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12377 SW Hollow Lane
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CITY OF TIGARD MASfERPERMIT
PEt?MIT#: MST2001-00307
DEVELOPMENT SERVICES DATE ISSUED: 7/24/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SIDE ADDRESS: 12377 SW HOLLOW LN PARCEL: 2S103CB-06700
SUBDIVISION: QUAIL HOLLOW- EAST ZONING: -4.5
BLOCK: LOT: 016 JURISDICTION: T!G
REMARKS: New Sr detached.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1.150 of BASEMENT: at LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FI,OOR LOAD: 41) SECOND: 1.430 sf GARAGE: 507 at FRONT: :o PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: I FINBSMENT: of RIGHT:
VALUE: $235,8;;2.40
OCCUPANCY GRP: R3 BDRW 4 BATH: 3 �M`1L: 2.50000 0 REAR: 7z
PLUMBING
SINKS: 1 WATEP CLOSETS: 1 WASHING MACH. I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS.
LAVATORIES: 4 DI�HlrIASHFPS: 1 FLOOR DRAINS. SEWER LINES: 100 SF RAIN DRAINS. 1 CATCH BASINS'.
TUBISHOWERS: 3 GARBAGE DISP: I WATER UEATERS. 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE.TRAPS
MECHANICAL OTHER FIXTURES:
I UFI 1 YPES FURN<100K: BOIL/CMP<3HP: VETT FANS: 4 CLOTHES DRYER: i
FURN 1=100K: I UNIT HEATERS: HOODS: 1 01 HER UNIT- I
MAX INP. W.. FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLLTS: I
_ tLcCTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUr(S MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 20t +mp: WISVC OR rDR. I PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 -400 amp: 1st WIO 3VC/FDR. 00 SIGN/OUT I_IN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 BOG amp: EA ADPL BR CIR: SIGNAL/PANFL. hI PLANT:
MANU HMISVCIFDR: 601 - 1000 amp. 601-amos-i OOOv: MINOP,LABEL:
10004 amptvolt
PLAN REVIEW SECTION
Reconnect only: --
>=4 RES UNITS: SVC/FDR>=225 A,: >600 V NOMINAL: CLS AREAISPC OCC
ELECTRICAL•RESTRICTED FNERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO d STEREOVACUUM SYSTEM: AUDIO&STEREO. FIRE ALARM: INTLRCOMIPAGING: OUTDOOR LNUSC LT
BURGLAR ALARM: OTH. BOILER, HVAC: LANDSCAPE/IRRIG: PROTECTIVE SICML,
GARAGE OPENER CLOCK: INSTRICIENTATION MEDICAL_: OTHR:
HVAC: DATA/TELE COM;, NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,543.50
This permit is subject to the regulation:.contained it. the
DON MORISSETTE HOMES DON MORISSETTE HOMES Tigard Municipal Corte,Slate of OR Sr)ecia'ty Codes and
4230 GAL EWOOD ST#100 4230 GALEWOOD STREET all other applicable laws All work will he dine in
IAKE OSWEGO,OR 97035 SUITE 100 accordance with approved plans. T - pr.rmit will expire if
LAKE OSWEGO,OR 97035 work is not started wrthi 1 180 days of issuance,or if the
work is susp, ded for more than 180 drys ATTENTION
Phone: Phone: Oregon law rer4Jires you 1'1 follow rules adopted by the
Oregon Utility Notification, enter Those rules are set
Rea#: 1 it forth in OAR 952-001-0710',nrough 952001.0080 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Mechanica Mechani:al Insp Shear Watt Insp 1;1su!ation Insp Mechanical F,Ial
Sewer Inspection Underfloor insulation Plumb op Out Exterior Sheathing Insl Rain drain Insp Plumb Find
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final Inspection
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwik Insp
Post/Bean)Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Issued By : — _' c�T -- Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGArRD _SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S24/01 OOi73
DATE ISSUED: 7/21/01
13125 SW Hell Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103C13-06700
SITE ADDRESS; 12377 SW HOLLOW LN
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 016 �_. JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS. 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL_TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached dwelling.
Owner: -- FEES
DON MORISSETTE HOMES Type By Date Amount Receipt
4230 GALEWOOD ST#100 ----
LAKE OSWF_GO, OR 97035 PRMT CTR 7/24/01 $2,300.00 27200100000
INSP GTR 7/24/01 ;35.00 27200100000
Phone: 503-387-7538 i Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections-----
This
nspections^ _—_This Applicant agrees to comply with all the rules and regulations c. 'he Unified Sewage Agency The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Perrnit and the A�, .cy 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 though OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued by: ..�; Permittee Signature:
Call (5113) 619 "1175 by 7:00 P.M. for an inspection needed the next business day
.10
Building,Permit Application
—�-__- Date received_ /11 Permitno.;",��/�Ir
Pity of Tigard
City nf'Pi�;nrd
4ddress: 13125 SW liall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
Phone: (503) 639-4171 / <� Date issued: By- Receipt no.:
Pix: (503) 598-1960 �'{� Case file no.: Paymen,Type:
Land use approval: _ 1&2 family:Simple Complex:
U 1 8.2 faunily dweC;ng or accessory Q Commercial/industrial U Multi-family ,&New construction U Demolition
U Addition/alteration/ieplacement U Tenant improvement U Fire sprinkler/alarm U Other:
Job address: '7 Bldg.no.: Suite no.: t
Lot: Block: Subdivision: L L `l (. Tax map/tax lot/account no.:��io
Project name: / �- �i �, ;�' --
Descri,)tion and location of work on premises/special conditions:
Name:
Mailing address:Id 2 1ILLCWLTLA --r 1 &2 family dwelling: vS
Phtonc: / JFax: State mmlLIP:_� i Valuation cf work........� J. o.............. $'
No.of bedrooms/baths...........1...................
