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12392 SW HOLLOW LANE i r N W cn N N C O O r 12392 SW Hollow Lane CITY OF TIGARD BUILDING INSFECTION DIVISION MST 24--Hour Inspection Line: 639-4175 Business Line: 639-•4171 --- BUP _ Date Requested_ / AM4 PM _ BLD _ Location <<�� 1 � tc _ Suite MEG Contact Person Ph �' �� "�' �� (' FLM c)i Contractor — Ph �� I �] SWR _ PUM.DING _ TF;nantiOwner ELC Retaining Wall ELR Footing I - Access: Foundation FPS Ftg Drain hev /(acl/ t - ------ -- Crawl Drain Inspection Notes. SIGN Slab —--- -..-._— _ — SIT' Post& Beam —_--- — Fxt Sheath/Shear Int S'ieath/Shear ------ --- - Framinq Insulation Drywall Nailing Firewall -------__....----._—.- Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc - - - ---- - ---- -_ _.—_-- Final _ PASS PART FAIL -- -- — _ -_— -.— __— PLUMBING Post& 6eam -- `—` - _ —--------_- Under Slab i Top Out (��, Water Service'k'-' ---`-Y- ------- Sanitary Sewer --�--_� -- `- --� - - Rain Drains PART FALL MECHANICAL _-- Post& Beam - -- - -- -- . ._ - ----- -- -- -------..- Rough m GasLine ---___- - _- --.___-------.___...__- ----W-___-__--._ Smoke Dampers Final - - - ------ PASS ---PASS PART FAIL ELECTRICAL Service Rough In -�--T- ---' UG/Slab Low Voyage -- --_-- � ---- .��— — Fire Alarm Final - ------------_—�— _ ..`_ PASS PART FAIL -.. SITE Backfill/Grading - --- ----- -- ----_.. --- - ----- Sanitary Sewer Storm Drain [ t Reinspection fee of$— -�required before next inspection. Pay at City Hall, 13125 Svd Hall Blvd Catch Basin Fire Supply Line ( ;Please call for reinspection RE:_- _ _-_- [ ] Unable to inspect- no access ADA Approach/Sidewalk C J`� Othor — _ Date _ L — Inspector `__ C -e- - Ext _ Final PASS - PART FAL- DO NOT REMOVE this inspection ii'ecord from the job site. CITY Of= TIGARD BW DINIG INSPECTION DIVISION MST --Zyz� l �, •_3a `7 24-Hour Inspection Line: 63'; 175 Business Line: 639-4, BLIP _ _Date Requested— ; AM—�_—PM _ BLU -_— Locaiion_ �Z / Suite c� MEC Contact Person 1_ �-2.- _ _ Ph �� C� T S �i� PLM Contractor /--a T_JJ� _ Ph SWF' BUILDING_ Tenant/Owner ELC - ---_-- Retaining Wall - -----`^— ELR Footing Access: FoundationFPS Ftg Drain - - SGN Crawl Drain Inspection Notes --------- Slab ---- - -- ---- ----�... ----- —-- SIT' Post 6 Beam ------- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ----- -------- ---- ----- ---- --_.W- --- Roof Misc: Final PASS PART FAIL — •'/�.t2o?.. - CC PLUMBING Under Slat, Top p -E G / — �- -r--.a•�- �� Water Service _ Sanitary Sewer - Rain Drains Final PASS PART .-AIL MECHANICAL Post& He;mi I -- I Rough In - _- Gas Line Smoke Dampers Final -- - - -- PASS PAR,r FAIL — Seivice Rough In - ----- -----_ _ - -- --- UG/Slab Low Voltage Fire Alarm - - --- --- --- ASS FART FAIL. Backfill/Grading ----- --- - - — Sanitary Sewer Storm Drain [ ]Reinspection fee of$ iquired before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Suppry Line ( [Please call for reinspection RE: _ _T _ i_ ( Unable to inspect no access ADA Approach/Sidewalk Other Date 'p inspector Ext - Final PASS PART PAIL DO NOT REMOVE this inspection record from the job site. CITYOF TIGARD BUII r)ING INSPECTION DIVISION MST ZZ?VI �3 � 24-Hour Inspection Line: 639 15 Business Line: 639-41'1 , BUP Date Requested_ % AM PM BLD )c ntion / Z Suite _ MEC _ Contact Person ..' Ph �' ` ' ' PLM Contractor Ph SWR rBUILDING Tenant/Owner ELC Retaining Wall ELR Footing ACGP,SS: Foundation �� /�� /'1 FPS Ftg Drain J `/ — SIGN Crawl Drain Inspection Notes: Slab — -- SIT Post& Ream I --- Fxt Sheath/Shear _ Int Sheath/Shear Framing Insulation 4X 6- e �. �a :� Drywall Nailing i Firewall ` Fire Sprinkler U _ ti�'2 t/ C r '�1 r"�@ / � _— Fire Alarm Susp'd Ceiling Roof Mic — _ — ----—------ ASS F R i FAIL ------------------ GG Post&Peam —.