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12376 SW HOLLOW LANE CA) v 2 O O r CD I ? E s 1 i 1 1 12376 SW Hollow Lane . 1 CITY, a ^O F TIGARD _ MASTER PERMIT A PERMIT#: MST2001-00003 DEVELOPMENT SERVICES DATE ISSUED: 1/10/01 13125 SW Wall B!vd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12376 SW HOLLOW LN PARCEL: 2S103CB-072.00 SU,3DIVISION: QUAIL HOLLOW - EAST ZONING: R-4.0 BLOCK: LOT: 021 JURISDICTION: TIO REMARKS: S/F Path 1 BUILDING REISSUE: STORIES: 2 _ FLOOR AREAS REQUIRED SETBACKS _ REQUIRED CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,605 sf BASEMENT: of LEFT: IS SAOKEDETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,790 sf Gl,RAGE: 703 or FRUNT: PARKING SPACES: .. TYPE OF CONST: 5N DWELLING UNITS: I FINSSMENT: of RIGHT VALUE: y31Q34700 OCCUPANCY GRP: R3 BDRM: r, BATH: 3 TOTAL: 3,39500 at NEAR _ PL.UMBING SINKS I WATER CLOSETS 3 WASHING MACH: I LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVAir',IES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS: TUB/SHOWERS: 4 GARBAGE DISP: I WATER HEATERS: I W4TER LINES: 100 BCKFLW PREV14TR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOILICMP<3HP: VENT FANS: 5 CLOTHES DRYIER: 1 cn5 FURN-100K: 1 UNIT HEATERS- HOODS: 1 OTHER UNITS: I MAX INP: blu FLOOR FURNANCES: VENTS: I WOnDSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL.UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS _ MISCELLANEOLIS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 snip: WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPECTION: FA ADD'l.500SF: 201 400 amp: 201 400 amp: tsl WIO S✓C/FDR: 00 SIGNIGUT LIN LT: PER HOUR: LIMITED ENERGY: 401 6U0 amp: 401 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFD!.. 601 • 1000 amp: 0014amps•1000v: MINOR LABEL: 10004 amp/volt PLAN REVIEW SECTION Reconnect only: >-4 RES UNITS: SVCIFDR>=225 A.: a 600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL. B.COMMERCIAL AUDIO 6 STEPFO: VACUUM SYSTEM: AUDIO 6 STERF r FIRE ALARM: TERCoM,rArING. OUTDOOR LNDSC LT: BURGLAR ALARM: OT14: BOILER: HVAC- ANDSCAPEIIRRIG: PROTECTIVE SIONL: GARAGE OPENER: CLOCK INSTRUMENTATION: MEDICAL OTHR: HVAC: DATAITELE COMM: NURSE C11 LLS: TOTAL M SYSTEMS: Owner: Contractor: TO rAL FEES: $ 4,972.06 MCRISSE TTE HOMES This permit is subject to the regulations contained in the DON MORISETTE HOMES INC DON x230 MCRISSGALEWOD STREET Tigard Municipal Code,Stale of OR Specialty Codes 'and SUITE 100 all other applicable laws All work will be(. s in LAKE OSWEGO,OR 97C35 accordance with approved plans. This permi,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 Rep N: LAC 35533 forth it OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to O( NC by calling(5U3)246-1te87. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Ream Mechanica Mechanical Insp Shear Wali Insp Insulation Insp Mechanical Final I 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 Irsp Footing/Foundation Dr, Electrical Rough In Gas Line Insp Appr/Sjwlk Insp Building Final Post/3eam Structural PLM/Underfloor Frmoing Insp Gas Fireplace Eleclncal Final J Issued By : 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#: SWR2001-00001 13125 SW Hall Blvd., Tigard, OR 91223 (503) 639-4171 DATE ISSUED: 1/10/01 SITE ADDRESS; 12376 SW HOLLOW L.N PARCEL: 2S 103CR-07200 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 ------ BLOCK: — LOT- 021 JURISDICTION: TIG TENANT NAME: LOT 21 USA NO: FIXTURE UNITS: CLASS Or WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: kcma.-ks: S/F Path 1 Owner: ---- ----.