Owner's representative: Total number of floors.......................... ...... _ �1
Phone: Fax: E-mail:
New Dwelling area(sq. ft.) .........................
Garage/carport area(sq.ft.).........................
Name: Y Covered porch area(sq. ft.) .........................
Mailing addresz: N '►^�� (� Deck arca(sq.ft.) ................................. ......
City:_ —State: ZIP: Other structure area(sq. it.)................... .....
Pholl": Fax: E-mail: Commercial/industrial/multi-family:
Valuationof work........................................ $ fi
Business name: Existing bldg.area(sq.ft.) .......... ..........
- - - New bldg.area(sq.ft.) . ...............
-Address: .2 '� ............:
Number of stories.
City: State: ZIP: �.
— Type of construction
Phone: Fax: E-mail: A... ..... y
CCB no.: Occupancy group(s): Existing: „
-- _
City/metro lic.no.: New:
Notice:Ail contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: L t �(' provisions of ORS 701 and may be required to be licensed in the
Address: ��� jurisdiction where work is being performed. If the applicant is
Add
AddState: ZIP: exempt from licensing,the following,reason applies:
City: IContact person: Plan no.:
Phone: Fax: E-mail:
Name Contact person: Fees due upon application ........................... $
Address: — Date received:
City: State: ZIP: Amount received ...................................... .. $
Phone: I E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Na all Jraisdictlons wcep credit cards,please call Jurisdiction for mat information.
attached checklist.A rovisions of I ws H,donances governing this o Visa U Masterctsrd
work will he compl wt ,whether ce or ntt credo card namnet / /
, Expires
Authorized SI natu i )k
ate: ( Now of cardholder as shown on credit card
� S
Print name: Cardholdet sipature Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613(&WICOM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
.�. }�,Ciof Tigard
Associated permits:
�/1ipard `J b O Electrical U Plumbing ❑Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97221 U Other:
Phone: (503)639-417 i
Fax: (503) 598-1960
1 1
1 Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning,Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved platflot. v_
4 Fire district__ approval required.
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must cant'original applicable stamp and signature on file or with application.
9 Erosion control U plan U permit requ;red. Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
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.
If Site/plot plan drawn to sale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-11.elevation differential,plan must show contour lines at 2-ft.intervals),location of easements and
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator,lot
area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and fixation.
13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, T
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 be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, v
fireplace construction, thermal insulation,etc. J�
15 Elevation views.Provide 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 references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floorstroof assemblies,indicating member sizing,spacing,and bearing
fixations.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 R-am 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 taw design details. _
21 Energy Code compliance,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 he applicable to the project under review.
JURUSKUTIONALSPECIFICS
23 Five(5)site plans are required for Item I I above. Site plans must be 8-1/2"x I V or I V x 17" _
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 mirrored building plans will be accepted.
27 _
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted pw ns may be in blue or black ink.
ink is reserved for department use orly. 440-4614(&MCoM)
Mechanical Permit Application REEMERFN
Date received: Permit no.:
City of Tigard Itoject/appl.no.: Expire date:
CiryujTigdrd Address: 13125 SW Hall Blvd.Tigard,OR 97223
Phone: (503) 639-4171 Uve issued: _ By: Receipt no.:
Fax: (503) 598-1960 Case Iiieno.: Paymenttype:
Land use approval: Ei rdding permit no.:
J&AJ D1,101 I
U 1 &2 family dwelling or accessory U Commercial/industrial C Multi-Family O Tenant improvement
�iir`New construction U Add[tion/alteration/replacement I]Other:
JOB
1 1VALUATION
Job address: -,ii L i_N , Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: i Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: LCeill $See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: _ I &2 FAINTILY J)WELLINGSCHEDULEPEIL%IITFEE
Description and location of work on premises:_ 1 t s � a t
Fee(ea.) Total
Est.date of completion/inspection: Descrleion Qty. Res.oaly Res.otdy
Tenant improvement or change of use:
Air handling unit CFM
Is existing space heated or conditioned?U Yes 0 No Air conditioning(site plan required) _
Is existing space insulated?U Yes U No I Alteration of existing HVAC system
of er/compressors
State boiler permit no.:
Business name: ( HP Tons BTUfH
Address: V0 riq Fue/smoke dampers/d — — a detectors
City: Ll11 State' 7.IP eat pump(site pan rcquit )
Phone: Fax: E-mail: Install/replacefumacelburner /
— Including ductwork/vent lh.er 0 Yes O No
CCB no.: 1 nsta replace/re ocate eaters-suspen r .
