Fe` ` Description Qty- (ea.) 'total no.in:p Business name: Nevyresidential-singkormtdti-frmil. Address: U.Includes attached girage. City: State: ZIPS Serviceh,cluded: 1000 sq.R.or less 4 {'hone: I'ax: E-mail: — — — —-- Each additional 500 sq,ft or portion thcrec! CCB no.: Ele.c.bus.lie.no: —� Limited energy,residential 2 City/nicirn tic. n �— Limited energy,non-residential 2 � Foch manufactured home or modular dwelling Service and/or feeder 2 Signau. f supervising a ecuician�(required) Date License Services or feeder-Installation, Sup.elect.name(print): S alteration or relocation: 1 1 200 amps or less — 2 201 amps to 400 amps 2 Name(print): 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps_ _ 2 Clay: s State: ZIP: �C Over 1000 amps or volts 2 Phone: �- Fax. -7 --mail: Rcconnectonl l Ownte installation:T'he installation is being made on property I own Temporarysenktion,oes or ereoc which is not intended for dale,lease,rent,or exchange according to installation,lessaltelion,or relocation: 2 2(10 amps or less ORS 447,455,479,670,701. 201 amps to 400 amps 2 Owner's signature: Date: Zo I to boo ernes 2 Branch circuits-new,alteration, or extension per panel: Name: _ _ A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit _ 2 — —_ — City: B Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 I'honr: Fax: E-mail: Each additional branch circuit: bf lie,(.Service or feeder not Included): Q n 225 Service uvamps-comrrxrctal U hEach pump or irrigation circle 2 ealth-care — 2 OService over 320amps-rating of 1&2 -rrardouslocation Each signor outline lighting fmrdiydwellings .biding over 10,000 squarefeet fouror Signal circuit(s)or a limited energy panel. U System over 600 volts nominal more residential units in one structure alteration,orextension' _ 2 U Building over three stories U Feeders,400 amps or more "Nscri tion: _ U Occupant load over 99 persons Q Manufactured structures or RV park Fick additional Inspection over the allowable In Any of the alcove: U Egress/lightingplan U Other -- per inspection r Submit_sets of plans with any of the above. Investigation ice The above are not applicable to temporary construction service. Other Permit fee..................... Not all jurisdictions accept crerfir cards,please C I jurisd ctioa for more information Notice:This permit application 3 U Visa U MasterCard expires if a permit is not obtained Plan review(at (8 96) — Credit cad number - / / within 190 days atter it has been State surcharge(896)....$ S .— _ B poet accepted as complete. TOTAL .......................S Name d ranatolder u shoot.on c 't card Cardholder signature s Amount 4444615(t MrOM) Plumbing Perinit Application i Date received: CityCit of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 City of Tigard Phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (50)598-1960 Date.iasued: By:_ Receipt no.: Land use approval: _ Case file no.: Payment type: TYPE OF PERMIT ❑ 1 &2 family dwelling or accessory ❑C:onrmercial/industrial U Multi-family U Tenant improvement ew constnlction ❑Addition/alteration/replacement U Food service U Other: JOB SITE INFORMATION FEE SCHEDULEtformation4ise checklist) Job address: r s _ Description Qty. Fee(ea.) Total 1�,��C'�( ��"� � �.� _ - Bldg.no.: Suite no.: New I-and 2-fancily dwellings only: Tax map/tax lot/account no.: (SFR dl bath ts 100 ft.for each utilityccnnec(ion) Lot: - Block: Subdivision: Sl7t(2)bath -�— Project name: SFR(3)bath City/county: ZIP: Each additional bath/kitchen - Description and location of work on premises: I Site utilities: Catch basin/area drain Est.date of completion inspection: Drywelis/leach line/trench drainPLUMBtNG — 1 / Footing drain(no.lin. ft.) Manufactured home utilities Business name: (Lk I Manholes Address: (( L Ir Rain drain connector City: Vt State: ZIP: -7 Sanitary sewer(no.lin,ft.) Phone: Fax: E-mail: Storm sewer(no. lin.ft.) i CCB no.: Plumb.bus.reg.no: Water service(no, lin. ft.) City/metro lic.no.: Fixture or item: Absorption valve Contractor's representative signature: / -- _ _ Back flow prevertter Print name: t( Date: Backwater valve _ CONTAff