__._--- -- -------�� _ _ FEES DON MORISETTE HOMES INC Type By Date Amount Receipt PRMT DLH 1/10/01 $2.,300.00 27200100000 INSP DLH 1/10/01 $15.00 27200100000 Phone: Y Total $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 be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If t;.- -ewer 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 aid 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 Yr a may obtain copies of these rules or direct questions to OUNC by calling(503) 246-1987 Issued by: -dl � Permittee Signature: ` Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day ser• Building Permit Application City of Tigard Date received: - - Q Permj�T Project/appl.no.: Expire date: Citynji+gard Address: 13125 SW Hall Blvd. Tigard,OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 1&2 family:simple Complex: - , 1 ❑ 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family ew construction U Demolition ❑Addition/aiteration/replacement LI Tenant improvement U Fire sprinkler/alarm U Other: A)B SITE INFORMATION Job address ;). j (i^ `; U _ r Bldg.no.: Suite no. Lot:Y Block: Subdivision: r \?�1-4� �y� Tax map/tax lot/account no.: Project name: Description and location of.rork on r�remises/special conditions:--�`—'�`� 37' J 4/,J. T� Name: ' ' ' ' Mailing address: � 1 _ 1 &2 randly dwelling: / yL City: _ State: ZIP: �2 C Valuation of work........................................ $ Phone: fax: E-mail: No.of bedrooms/baths................................. Owner's representativ, iSL . Total number of floors Phone: Fax: Email: New dwelling area(sq.ft.) .......................... APPLICANT Garage/carport area(sq.ft.) _ Name: Y 1 Covered porch arca(sq.ft.) ........................ Mailing address_ �7GL IrY Deck area(sq.ft.) ....................................•.. _— City: State: rZIPOther structure area(sq. ft.).................•....•.• E-mail: Commercial/industrialimulti-family: Phone: INX: 1 1 ' Valuation of work.....................•....... ......... $_ Business name: Existing bldg.area(sq.ft. ..... .... ............. Address: ��.,,-��j � New bldg.arca(sq.ft.)............ .................. City: State: ZIP: Number of stories............... ....... .............. Fax: Type of construction................................... Phone: E-mail: _ � Occupancygroup(s): Existing: cc Kn=' _ New: City/metro lic.no.: Notice:All contractors and subcontractors are required to be t ' 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: State: ZIP: exempt from licensing,the following reason applies: Contact person: Ilan no.: _ — Phone: Fax: E-mail: Name: LtM,i t Contact person: Fees due upon application ........................... $. Addrejk. QrDate received: City: t4 i ` ZIP: Amount received ....................................... $_ Phone: - - , e'E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all lunulictiom accept credit cards,please call jurisdiction for more inrorrmtion attached checklist. All provisions of laws and ordinances governing this ❑visa o MasterCard work will becomp t ith,whether pecift ere b or no Credit card number: _ Expires Authorized i nntur� ate: Name or cardholdrr u shown on credit e Print name: �� Cardholder sitnature _s Amount Notice:This permit application expires if a permit is not obtained within 190 days after it has been a.cepted as complete. 