Citwmetro lic. no.: NIA wall,or Floor mounted
Name(please printf. 1
Vent ora ranee other than furnace _
e eratlon:
Absorption units, BTU/11
Name: �_ �`ft ��� Chillers_ Hit
Com ressc rs HP
Address'tri t;jL Enrironmental exlwust an rentiIatlon:
City: State: LIP Appliancevent
AC
Phone: Fax: E-mail: ryere gust
ape IUres. rtchet iarmai
hood fire suppression ystem
Name: r ' Exhaust fan with sirdle duct(batt fans)
Mailing address: ) ��,' xttaust system a ;st from eau
tie piping as Lar tit on(up to outlets)
Citi.: State 7_IP 1 Type: __L.pt, NG oil
Phone: Fax: E-mai;: Fuel pi in,eac additional over 4 outlets
roeess piping(schematic required)
Number of outlets
Name: ter ea a,pplianre or equipment:
Address: Decorative fireplace
City: i State: LIPInsert-type
Woodstove/pellet stove
Phone: Fay: E:•m ll: Other: --
5 ` Applicant's signntu` pate C � I Other.
—�^ Permit fet
Nor ail tutisdicuonr accept creditse cud%,pleacall juri"cuon for more information. Notice:This permit application ................
O Visa ❑Mastercard fee................
fee
�— _ expires if a permit is not obtained plan review(at _ %) —
Credit card number Erpre i.cithin Igo days after it has been State surcharge(8%)....$ —_-----
-- Name of cudhol r u%hown nn credit card aCCeplC l as complete. TOTAL .................. S —_ —_--
f
j
Cardholdet tipature Amou "G-4617(6Or3COM)
tw.
Electrical Permit Application
Date received: Permit no.:
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: _
TYPE OF PM11T
❑ I &2 family dwelling or accessory ❑Commercial/industrial ❑Multi-family ❑Tenant improvement
Ncw construction 0 Addition/alteration/replacernent ❑Other. ❑Partial
11 WE INFORMATION
Job address: ?j'� U Bldg,ao.. Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision: t 1 _
Pro name: Description and location of woe^on premises:
Estimated date of completior>rnspection:
t
Job no: Fee INax
Business name: Descri tion Qtr. (ea.) Total no.las
Address: New tesidenfLl-single or multi-family pr
1 dwelling tadL Includes attached garage.
City: State: ZIP: Service included
Phone: 1j ILcv Far: E-mail: 100o sq.ft or less 4
CCB no.: Each additional 500 sq ft.or portion thereof _-
EIeC. bus. Ijc. no: Urrutedenergy,residential __ 2
C' Limited energy,non-m%idenual 2
FAch manufactured home or modular dwelling
azure ojsup®vtsrn(electrician
(required) Date Service and/or feeder 2
Services or feeders-Installatlan,
Sup elect nametpnntl 1 License no allerationorrelocation:
200 amps or less 2
Name (print): ` 201 amps to 400 amps
401 amps to 600 amps _
Mailing address: _ 601 amps to 1000 amps 2
State ZIP: Over 1OWamps orvolts 2
Phone: Fay: -� mall: Reconnect only 1
t feeders-
Owner insrallarion:the installation'is being made on property I otsn Temporaryserviceso,orreloc
which is not intended for sale, lease.rent.or exchange according to 200
tsorless on,orrclocatlon:
200 amps or less 2
ORS 447,455,479,670, 701. 201 amps to 400 amps 2
Ovv ner's signature- Date 401 to 600 amps 2
B Brunch 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: State: ZIP: B. Fee for branch circrits without purchase
of service or feeder fee.first branch circuit: 2
P1101w: ITat' E-mail: Each additional branch circuit:
Misc.(Service or feeder not Included):
U ';r .,n.i,..,,rnmercial U Health care f.- :bn Each pump or irrigation circle 1 2
U Service over'�o amps rating of 1 ft2 O Hazardous location Each sign or outline lighting _� 2
family dwellings O Budding over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
❑System over:;00 volts nominal more residenual uruu in one structure 'Iteration,or extension' L 2
Q Buildin,over t'tree stories O Feeders,400 amps or more afkscri tion
O Occupant load over 99 persons ❑Manufactured structures or R V pari( Each additional Inspection over the allowable In any of the above:
Q EgmssAightingplm O Other Per nspecuon
Su'omit____sets of plans with any of the above. Invesugation fee _
The above-are not applicable to temporary construction service. Other
No(all jurisdictions rceN crtdii cards,please call junsdscuon for mart,nlomuuon Notice:This permit application Permit fee.. ..................S
❑Visa p MasterCard expires if a permit is not obtained Plant review(at _ %) $
Ctedir card number L / within 180 days after it has been State surcharge(8%)....$
Expires accepted as complete. TOTAL $
......................
None u(cartllsolder-a shown on credit card
_ S
Cardholder stptatute Amount 4ap1615(&%COM)
Plumbing Permit Application
—� Date received: Pennit no.:
City of Tigard Sewer permit no.. Building permit no.
Address: 13125 5W Hall Blvd,Tigard,OR 97221 �----�-'—
City ufTiburd Project/
Phone: (503) 639-4171 :tppl.no: `_ Expired=
Fax: (503) 598-1960 Dweissued: By:
Land use approval: Recerpnr
Case file no. Payment type.