PERSONBasins/lavatory Name: Clothes washer ------- Dishwasher _ Address: City: State: ZIP: Drinking fountain(s) Ejectors/sump Phone: I Fax: E-mail: Expansion tank Fixture/sewer cap Name(print): � Floor drains/floor sinks/hub - Mailing addressl `9 t Garbage disposal _ Ilose bibb _ City: Statej,. Ice maker Phone::31C IFax.7A,7 7 E-mail: Interco for/grease trap Owner installatiun/residentiai 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 pmperty I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's signature: Date: Sump r Tubs/shower/shower pan NUrinal Name: - -� -- -• Water closet _ Address: _ Water heater —' City: _ State: ZIP: Other. _ — Phone: Faz: E-mail: Total Not all,nins.6ctirnu accept credit cards,please call jurisdiction for more inforrrwlionNotice:"Thi Minimum fee................S s permit application — O Visa U hlastetfatd expires if a permit is not obtained Plan review(at _ 96) $ Credit card number _ _ State surcharge(8%) ....$ - � Expires 180 days after it has been Name d cardholder u shown on credit card accepted as complete. TOTAL, .......................S — S Cardholder signature _-- _A aouM "0s616(WC'OM) Mechanical Permit Application Date received: Permit no.: City of Tigard Projeet/appl.no.: Expire date: City of i"igard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 6394171 Date issued: By: Receipt ne.. Fax: (503)598-1960 Case file no.: Payment type: Land use approval: _ Building permit no.: U I &2 family dwelling or accessory U Commercial industrial O Multi-family U Tenant improvement dew construction U Add ition/al teration/replacemenl U Other: 11 SITE INFORMATION1MMERCIAL VAILUA;(ION SCHEDULE Job address: ) ' �' �. . Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all labor.echanical materials,equipment,labor.overhead, Tax map/tax lot/account no.: profit. Value _ Loc Block: Subdivision: lA Z i i -see checklist for important application information arid Project name: ,Ljurisdiction's fce schedule for residential permit fee. City/county: I &2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: t s t s 1 Fee(m) Total Est.date of completion/inspection: Description Qty. Rcs.only Res.oily Tenant improvement or change of use: VAC:: Is existingace heated or conditioned?U Yes U No Air handling unit — _CFM space Air con 5uoning(site p an regwr ) Is existing space imulaled?U Yes U No I Alterattono existing l AC systemMECIIANICAL _ 1 oiler/compressors State boiler permit no.: Business name l 11 HP _Tons—!BTUAI -� Address: 11 Pire/smo c ampers/ uctsmo edetectors _ City: ( State: ZIP: eat pump(site p an required) Phoned ax: E-mail: nsta Urep ace furnace/burner ! Ff Including ductwork/vcnt liner O Yes O No — 17 p no.: _ nstalUreplace/relocate heaters-suspended, City/metro lic.no.: wall,or floor mounted Name(please print): Vent forappliance other than furnace CONTAUTPERSON e gems on: Absorption units BTU/H Nanie: Chillers _ HP Com pressors HP Address: _ nv ronmental ex taunt s—'n entliaftiv City: _ State: ZIP: Appliance vent Phone: E-mail: ryerez aunt _ Hoods,Type 11 II/res.kitchen azmat hood fire suppression system -- Nat_ne: 1 I�� ' Exhaust fan with single duct(bath fans) Mailing address: ) Exhaust system apart from heating or AC city.-- State: L[P' ue p p ng andistribution(up to ouTts) Type: LPG NO Oil Phone' - Fax:, T7 E mail: Fuel iping each adr itwnal over4 out els Process piping(schematic required) umber of outlets _ Name: _ _ )Iher lisled app ance or equipment: Address: Decorativefireplace _ City: —---State: ZIP: nsert-type Phone: Fax: E-mail- �oodstoveliv et stove _ / (met: r: y - Applicant's signature: ),rte: � " Ut er: Name (print): Na all Jurisdictions accept credit cards,please call jurtulicUnn for rnnrr,nhxmaricn Permit fee.....................$ O Visa O MuterCard Notice.This permit application Minimum fee................$ —� expires if a permit is not obtained plan review(at _. %) $ - Credit card number Espire - wlrJtln 180 days ager it has been ted az complete. State surcharge(8%) ....$ Nam Naof cardholder a shown on credit cuT- P -- Cardholder siquturr Amount 410.6617(&OBC.'OM)