------- ._... Under Slab Top Out - -- - Water Service Sanitary Sewer - — —v-- — Rain Drains ASS PART_FAIL \ 4IIIIEC'4AICAL .r__--__-_------- — — Post&Beam 1 (Rough In Gas Line Stroke Dampers p7hat — - - -- — -- --_-- FAIL � ®rE) Servr In UG/Slab Low Voltage Fire Alarm na � S`8 PART --- SITE 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 _ ( )Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Other Uate - ____ inspector --_ __Ext Final PASS PART FAIL__, 00 NOT REMOVE this inspection record from the job site. Mechanical Permit Application -F Datereceived: Permit no.: City of Tigard Project/appl.no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date asaucd: By: Receipt no.: Phone: (503) 639.4171 Fax: (503) 598-1160 Case file no.: Y _ Payment type_ - Land use approval: Building permit no.: i1 &2 family dwelling or accessory U Commeicial/industrial Cl Multi-family O Tenant improvement Jew construction Cl A,Idition/alteratiort/replacement C]Other JOB SITE INFORMATOON1N*RCIAL *ALbATION SCHEIMILE Job address: VkAb L-1 \ . Indicate equipment quantities in boxes below.Indicate the dollar Bldg. no.: Suite no.: value of all mechanical materials,equipment,labor,overhe,id, Tax ma /tax lot/account no.: profit.value$ _ Lot: Block: I Subdivision: �t _ - "See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: I ZIP: 111 GyMi 101 t 140 Description and location of work on premises: _ TAC: / a it l 3t t Fer(ea_) Total Est.date of completion/inspection: B+e+crl oo trv. 11m.oniv lte�.only Tenant improvement or change of use: Air handling unit CFM _ Is existing space heated or conditioned?O Yes ❑No I Aar conditioning(site plan required) Is existing space insulated?El Yes U No I Alteration of existing HV AC system oiler/compressors Slate boiler permit no.: Business name: '- ' 1 HP --Tons BTUM Address: ire/smoke dampers/duct smoke et xtors Cin: L! State' ZIP: eat pump(site p an r wired) Phone: Fax: E-mail: nsta�irelTe rnacelburner ! ----- --- Including ductwork/vent liner O Yes U No CCB no.: 3 1�'Dc_ _ _._ nsta replace/relocate esters-suspen ed, City/metro lic. no.: N/A _ wall,or floor mounted Name(please print). _ 1 (— � enc or-appliance other an furnace pSi� e gerat on: CONTACT 111IRSON Absorption units BTUM Name: -�`��(� _ Chillers HP Address. . , Com ressars__ HP C l� nv rotnneotal exhaust and eentilat on: City: State: ZIP: _ Appliance vent Phone: Fax: L--mail: ryerexhaust s, ype res.lutchert/l azmat hood'ire suppression system - Na�e: 1 ' Exhaust fan with single duct(bath fans) Mailing address: ) �,' _ h: systema an fmm or A ase I piping an distribution((uup to 4 outlets) City: L StateZ,IP _ Ty LPC NG Oil Phone: 7' Fay F-mail: ase i in each additional over 4 outlets rneesxp p schematicrequired) Name: Number of outlets __ _ _ ter lFsied appliance or equ pmenu Address: Decorative fireplace City' ��----------� State: ZIP: nsert-type Phone: l \ F•mail: c stovelpe et stove cher. Applicant's signutu Date: Uthcr: Name(print): k,_he, Permit fee ................$ Not ill runsdicuoru xcept credit cards,please call runubcom rot more informm ati —— Notice:This permit application Minimum fee ................S --- O Visa U MasterCard expires if a permit is not obtained ". _ Plan review(at _ %) $ Credit card numb - ;p1fef within I go days ager it has been State surcharge(8%) ....