_ -- —
TYP, 1
4Jobladdress:
&2 family dwelling or accessory L1Commercial/industrial U Multi-family U Tenant improvementew -mistniction U Ad(lition/alteration/replacetncnt U Food service U Other:30 1 1 1 i 1 i r'i) \, \ Description Qt . Fer(ea.) Total
New 1 and 2-family dwellings only:
Bldg.no.: Suite no.: (Includes loon.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bade _
LOO Block: Subdivision: i SFR(2)bath
Project name: las, SFR(3)bath
City/county: ZI►': Each additional bath/kitchen
Description and location of work on premises: — SiterrtiliNes:
�Catch basin/area drain
F t.date of completion/inspection: sin/ah r�drain ch drain
g drain(no.lin. ft.)
Manufactured home utilities
Business name—Manholes
Address: ` Rain drain connector
ZIP: Sanitary sewer(no.lin.ft.)
City: State
Phone: -�jt- Fax: E-mail: Storm sewer(no.lin.R.)
Water service(no.lin.ft.)
CCB no.: j "j\- Plumb.bus.reg.no: Flxhwe or Item:
City/metro lic. no.:N/A Absorption valve _
Contractor's representative signature Back flow preventer
Print name: NV—Di Backwater valve _
BasinsAavatory
Clothes washer
Dishwasher _
Address: Y Drinking fountain(s)
City: State: I ZIP: Ejectors/sum
Phone: Fax: E-mail: Expansion tank
Fixturelsewer cap
Floor drains/floor sinksthub
Name (print): Garbage disposal
_Mailing address: a Hose bibb
City State ZIP: Ice maker
Phone: - Fax: �� 7(ti F-mail: Intet.e for/grease trap —
Owner installation residential maintenance ortiv:The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
emplt
property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Ownsignature: Date: Sump
-- Tubs/shower/shower an
Urinal
JamWater closet
AddWater heater
City Stater ZIP: Other:
PhonFax: E-mail: Total
Not all unkhcuon%accept crcdii card%,plean call erlsdicdon for more information Plan
Minimum fee............ ) $
t q 1 Notice:This permit application Plan review(at � 96) S -
O Visa O MasterCard expires if a permit is not obtained
Credit cud number _ .moi—_ within ISO days after it has been State surcharge(896) ....$
Expireswithin
as complete. TOTAL •••••S
a u -
Name of dholdn shown on credoaM c =
ab-%616(fiOdC oM)
Cardholder tivatum Amouni
i
ICON • MORISSETTE
H O Y 0 0 I K C O D P 0 2 A T 3 D
4000 OAL3W00D 0T. 0 U I T 2 100
LA10 088100• 00 ■ 00 M 97006
t60s) 867 — T636 FAX (60A) 66T - 7616 ^ BTS 1969
STANDARD ELEVATION LOT: 16
DATE: x:/27/01
PROPERTY: QUAIL-HOLLOW
CITY: TIGARD
SCALE: 1"=20'
PLAN No.: 133A
284
50.001 238
288
------------------ ---
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0 2 1/2 bath
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2 car gar
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289
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12
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Ft.
C!•rY OF TIGaARD BUILDING INSPECTION DIVISION MST —zA 30 7
24 Ho-r Inspection Line: 639-4175 Business Line: 639-4171
BUIL
Date Requested �Z'� AM PM _ BLD
Location �k7c.7r /1Z.,-0
1Z.,- . Suite MEC
Contact Person Ph r"Jg�� PLM
Contractor Ph SWR
BUILDING Tenant/OwnerELC
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
Fire call
Fire Sprinkler
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 8 Beam --
Rough In
Gas Line / - ---
5rr,oke Dampers
Final -
PASS PART FAIL_
ELECTRICAL -`- — --
Fire arm
Fi _
FAS` PART FAIL
Backfill/Grading --"—�— — --
Sar.,lary 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' - [ ] Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date Inspector CL Ext
--- -
Final -
PASS PART FAIL DO NO'r REMOVE this fi -pection record from the job site.
CITY OF TIGAR D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00453
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/25/01
PARCEL: 2S1()3CB-06700
SITE ADDRESS: 12377 SW HOLLOW LN
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.15
BLOCK: LOT: 016 JURISDICTION: TIG e
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPAC S:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
'RES LAUNDRY TRAY J: SF RAIN DRAINS:
SINKS:av! URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISI'WASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow prevention device.
FEES__
Owner: -
Type By Date Amount Receipt
DON MORISSETTE HOMES PRPrIT CTR 9125101 $36.25 27200100000
4230 GALEWOOD ST #100
LAKE OSWEGO, OR 97035 SPCT CTR 9/25/01 $2.90 2200100000
Total $39.15
Phone 1: 503-387-7538
Contractor:
PROGRASS LANDSCAPE SERVICES
2.9895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: 682-6076 Final Inspe,;tion
Reg #. LIC 6136
PI-M 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 p;,-.,ns.
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. '' 'l �� Permittee Signature:.__—_ 6V11,11i 9 iilN
Call (503) 639-4175 by 7:00 F.M. for an inspection needed the next business day
Plumbing Permit Application--_.