440 4613 tbtxvconrl Mechanical Permit Application Date received: Permit no.: City of Tigard Project/appl.no.: Expire date: City gTigard Address: 13125 SW Hall Blvd,T4_,ard,OR 9722 Date issued: 13y: Receipt no Phone: (503) 6394171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: Building permit TYPE OF PERMIT U I &2 family dwelling or accessory U Commercial/industrial U Multi-famd,, U Tenant improvement X"construction U Addition/alteration/replacement U Oih JOB SI FE INFORMATION - COW -SCHEDULE Job address: Indicate equipment quan ities in boxes below. Indicate die dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision *See checklist for important application information and Project name: _ jurisdiction's fee schedule for residential permit fee. City/county: ZIP: r t Description and location of work on premises: — r r r I r - Fee(ea.) Total Est.date of completion/inspection: _ 0° may' ue''Onfy H`B'O°ly Tenant improvement or change of use: Air handling unit _ CFM Is existing space heated or conditioned?U Yes U No it conditioning(site p an requrr@ Is existing space insulated?El Yes U No A ieration of existing HVAC system MECHANICAL CONTRACTOR of er compressors State boiler permit no.: Business name: 1OSta4le: HP Tons BTU/H Address: 1rFire/smoke dampers/duct smoke detectors _ City: ZIP: eat pump(site plan required) e C' - ax: E-mail: nsta rep ace rnac urner Phon -- --- Including ductwork/vent liner O Yes O No Install/replace/relocate heaters-suspen?eT City/metro lic.no.: wall,or floor mounted Name(please print): Ent ora lance o er than furnace ! of geration: Ing Absorption units 13111/11 Name: Chillers HP -- - Compressors— HP ' Address: f Environmental exhaust an ventilation: Cily' Statc. 1'��' Appliance vcnt Phone: Fax: li maiL ryere gust t s,Type res. ahenthazmat hood fire suppression system Name: 'y(1 - ' Exhaust fan with single duct(bath fans) Mailing address: ) oust systema art from caring or C State: 7.IP! 'je piping andistribution up to Outlets) City: Type: LPG NG Oil Phone Fax: 7 E-mail: tie i in bac additions over out ets racessp pIng(schematic required) Number of outlets Name: — Ot ter listed appliance or equipment: Address_ Decorative fireplace _ City: State: ZIP: nsert-type Phone: F x: Email: Woodstov pe et stove t er: S1 Applicant's signature: ate: \ ter. _ Name (print): ty Not ail Juriulictions acceptcar credit ds,Presse call Jurl"cuon 1`01 more inrtn roalan Notice:This permit application Minimum fee um feeee................$ _ ................$ U Visa U hlasterCud expires if a permit is not obtained Credit card number Plan review(at _ %) $ expir s within Igo days after it has been State surcharge(8%)....S _ —— Nwm of cudholder u shown on credit card accepted as complete. S TOTAL .......................S - Cardholder situtute Amount 440-4617(6OCYCOM) Plumbing Permit Application City Of --�--"--Tigard - Date received: Permit no.: Sever permit no.: Duildink per-nit no Address: 13125 SW Hall Blvd,Tigard,OR 97223 City ofTigard phone: (503) 639-4171 Project/appl.no.: Expire date_ Fax: (503) 598-1960 Date issued: By: 1 Receipt no.: Land use approval: Case file no.: payment type: TYPE OF PERMIT_� 0 1 Fc 2 tainily dwelling or accessory l7 Commercial/industrial U Multi-family 0 Tenant improvement ew con.anic:tion 0 Addition/alteration/replacernent U Food service U Other: 1 1 1 t t Job address: 31�) 1A. Description (?ty. I_c�(ea.) Total Bldg.no.: Suite no.: New I.and 2-family dwelliri i only: (includes 100 fl.for each utility connection) Tax map/tax lot/account no.: SIR(1)bath Lot: Block: Subdivisior. ua SFR(2)bath --- Project name: SFR(3)bath City/county: ZIP: _ Each additional bath kitchen Description and location of work on premises: -_� SheutWtles: Catch basin/area drain Est.duty of cornpletictn/inslxrction: -- Drywells/Icach line/trench drain _ Footing drain(no.lin. ft.) 1 1 Manufactured home utilities _ Business narneI i Y� IYY� — Manholes Address: 11-7 ry, J Rain drain connector City: y::� State:C7 'ZIP: 1 Sanitary sewer(no.lin.ft.) Phone: Fax: E-mail: Storm sewer(no.lin.ft.) CCB no.: 't Plumb.bus.reg.no- Water service(no.lin.ft.) Fixture or Item: City/metro tic.no.: — Absorption valve _Contractor's representative signature: Back flow reventer Print name: Y t Date: Backwater valve 1 1 Rasins/lavatory Name. Clothes washer -- — Dishwasher _ Address:_ Drinking fountain(s) City: - State: ZIP: Ejectors/sump Phone: Fax: E-mail: Expansion tank Fixture/sewer cap Name(print): Y t Floor drainE/loor sinks/b.-ib Garbage disposal Mailing address _ Hose bibb City: Sta'.e ZIP: Ice maker Phone: 7- Fax: -7 E-mail: Interceptor/grease trap Owner installation/residential maintenance only: The actual installation Primers) 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 sii!nature: Date: Sump Tubs/shower/shower pan Urinal Name: _ Water closet Address: _ Water heater City: State: ZIP: Other. Phone Fax: E-mail: Total Not all jurisdictions ICCe credit cult,plena call Jurisdiction fa more inromution Minimum fee................$ - ) p Notice:This permit applicetiw^ Plan review(at _ 96) $ — ❑Visa U MasterCard expires if a permit is not obtains:+ t �tedlt eard Dumber:_ / within 180 days atter it has been State surc.iarge(8%) ....$ Expires Naof cardhol u shown on FQ0 card accepted as complete. 'TOTAL ....................... Nam S C ldholdet siputure Airuunt 1104616~'0M) Electrical Permit Application Date received: Pertritno.: City of Tigard Project/appl.no.: Fxpiredate: CiryojTfgard Ad6ress: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Rcccipt Phone: (503) 639-4171 _ Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: t J I &2 family dwelling or accessory U Commercial/industnal U Multi-family U Tenant improvement New construction U Addition/alteration/replacement U Other. U Partial 1 { SITE INFORMATION Job address: "� Bldg.no.: Suite nu.. Tax map/tax lot/account no.: Lot: 1I Block: Subdivision: �y� \ (,' � S-" _ Project name: _ Descript�i and location of work on premises: Estimated date of completion/inspection: CONTRACFOR APPLICATION FEE SCIIEDUVE .lob no: Fee Description Qty. (ea.) Total no.Insp Business name: . Nen residential-single or muili-farrrily per Address: dwelling unit.Includes sttached garage. city: state: ZIP: sK.icelncmrka: Phone: i Fax. E-mail: IQO(1 sq.ft.or less -- 4 Each additional 500 sq.ft or portion thereof CCB no.: Eltx.bus. lie.no:" Urnited energy,residential 2 City/metrolic. r1j: _ _ Urnitedenergy,non-residential 2 r -�`^� Each manufactured home or modular dwelling Signet . f vi,igectrtcuui(required)— Date Service and/or feeder 2 Sun.elect name(print): , License no: ' Serried or feeders-bstallallon, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name(print): 1 201 amps to 400 amps 2 ' 401 amps to 600 amps _ _ 2 Mailin-address: �– 601 amps to 1000 amps 2 City: , ), State: ZIP: �j` Over 1000 amps or volts 2 Phone: 7- Fax. =J -mail: Reconnectonly I Owner insta]lation:The installation is being made on property I own Temporaryservlcesorfeeders- which s not intended for sale,lease,rent,or exchange according to Insullatfon,alteration,orreloation: 200 amps or less _ 2 ORS 447,455,479,670,701. 201 amps to 400 amps Y _ 2 Owner's si nature: Date: 1 401 to 600 ams 2 Branch circuits-nen,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: f State: ZIP: B. Fee for branch circuits without purchase — -- of service or fader fee,first branch circuit: 2 Phone F'ax E-mail: Each additional branch circuit: + + Mtsc.