$ _ —-- Name of ciulhoUtt as shown on credit card s accepted as complete. TOTAL .......................a 1617 IF Jpif)Mt Cardholder signature Amount Aa+l Plumbing Permit Application Date received: Pernu�no.: Cit of Tigard City g Sewer permit no.: Building V.rmit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 CiryrjTigurd phone: (503) 639-4171 Projecdappl.no.: Expire date: Fax: (503)598-1960 Date issued: By: Receiptno.: Land use approval: _ Case file no.: Payment type: 7e,',o7astucLion y dwelling or accessory D Commercial/industrial ❑Multi-family 0 Tenant improvement Cl Additiom/alterution/repIace mrn1 0 Food service ❑Other. . JOB t t aSCHEDULE Job address: (,� L V rV (r`'� r Description . Fee(ea.) Total I Bldg.no.: Suite no.: New l-and 2-family dweWngs only: (includes 100 ft.for each utWty connection) Tax map/tax lot/account no.: SFR(1)bath Lot ` N Block: Subdivision: 1Ctlk&W SFR(2)bath Project name: U.M SFR(3)bath City/county: ZIP: Each additional ba tchen Description and location of work on premises: — Siteutilitles: Catch basin/area drain Est,date of completion/inspection: DrywelisAcach line/trench drain Footing drair.(no.lin.ft.) Manufactured home utilities Business name ` L Manhole Address: `' I Rain drain connector City: FSC State, LiP: Sanitary sewer(no.lin. ft.) Phone: - Fax: E-mail: Storm sewer(no.lin.ft.) CCB no.: [ -�Ll-7 Plumb. btls. reg. no: --�Y Water service(no.lin.ft.) lFlxture or Item: City/metro lic. no.:N/A Abso tion valve Contractor's representative signature� Back flow preventer Print name:, L� Backwater valve Basins/lavatory Narne: �- Clothes washer _ — Dishwasher Address: "V Drinking fountain(s) City: State: ZIP: Ejectors/sump Phone: Fax: E-mail: Expansion tank Fixture/sewer cap Name (print): X �c�t �� ,�-; Floor ge disposal sinks/hub _ Garbage disposal Mailing address: - Hose bihb City: _ l , State ZIP: Ice maker Phone: Fax: E-mail: Interceptor/grease trap _ Owner installudvn/residendal maintenance onhv: The actual installation Pnmer(s) will be t—We by me or the maintenance and repair made by my regular Roof drain(commercial) employee or.the property I own as per ORS Chapter 447. Sink(sl,basin(s),lays(s) Owner's signature Date: Sum Tubs/shou er/shuwer pan llnnal Name: __ __ Water closet Address: _ _ Water heater _ City State: ZIP: _ Other. Phone: fax: Ti-mail: Total Na ail unsdicnons ecce credit rant lease call urisdicuon for mote mfammlon Minimum fee................s i a P ) Notice:This permit application ❑Visa O MasterCard expires if a permit is not obtained Plan review(at ,- %) $ Credit card number _ / / within 180 days eller it has been State surcharge(8%) ....$ ____-_------ Name of cardholder as"*non credit card Eap,ra accepted as complete. TOTAL ....................... -- Cudholder stRnature Amount 440-1616(610)com) .electrical Permit Application -� _-� Vatereccrved: Permit no.: City of Tigard Project/appl.no.: _ Expiredatc: CiryofTigord Address: 13125 SW Hall Blvd.Tigard,OR 9723 Date issued: Ay: Recciptno.: Phone: (503) 639-4171 - - Fax: (503) 598-1960 Case file no.: Payment type: Land use. approval: t ❑ I &2 family dwelling or accessory ❑commercial/industrial ❑Multi-family ❑Tenant improvement New construction ❑Addition/alterstion/repla_-nrcnl ❑Other.__ 0 Partial 40—USITE AFORM—k-Cs Job ad cess: I " �f {'�. - Bldg. no.: SuiIC no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: - - - -- - — — — — Project name: Description and location of work on premises: Estimated date of completionrinspection: 21 0 J Job no: Fen Max Business name: 1 Description V+r. (h-) Total no.cusp Nen residential-single or multi-family per Address: L�v ) t dwelling unit Includes artartsrd garage. City: M State: ZIP Serviceircluded: Phone: 1jFar: E-mail: 1000 sq.it or less _4 Each additional 509 sq.it or portion thereof CCB no.: Elec.bus. lic. no: Urruted energy,residential 2 C' Limneded manufactured d home or m 2 ' Each manufactured home or modular dwelling r coupe ojsapervurnr tfenrlctan pegalredl Date ,;, Service and/or feeder 2 — Services or feeders-installation, Stip elect name(print) 1 Llcenseno Alteration or relocation: 200 amps or less 2 Name (print) ` 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 1l 601 amps to 1000 amps 2 City: , State ZIP: Over 1OWamps orvolts 2 Ph,,- . Fax: -_7L, '. mail: Reconnectonly I Owner installation:The installation is being made on property I o%%n Temporary services or feeders- «hich is not intended for sale, lease,rent,or exchange according to illation,Alteration,orrelocation: 200 amps or less 2 ORS 447. J� 479.670,701. 