,. � atcreceived: Permitno.:PU 0
City or f Tigard
igard RF(,'�'1�K Sewer prrmit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Projecdappl.no.: airedatc:
City of Tigard phone: (503) 639-4171
Fax: (503) 598-1960 SEP 2 1 2001 Date issued: By Receipt no.:
_ COMMIIMI1r OFvJ 1t wl V rase file no.: Payment type:
Land use approval
t
O 1 &2 family dwelling or accessory U Conimerciai/industiial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Food service U Other:
Jobuddress: � LV Description Qty.. Fee(ea.) Total
Suite no: New 1-and 2-family dwellings only:
Bldg.no.: — . (includes 1001.for each utility connection)
Tax raap/tar lot/account no.: �r, J8 S, SFR(I)bath
Lot: , Rlock: Subdivision' A 'Lr-<_ I (_R.L) SIR(2)bath
Project name: QA-t_�l Lrt (I Uth SFR(3)bath
City/county: 7"t Q e Act LL AS(� ZIP: '172 23 Each additional bath/kitchen
Description and local} n of work on premises: Slteutilitles:
Deo iC e-) Cath basin/area drain
�/ C'� C, Grywells/leach line/trench drain
I?st.date of completion/inspection: Footing drain(no.lin.ft.)
1 t Manufactured home utilities
Business naineij�(j(>1 C"l S S_�,(it k1S Zyx - i=1 C --- Manholes-
-— --
t- ko Rain drain connector
Address: q � ,� C.r -----San sewer no.lin.ft.
City: i G _ Statc:C� ZIP: '7 0 ( ) —
E-mail: Storm sewer(no.lin.ft.)
Phone Fax: $off A 9 Water service(no.lin.it.)
CCB no.: Plumb.bus.reg.no: _ Fixture or Item:
City/metro lic.no.: / Absorption valve _
Contractor's representative signature_ ( L c) Back Flow pmventer 1 .2 55 iV,55
Print nam": //Gr) t c Backwater valve
UON'I ACT PERSON Basins/lavator�+ _
Clothes washer
Name: rJi !eL~i�n __ Vis washer -
Address: 95 Drinking fountains) __—
City: l State: ZIP: q'7U70 E'ectors/sump
Phone: q Fax:baa 9 E-mail: Expasion tank —
Fixture/sewer cap
Floor drains/floor-sinks/hub
Name(print): Oi''I Sse - - Garbage disposal
Mailing address:ya3U ' .W_6' �uoc I S7— Hose bibb _
City: State:[ '` ZIP. ''Tb3 Ice maker
Phone: ax: E-mail: Interceptor/grease tral)
Owner installation/residential maintenance only: The actual installation Primer(s) _
will be mane by me or the maint mance and repair made by my regular Roof drain(commercial) _
employee on the,property I owr.as per ORS Chapter 447. Sink(s),�astn(s),lays(s)
Owner's si nature: Date: Sum _
.
V11 Tubs/shower/shower pan
Urinal _
Name: Water closet
Address: Water heater Y —,
City- ::�— State: ZIP: Other
Phone: Fax: Email: Tota
Minimum fee................$Not
5--
Not all jurisdicilons accept credit cards,please call Jurisdiction rot more Information. Notice:This permit application plan review(at _ %) $
O Visa O MasterCard expires if a permit is not obtained State surcharge(896)....$ 9D
Credit card number: -- apfms within 19p days after it has been .TOTAL .......................$ -3y_ 5—
_ accepted as c,mplete.
- ' Nune of cardholder v shown on credit card s
Cardhol r signature Amount 410-4616 MO COM)
PLUMBING PERMIT FEES:
PRICE r -TOTAL New 1 and 2-family dwellings only:
FIXTURES Individual plumbin
QTY :'ea _ AMOUNT lincludes all g tixttires'in PRICE TOTAL
Sink 16.60
the dwelling and the first100 ft. QTY (ea) AMOUNT
13.60 for each util�onnect!on -
Lavatory One1�_j�ath_ - $249.20
Tub or Tub/Shower Comb. - 16.60 wo 2 bath _ _ $350.00
Shower Only
16.60 Three(3)bath $399.00
- ----- -
Water Closet 16.60 -- SUBTOTAL
Urinal 16.60 W _8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
--- -_- TOTAL.