(Service or feeder not Included): 7system er 225 amps-ecramerc+.d U i Lralth<art facility Each pump o,irrigation circle 2 er 320 amps-rating of I&.,' U Hazardous location Each sign e!outline lighting 2 • over U Building over 10,1x)0 square feet four or Signal circuit(s)or a limited energy panel, er 600 volts nominal more,residential units in one structure alteration,or extension* 2 ❑Building over three stories U Feeders,400 amps or more 'Description: O Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable in any of the above: O EgrrssAighting plan U Other -- Per inspection Submit-sets of plata with any of the above. Investigation(ee The above are not applicable to temporary construction service. Other Permit fee.................. Not all junsdictions accept credit card,please call oriadkuon for erm me info .«ion Notice:This permit application ...S — U Visa ❑MasterCard expires if a permit is not obtained Plan review(at __ %) $ Credit cud number _� __ — within 180 days after it has been State surcharge(8%) ....$ — Expirr�s accepted as complete. TOTAL .......................S Name c r v shown on credit Cardholder siprature s Amount J 4461615(690+COM) DON • MORISSETTE OBE : 19'74 60 G A L E W O O D O R8 T R ET 4 2 3 F. T LOT. 21 LAKE 09REG0, OREGON 97035 DATE: 12/27/2000 (6 0 3) 3 8 7 - 7 5 3 8 r A x (5 0 3) 3 8 T - 7 8 1 6 PROPERTY. QUAL-HOLLOW OPTION 1 ELEVATION CITY: TIGARD SCALE: 1"=20' PLAN No.: 191 x-•10 - -OIC LANE t: o ILIAL 284 00, •tai ;. 288 _ .84 U ewAy 9, Y 0, ~ �� EL aw AFF. I 286, 3 Cdr � gar, I 5-8• rl 31.6• ------ I 8 3 bath I 0 i 5 bdrm I 3395 g'-m' 6. 25- L S I I m 288 -- 6©00' - )292 meq.. LOT 021 b'000 eq. ft. CITY OF T I GA R D __—_. PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00050 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417. GATE ISSUED: 3/2/01 SITE ADDRESS: 12376 SW HOLLOW LN PARCEL: 2S103CB-07200 SUBDIVISION: QUAIL HOLLOW- EAST ZONING: R-4.5 BLOCK: LOT: 021 JURISDICTION: TIG ASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: 5F RAIN DRAINS: iSINKS. URINALS: GREASE TRAPS: LAVATORIEF. OTHER FIXTURES. TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Back Flow Preventor Owner: _ — — -- FEES --- --____ _ — -- __ — Type By Date Amount Receipt DON MORISETTE HOMES INC PRMT CTR 3/2/01 — $36.25 27200100000 5PCr CTR 3/2/01 $2.90 27200100000 Y�Total $39.15 __— Phone 1: Contractor: PROGRf,SS LANDSCAPE SF ?VICES 29895 SW KINSMAN RD WILSONVILL.E, OR 97070 REQUIRED INSPECTIONS Phone 1: 682-6076 RP/Backflow Preventer Reg #: LIC 6136 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 doge 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 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 Issued By: `� k_� Permittee Signature:_� } L - Cail (503) 639- 175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Datereceived: Permit no. Gn I-fop City of Tigard Sewer Kermit no. Building permit no.: Address: 13125 SW I lall Blvd,Tigard,OR 97223 Pro�ecdappl.no.: Expire date: City of77gurd phone: (503) 639-4171 Fax: (503)598-1960 Date issued: By: - Receipt no.: Case file no.: _ I Payment type: Land use approval: E.OF O 1 &2 family dwelling or accessory U Comtnercial/industrial ❑Multi-family O Tenant improvement ew construction I]Addition/altcmtion/replacement (3 Food service O Other: 1 t i t t / ��(/(r Z( tY_n f Descri tp ion _Q, Pee(ea.) Total Job address: r 3 7N!, I-and 2-famlly dwellings only: Bldg.Ito.: Suite no.: des 100 