Garbage Disposal 16.60 --- -- --- ---- - __
Laundry Tray 16.60
Washing Machine 16.60 -
FlatrDrain/FlourS!nk 7." 16.6° PLEASE tiOMPLETE:
3^ 16.60
q^ 16.60 - -- -- ---
-- �G!uantit 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
MFG Home New Water Service 46.40 Sink - �- -
MFG Home New San/Storm Sower 46.40
---- Tub ur Tub/Shower
Hose Bibs 16.60 ,Combination_ _
Roof Drains 1660 Shower Only _
Drinking Fountain 16.60 (Nater Closet --
_ Urinal
Other Fixturos(Specify) %60 Dishwasher _
- Garbage Disposal
1-2und Roorn Tra
- Washing Machine
Floor Drain/Sink:
Sewer-1st 100' 55.00 3•
Sewer-each additional 100' 46.40 _4"
Water Service-1st 100' a 55.00 {Nater Healer
- Other Fixtures
Water Service-each additional 200' 46.40 -(Specify)
Storm 6 Rain Drain-1ct 100' 55.00 _
Stone&Rain Drain-each additional 100' 46.40 - --- -
Commercial Back Flow Prevention Device - 46.40 -
ftesident!al Backf11 low Prevention Device' �� 27.55 -
Calch Basin 16.60
Inspection of Existing Plumbing or Specially 7250
Requested Ins actions erRv - COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 ----
Grease Traps 16.60 -- --
QUANTITY TOTAL t
Isometric or riser diagram is required if / b2'1. 5S ' P7. C S
Quantity Total Is >a _ -
•SUBTOTAL S __
8%STATE_SURCHARGE O
'PLAN REVIEW 25%OF SUBTOTAL
Required only,If fixture .total Is>g
TOTAL $39 r
"Minimum permit fee is sZa.5ostate surcharge,except Residential Backflow
Prevention Device,which Is$38.25,+>%stale surcharge
**Ali New commercial Buildings require plans with isometric or riser diagram and
plan review,
1:\dsts\forms\plm•fees.doc 10/10100
HLJC IV IJI l I : 47a procom comm 503 2:.33 0052 p. 1
06/06,12ou1
Electrical Per rmt Application •;
Due rioeelvcd Pruni!no.:
City of Tigard 1 A Prolecdappl.no.: r Expire date:
Ciryn/Tig�.d Address- 131Z5$W Hall BI , IA4ud,-L)W-V1. 11 Dltclslucd. ily. ReceJptno.:
Phone. (503) 639-4171 V__ _
Fads (503) 5911-1960 Cjsc me,vo: Payment lypc
band use approval: .
U 1 &7 family dwelling or accessory C]CommerciWinduslnal U Mi,:d-family U Ttnant improvemcal
0 New concourtlou ❑Addinon/altcrution/replacelnrnt U Other,-A4_A,_ 0 Pardal
JOBSITIF INFORMATION
lob addles I _� j _ I ow1� Eldg.no.: Jude no. Tuc ma tsvc IoUaceount no.:
T . ----- 91ack� 5ybdiviaion: _
Pro)ou n:Jne _ [k:scri Doo and It7culon of wont on tefnilel:
Estimated date of compl:,loldinlpection:
CONTRACTOR l
Job no: Pan Kill
Business nano ppj� Dracrifwlen Om) Toul no Ira
New ra►f4n0a1• k H rau111-lirrrrily per
ll
nad,es.; -L .r.*lf6rlan,ll eaclarsaasmrl.rtprratr.
City: riA Ijur Stale' (Z ZIP' S.a.iorbrcia"
Phone: Aaf:_2 3 .msil: 1000•- N a lea 4
Fa^h addrdmal 700 fl,Or Non therm
CCU no.: /0 q 42 Me:,bur, he nu. -"q —�
� _Z 4-__ Limitodcnrgy,raldenual — I
City/mm lit-no.: _ —�� �ntiledenergy non•taldendal I
FAch minufmuted home or mndulu it r lline
sf nataue or Isin davi lan(rtsgY _Ind) uele -Zr� suvlmand/or hsderSup.slam none(print): urwueno Sienlseprfeedeya 4ats�la�l7vo,-
e
alters donorinlota ear
100 Amps of Jim$ 2
Nino(print): IDI ampalo400amvr _ -� - 7
401 anyn iu 600 am r 2
M1tnUng addiesl: - p- --
----- �. - �---��,:.- a to I0R7 am r 7
Csty. _ �Stalt:� _ L�_ Otiet1000 paavola
Phone ��._L'._�
Owner in�dlllnlivnThe inaallftion is being made an property l own laaaliermyvarv5com-rhmd"I-
Which to not iuterxled for sale,lease,frill,or exuAtange according to lwablt.�i.q allar►awa stills slian;
ORS 447,455,479,670.-)01. M am of lCaA
()Wne(s lrgyvahlrr. Ewe: 401 to 6W cops - 2
$rWAA airaaila•res►,allermbru,
Nome: K ellhrelaa pr PONW:
Addlt:sl: w vioc or hedv fat,aarh brwrb circuit 1
City $lath ' 0 Pee for branch rinvta without purehas
- o awia w leedr leap fort braftd rtreulc I
Ptnoc Fax. I;null: --,-- - -—
harcrt adNtlooa!uraarclU cvcvrl:
iac.(SclvSotHfeeMaroliyc dai►;
O k., r ria 225 ampcnrMmcrnal U He►Id+eam farrliry F.leh WmP ar YtlQaaon cir�lo 2
A Savta nva 120 urp+-rulnl of 141 1.1 Fluadour Inciiw Etj ai ur ouU;nc lrlhung - } 2
ranuty 0o1111np U auu:ia/ova 10,00 squam k-x h,ur a 911n amijit(r)ur a hnuwd ur,ly pu,el,
p Syveio over 600 volar naWnal more rtndtntlal oau in".c abvctun Qv eadufr,W utemion•
U 1wilden/ova dua rlorim U F rain ,4(n amps or fine* :tkaalpuon:
r]Oeeupaeu load a•w 991.ror•u U Mum.-turvJ enu ,v,or n V pv44 - -�-
[Jai aUlrlwl lanyrerfi�.wrr d.a aUewalde in WV d rM ahe►m
U t4r serlrl►ngplan J()Ifire --•-
Par rnrpecdon 1_�
Seblrall_. _ICU of poo with may crib*alrese.