ft.for each utility connection) Tax map/tax lot/account no.: t,cJ (1)bath Lot: ,') / Block: Subdivision:(,2uci L.0 t) l o SFR(2)bath Project name:L,l t4.L< E I (t L O � SFR(3)bath City/county: Tititti l t.t NS H ZIP: Q�` _ Each additional bath/kjtehen Description jLnd location of wprk on premises: SiteutWties: /aG �W d�U r C�� Catch basin/arer drain Drywells/leac t lineltrench drain Fst.date of completion/inspection: IY)I I1n i ct Poodn drain(no.lin.ft.) Manufactured home utilities IB!u!lness name: f LgsS f!.o,1 d9CC wi oles _ Address:a gej S t n S-Y1'1 6t(I R Rain drain connector City:( Stat ZIP: 7 U Sanitary sewer(no.lin.ft.) _.. Phonej,j&;j-!0U to Fax: Storm sewer(no.lin.ft.) _ Water service(no.lin.ft.) _ CCB no.: �;310 Plumb.hos.reg.no: Fixture or item: City/metro!ic.no.: U 3-:1-1 Absorption valve Contractor's representative signatu _Gc/1 Back flow preventer SS Print game: "�?tv Date: �(o O Backwater valve Basins/lavatory _ Clothes washer _ Name: e � ' Dishwasher Address-2_??`? l �1�G.� Rn Dunking fountain(s) City: t State�►�' ZIP:(?-7071 Ejectors/sump Phone:bW-/00`7 2 Fax.: mail: Expansion tank ixturelsewer cap — moor drains/floor sinks hub Name(print): t)cM rn M,5 e_7`7�, f>�Ynt_S Gtuba a di sal Mailing address: a 30 �,tL) �c(let-0007K t_ v Hose bibb City: 2 Ugt Ut'--� StateU/Z ZIP: ,3 !ce maker Phone: Fax: E-mail: Interceptor/grease trap owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or Vie maintenance and repair made by my regular Roof drain(commercial) employee on the proper.y I own as per ORS Chapter 447. Sink(s),Basin(s),lays(s) _ (ltener's signature: � Date: Sump 1 Tubs/shower/shower pan Urinal Name: _ star closet _ Address: 'Vater heater _ City: State: ZIP: other: Phone: Fax: E-mail: Total Minimum fee ...............S - Not all jurisdictions accept credit ceras,please can jurisdiction for more Infornutlon. Notice:This permit application Plan review(0 , %) $ O Visa LI Mastercard expires if s permit is not obtain^,d State surcharge(8%)....$ _6' �- within 180 days after it has been Credit card number: --- Expires accepted as complete. TOTAL ....................... Name of earefholder v shown on credit card S Cardholr er denature J� moual 4401616 16 0YCOM) PLUMB NG PERMIT FEES: -- PRICE TOTAL Now 1 and 2-famlly dwellings.only: FIXTURES (individual) __ _QTY ea AMOUNT (includes all rlumbing fixtures In PRICE TOTAL 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Sink --- for each utility connection)_ Lavatory 16.60 _ One(1)bath $249.20 Tub or Tub/Shower Comb. - 16.60 Two 2 batt. -..�-. $350.00 - - - Three(3)bath $399.00 Shower Only 1660 ----- - --- Water Closet 16.60 - - _SUBTOTAI. Urinal 16.60 _ 8%STATE SURCHARGE 1 F SUBTOTAL Dishwasher - 16.60 PLAN REVIEYJ_25•/.G _ _ - --- J _TgTAL Garbage Disposal 16.60 ------- Laundry Tray 16.60 Washing Machine - 16.60 Floor Drain/Floor Sink 2" 16.60 - PLEASE COMPLETE: 9" 16.60 4" 15.60 ------ - _ _ Quantit b Work Performed Water Heater O conversion O like kind 16.60 Fixture Type: Now Moved Replaced Removed/ Gas piping requires a separate mechanical - - Capped permit. 