The dwre w nota ble to tem
PPIb Parat7 coo/tr�cHoo ecas4<e 7rbn
Nw J}�aMiCoter rasp aaIIIIU rrd►praaaaeW)arladlcllsa Nw arca Mfawam Nairxfhis i stall apPlirl'ion Pvmll R[ ........... . .
M,A. U Mmkacmd *,spirts rf a permrt is nol obuined Plan review(as %) S
__ withu, 190 days all&it has been Stale►utchalge(B%)...$ -�
'��Tiar�el arc 1 r wid _
tuP r aarrind as ritoorlerr I UTAL S
S
Ilug 17 01 1 1 : 4fla procom comm 503 233 8052 P- 2
05.125{Z001 11 34 FAX 506847297 M3, o1 Tigard W100J
electrical Permit Fees: Limited Energy Fees:
LY
Complete Fee Schedule Below, Restricted
OF WORK INVOLVED-RE _NTIAL ON
Restricted E w W Freel................... .......................... $15.00
Number of inspections r perotill all awr l (FOR ALL SYSTEMS)
Service Included: Items Cost Total Check Type of work Involved•
Reel6ontial-per unll r_
1000 su,h or lesIj
s _ $146.15 1 Awho arid Slaroo Systems
Loch addili0,lal 504�Q 11,of
pndlon thereof $33 4U --_ 1 Bu+filar Ales
l uhrled Energy $15 00
Looh Manurd Home or Modufer Ll Oerage Door Opener'
owtowng service or Feeder __ 590 90 2
Services or Feeders F1 I leafing,Venfilaliun and Air Cundilronmg Systern'
Inuttlladun,eltatown,or relocation
200 amps or tees _ Sao a0_ 2 ❑
201 amp&to 400 amps 31 U6 a5 7 Vacuum Systems'
401 amps to 600 amps _-- -_- S160 Fn 2
001 gimps to 1000 amps -, S)40 fin_ - — 2
Gal
(TOther
_ ------------ ___
Ove 1000 amps or volts $454 65 2
Rwrnnnert only f66.05 2
TYPE OF WORK INVOLVED-COMMERCIAL ONLY
Temporary Services or Feeders
InelaNatlon,slier suon,or ralocallon Fee for each system....................................... ................. $f5 00
100 amps nr leas $66,55 2 (SEE OAR e10.760.M)
201 amps to 400 amp& 5100.30 ____ 2
401 amps In Eno ampr %131 f1 7s _ 7 Check Type of Work Involved.
Over 60U amps to 1000 volts,
sen"b"above. Audio and Stwoo Sy-lemt
Arench Glicultb 1 1 Roller Contrails
New,allcraliun a o,tonsion pct panel
A)Thr fee fnr hranch orcurts
W,th purrhaee of rervlep or Cluck systems
fMldee fee.
Fadi brarw:h circiAl _ S055 __ 2 Data Te,,eoommunlcahun Installation'
b1 The(as for branUi urcurts
without purchase of service Fir-Alarm Inerall2110n
or haler/ea
First branch rJrr A _ $44HVAC
,05 r-t
Fadi addMkrch lel brancirculi $6.55
Mlscallannoun Instrumentation
(Servka or leedcr not tnduded(
Each pump or irrigation circle $5340 _` LJ Inlerwm and Pa n ti sterns
Earn sign or mArine lighting $5140 Ir H Y
Signet cirwitls)or a Ilmiled energy
panal,aeeration or eir mwun S75 00 �__ Landscape Imgabon Control'
Minor l abets(10) —�_ 312500
Medial
Each additional Inspe0ori vvei
the allowable tar any of It--abova Nurst Celli
Per Inspection $62_.._-- $67 50
Per hour $62 50_ _ _
to Plant -- - — 17375 � Ou(door Landscape Lighting'
FL-es: E3 I'minrilve Signaling
F n1ar Intal of above face 3 _ Other-- --'---
0%Stale swchsrge s ^T _Number of Systems
75%Ptan Review Fac
.ger'Plan Nevrevl sercton on $ No Npneee ere required lkenfl0s SMtepvlred for all olrrN lnslatuUonr
konl of appl"t On
-- Fees: �
TOWHalarrce Otte $ ✓� ��
- Enter total al above fees $ �_
UTrust Account p___ 6%Slag Surcharge
To',vf Hallance nue =.
,tl4bV armf�clr Icrr dc4 IOr99/On
ELECTRICAL PERMIT-
CITY OF T I G A R D
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2001-00211
13125 SW Hall Blvd.,Tinard, OR 97223 (503) 639-4171 DATE ISSUED: 8/17/01
SITE ADDRESS: 12377 SW HOLLOW LN PARCEL: 2S103CB-06700
SUBDIVISION: QUAIL HOLLOW- EAST ZONING: R-4.5
BLOCK: LOT: C16 JURISDICTION: TIG
Proiect Descrintion: Installation of data/telecommunications.