46.40 Sink MFG Home New Water Service - -- Lavatory _ -- MFG Home New San 8lorm Sewer 46.40 Tub or Tub/Shower Hose Bibs 16.60 Combination _ Roof Drains 16.60 :ihower Only - - 16.60 Water Closet Drinking Fountain Urinal _ ----- Other Fixtures(Specifyr)- 16.60 Dishwasher _ Garbage Dls_pnsal Laund Room Tra - Washing Machine _ � ---- Floor Drain/Sink: 2" _- Sewer-1st 100' 55.00 3"-T6 " - - Sewer-each additional-100' 46.40 -_ 4" ---- 55.00 Water Heater Water Service-1 a 100' Other Fixtures Water Service-each;additional 200' 46.40 g erif Storm b Rain Drain-1�l 100' 55.00 46.40 C JG SF,.,6 Rain Drain-each additional 100' - t;ommercial Back Flow Prevs,,ticn Device 46.40 ~- Residential Backflow Preventlon Device27.55 Catch Basin 16.60 Inspection o`Existing Plumbing or Specially 722. COMMENTS REGARDING ABOVE: Requested Inspections 65.25 - -- - Rain Drain,single family dwelling - - Crease Traps 16.60 QUANTITY TOTAL - Isometric or riser diagram Is required Ir y).r7, J - -.--- ------- Quantity Total Is >g *SUBTOTAL 8%STATE SURCriAZGE "'PLAN REVIEW 25%OF SUBTOTAL Required only If fixture rty.total Is>g TOTAL :,Qy *Minimum permit fee Is$720+a%state surcharge,except Residential Backflow Prevention Device,which I St�5+a stale surchorW.- "All New commercial Buildings require planswith plansomal r,or riser diagram and plan review. is\dsts\forms\pin0ees.doc 10/10/00 t CITY OF TIGARD 13125 S.W. HALL BLVD. 'TIGARD, OR 97223 IMPORTANT PERMIT NOTICE HARRY + SON PLUMBING INC 7117 NORTH ARMOUR PORTLAND, OR 97203 Plumbing Signature Form Permit #: MST2001-00003 Date Issued: 1/10/01 Parcel: 2S103CB-07200 Site Address- 12376 SW HOLLOW LN Subdivision: QUAIL HOLLOW - EAST Block: Lot: 021 Jurisdiction- TIG Zoning: R-4.5 Remarks: S/F 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 he authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: DON MORISETTE HOMES INC HARRY + SON PLUMBING INC 7117 NORTH ARMOUR PORTLAND, OR 97203 Phone It Phone #.- Reg :Reg #: I IC. 00068900 PI M 26-448nb AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Authorized Plumber If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE CITY ELECTRIC + SUPPLY CO 8900 SW BURNHAM F-27 TIGARD, OR 97223 F&C'S C'S Electrical Signature Form Permit #: PAST2001-00003 Date Issued: 1/10101 Parcel: 2S103CB-07200 COMMu��. ` Site Address: 12376 SW HOLLOW LN Subdivision: QUAIL HOLLOW - EAST Block. I_ot: 021 Jurisdiction: TIG Zoning: R-4.5 Remarks: S/F Path 1 Your company has been indicated as the electrics. < ontractor for th3 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 MORISETTE HOMES INC CITY ELECTRIC + SUPPL.Y CO 8900 SW BURNHAM F-27 TIGARD, OR 97223 Phone #: Phone #: 641-80''2 Recd #: SUP 3592S LIC 42422 ELE 26-289C AN INK SIGNATURE IS REQUIRED ON THIS FORM 'gne of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD BUILDING INSPECTION DIVIZ-o!ON MST 24-Hour Inspectioa Line: 639-4175 Business Line: 639-4171 BLIP _ —_Date Requested_—,/�- � AM PM _ BLD Location / Z _74 /`e - /' �1L'�✓ l �-' Suite _ _ MEC _ Contact Person _ PhPl_M Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS _ Fig Drain — SGN Crawl Drain Inspection Notes: — - — Slab _ SIT Post&Beam -- _-- EKt Sheath/Shear _ Int Sheath/Shear _ Framing -----------_..-_-- Insulation Drywall Nailing Firewall 4 Fire Sprinkler i ///�ti1/ +�n % ��'t+�� Fire Alarm Susp'd Ceiling ,�/� /�E�tif mss.t' --- Roof Misc: — Final — -- -- r // I PASS PART FAIL. ------ PLUMBING Post& Beam -- — Under Slab K IE:E lyS/,V-=c- J-70P- r _ 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 Pough In UG/Slab _ _-_---------— -----Low Voltage Voltage T Fire Alarm Final PASS PART FAIL —�— E TS_7RI/Grading -- -- — S,initary Sewer Storm Drain [ ]Rc-;nspection fee of$_ `_— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ Please call for reinspection RE ]Unable to Inspect-no access Fire Suprriy Line Vroach/Sid ; o _ Daie — _ ._ / Inspector_�-`-/ ------ —Ext Final PASS PART BAIL 00 NOT REMOVE this Inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 2-e'-'11-61 It'D& 3 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — BUP - —_ Date Requested -�' AM --PM _ _ BLD _ Location / ` 3 L S �� l��•� C �- _ _— Suite Contact Person - Ph 2,,l1 - PLM — — Contractor Ph SWR BUILDING—_ 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 Sprinkler T Fire Alarm Susp'd Ceiling - -- —�- -- Roof Misc:_ 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 ,as Line Smoke Dampers Final -- ...___. ._... PASS PART FAIL - ---- - - --- ---- ----------- - - — Rough In - - ------ --.— ----- -_------- UG/Slab Low Voltage Fire ------- --- - i A PART FAIL ---- ---- - ---- -- — — ITE backfill/Gradiny- --___-- Sanitary Sewer Storm Drain [ ]Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please call for reinspection RE: ] Unable to inspect no access ADA Approach/Sidewalk Other Date __� /� �' - Inspector _� C.G-fes'-� Ext Final PASS PART FAIL, Dig MOT REMOVE this inspection record frosts the job site. N -n � � n � c G CL �. r � a �' ro A n n o �N r n O �e 0 2 R° 3 im CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - — BUP Date Requested // (AM _ PM BLD _ Location 4 3��, Com{/ tk �� Suite MEC _— Contact Person Ph _,2)C Y 4 8 PLM —_ Contractr:i �— Ph _ SWR UIQ► Tenant/Owner ELC Retaining Vatt-_ ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: �- Slab _-- _-_-_____ __ _- SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear nsuIation - — Drywall Nailing ---_-- __-- ----_- _-_____-. Firewall Fire Sprinkler __-_- _--___—. -�— --_—_-- -.---------- - Fire Alarm Susp'd Ceiling ---- - --------- -- -- - -- -- -- R oof Mi -- -- -- ----- --- - PART FAIL PLUMBING Post8 Beam -------_-. -----------_._.___ __—_- --------- - --- ---- ------ Under Slab - - - --- ---------- -._�--_ ------- - 1 op Out Water Service Sanitary Sewer Rain Drains Final P[>,SS BART FAIL ECH NI L N-grglTearn ---- - ------------ ---- - -- Rough In Gas Line —�.. --------------- --....-- -_ - -- - -- --- Ss n C)arnper f SS PART FAIL ELECTRICAL -- _— —_--_--__-----� _ -. Service Rough In _..- -- ------__. -------- UG/Slab - ------ --- ----- --- - Low Voltage Fire Alarm Final PASS PART FAIL ------ —_ ---- - --- ---- -SITE Backfill/Grading ._-.-- _ -- -- _-----.--- ---- _--- ----- -- Sanitary Sewer Storm Drain i ] Reinspection fee of$ ___---_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line I ] Please call for reinspection RF - -- _---_ I ]Unable to inspect- no access ADA Approach/Sidewalk Other Date Inspector _ — —_ Ext _ Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECT ION DIVISION MST ��/-i✓�'u�3 24-Hour Inspection Line: 639-4175 Business Line: 639-4971 BLIP Date Requested—�= — AM _PM _ BLD Location / 1 .j JG Stv /�r /i4'�� — Suite _ �AEC Contact Person _ —_ Ph Z_ �� L 00 d�d Contractor Ph SPUR BUILDING Tenant/OwnerELC — Retaining Wall — ELR Footing Access: Foundation FPS Fig Drain � -�-�(��.( �. Crawl Drain Inspection Notes: Slab -_ —_ SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear Framing �i `� �.�1 ii - �� i U r &VIuA wv Insulation .( a Drywall Nailing C-� = Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Final PASS PART FAIL -- — osFB Beam Under Slab di Top Out Water Service Sanitary Sewer �— Rain DrainsL1/�Q_ �•- (J`-< � ••-1 "�v� v "' , , -lrAS51 PART FAIL 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 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 Supply Line [ ]Please call for reinspection RE: — [ ] Unable to inspect no access ADA Approach/Sidewalk Date 1 C� 1 Inspector (A f-��` Ext t Other _ -- _ ---- -. Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.