A. RESIDENTIAL B.COMMERCIAL _
AUDIO & STEREO: AUDIO&STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: DATA : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL#OF SYSTEMS:
Owner: Contractor:
DON MORISSETTE HOMES PROCOM COMMUNICATIONS INC
4230 GAI_EWOOD ST#100 P.O. BOX 22288
LAKE OSWEGO, OR 97035 PORTLAND, OR 97269
Phone: 503-387.7538 Phone: 233-8037
Reg #: LIC 109929
SUP 2933.ILE
ELE 3-397CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
�PRMT CTR 8/17/01 $75.00 2720010000 Elect'I Final
5PCT CTR 8/17/01 $6.00 2720010000
Total $81.00
This Pen-nit 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 ATTENTIONOregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246-1987
Issued by L f/ /_._ Permittee Signature/t
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N ',, _ DATE:
LICENSE NO: _ — -, ___--
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST /-CSD �O
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
IBUP
Date Requested �U 8� AM PM —_ BLD -
Location �/� �� _ -Y-� _. Suite MEC
Contact Person _— Ph _ —_� PLM
Contrac _�----__ _ Ph — --- SWR --------
I'L I6 Tenant/Owner ELC
etaini,rg 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:Misc --- ------- -- -- -------- --- - -_ .��—----------
Fi
AS PART FAIT_ --_--
Ihlt3
Post& acorn -- ---- - - - — ------ ---
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains _
Final
PAS T FAIL —
CHANIC
Gas Linc. - - -
Smoke ()ampr-.rs
1(=�-MRT-, FAIL
EL CTRICAL - -- ---�
Rough)n
UG/Slab
Low Voltage
Fire Alarm __ ----_-_---__--------__--- -
PART FAIL ----.-- - —
E
Backfill/Grading
Senitery Sewer
Storm Drain [ I Reinspection fen of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( I Phase r;ll for wimm pection RF _ _ r __— [ )Unable to inspect- no acr.ess
Fire Supply Line
ADA /7
Approach/Sidewalk Date 1 �f�,c��r - Inspector Ext
Other —...._ - - - -- -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
Residential Certificate of Qccupwicw
v v3o n�,��rr�s: /a& 7�
Permit No.: Z90- --__—_
Owner/Contractor: �A(_ �
Date of Final Inspection: � Inspector:
This structure has been found to he in substantial compliance with the provisions of the.Stove of Orrxnn One& Two Family Dwelling
Sperigity Code and is hereby approved for occupancy. --------
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 61 175 Business Line: 639-4-,. -��- -
BUP
-__--`Date Requested l L c AM PM _ BLD
Location _—___L_�_ •t.� rl_ Suite MEC
�.�r�-�� Ph • �5 Z 4, 0 7� PLM
Contact Person
Contractor _ Ph SWR
BUILDING Tenant/Owner ELC
Retainino Wall ��— ELR _
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Grain Inspection Notes -�-- --
Slab _-----_ -_____ __--- — _----- SIT
Post& Beam
Ext Sheath/Shear -----
Int Sheath/Shear
Framing 4,-
Insulation Insulation
Drywall Nailing -
Firewall
Firer Sprinkler
Fins Alarm
Susp'd Ceiling --_ - -------
Roof
Misc: —
Final - ---
PASS PART FAIL --
PLUMBING
Post& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer -------�-_-�--
Rao Drains
T�y1a{.a-
.SS)__EART FAIL- _
NICAL
Post& Beam -- - - - -Rough !n
!n
Gas Line - --- --- -- -
Smoke Dampers
Final T- -- -...-- -- — --- -
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG/Slab - - --- .. ..------ __--. --
Low Voltage
Fire Alarm --
Final
PASS PART FAIL ----------- --- _ ------ -----
SITE
Hackfill/Grading - - - ----- -------_,_..�---
Sanitary Sewer
Storm Drain ( )Reinspection fee of$_ _-required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I 1 Please call for reinspection RE: _ _ ( Unable to Inspect-no access
Fire Supply Line --
ADA
Approach/Sidewalk
Other
Date /Z � , inspector_ � Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST 2c')0, Oa 30
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested__ —AM PM — BLD
Location i Z. 32 :7 _ _(—o 1; -innSuite MEC
Contact Person ---�'��� ��. Ph PLM
Contractor Ph SWR
BUILDING Tenant/OwnerELC —
Retaining Wall — ELR _
Footing Access: —
oundation FPS
Fig Drain SGN _
Crawl Drain Inspection Notes _-- --
Slab SIT
Post&Beam
Ext Sheath/Shear
int Sheath/Shear
Framing
Insulation -- �- —
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm i -- -----�— �-_4---- --
Susp'd Ceiling
Roof --------__ —_--
Misc: - ---- -- -- - -- ..
Final -------
PASS PART FAIL __.---
PLUMBING
Post& Beam
Under Slab
Top Out -- ---- --__ ___ -- --- ---
Water Service
Sanitary Sewer ----- ----- ------ ... ------ ------
Rain Drains
CPASSJ PART FAIL. - -
MFMANICAL
Post& Beam
Rough In
Gas LineSmoke Dampers
Dampers
Final ------- -- --- --- -_ - --—
PASS PART FAIL
ELECTRICAL - --- ---- - --- -. _..
Service
Rough In - ---- ---- --
6';Slao
' ow Voltage
Fire Alarm
Final �__� �__------- ------- ---..
PASS PART FAIL ------
SITE
--
Backfill/G adhig --- - ----- ---- - -- — -- _------ -
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ]Please call for reinspection RE y_ ( j Unable to inspec!-no access
ADA
Approach/Sidewalk
Other Date _> _ Inspector4t""e" Ext
Final -^
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.