201 amps to 400 amps !V2!O%%ner'-, sikn.lture• Date: 401 to 600 ams V Branch circuits-new,alteration, or extension per panel: Name: A. Fee for branch circuit%with purchase of Address: service or feeder fee,each branch circuit City: rMate: ZIP: B. Fee for branch circuits without purchase 2 of service ur feeder fee,first branch circuit: Phone TFat Email: Each additional branch circuit: Misc.(Service or feeder not included): ❑Service over 225 amps-conutetci at O Health,ue facility Each pump or irrigation circle 2 ❑Service over 120 amps-rating of 1&2 O Hamdom location Each sign or outline lighting 2 familydwellings ❑Building over 10,000 square feet four or Signal circuit(s)or s limited enerp,y panel. ❑System over 600 volts nominal more residential units in one structure alteration,or extension* 2 O Budding over three stories O Feeders,400 aunps or more 'Descriuen O Occupant load over 99 persons O Manufactured structures or RV parte Each additional bnspection over the allowable In any of the above: O Egress/lighungplarl U Other —_ Per inspecuon submit—_sets of plans with any of the above. Imesugauon fee The above are not applicable to temporary construction service, other .............S Nd Nsdi alt jucurnt s cep crrdir:aids.please call jrrtidktioa f«rrMre otm duauon Notice:Thi Permit fee........ permit application El visa O MasterCard expires if a permit is not obtained Plan review(at __ 41r) Credit card number _ within 180 days after it has been State surcharge(8%)....S accepted as complete. TOTAL ....................... Name of canlholder ar shown on credit card S Cardholder nanature Amount stir u 1%r6RYN' DON - MORISSETTE OBE . 1973 4aa20 GAL2w01 0n02 9TR3raT LOT: 20 LA 12 03V200. 011a0N 97035 (603) 367 - 7638 1Az (603) 367 - 7e to DATE: 5/25/01 PROPERTY: QUAL—HOUDW OPTION 1 ELEVATION Cl PY: TIGA.RT! SCALE: Y"=20' PLAIN No.: 1.70 LU,, HOLLOW , I �' -- 282 j 284 132 ConCrete.. -- Drivewag n ----------- parch -------porch S 1 2 3 u _ Ohm eq, r 2 car !@Ar. I F.FS 285' n ; C,4 eq. rt. 2 lit bath I FFE28,6' I I �e patio I ------------ I e I � f h 284 ! �5-0fa' 288 \ LOT 02O 5,430 eq, ft. ....y�Oenxam�ticl►as�:u�➢vnrei;eiaR��.c•.,,�-r��:.r..ac� cr�t�"�W'r;acv^e�:m�..�r:^+.�o��:�C:•nns_:r�_.:.'!::�c e�::t:ivt:z.:n3T_'�oRxi.7�af'y,u-� CITYOF TIGAR D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00630 13125 SW Hall Blvd., Tigard, OR 97223 (503) 539-4171 DATE ISSUED: 11/28/01 SITE ADDRESS: 12392 SW HOLLOW LN PARCEL: 2S103CB-.07100 SUBDIVISION: QUAIL HOLLOW - EAST 'ZONING: R-4 5 BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: OTR, GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRN: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES _ r-AUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: -'IB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Backflow prevention device for irrigation system. _ FEES_ Owner: — ',ype By Date Amount Receipt DON MORISSETTE HOMES INC PRMT CTR 11/28/01 $36.25 2.7200100000 4230 GALEWOOD ST#100 5PCT CTR 11/29/01 $2.90 27200100000 LAKE. OSW'EGO, OR 97035 - Total $39.15 Phone 1: 503-387-7538 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSONVILLE. OR 97070 REQUIRED INSPECTIONS RP/Bacf,flow Preventer Phone 1: 682.-6076 Final Insl+ection Reg #: LIC 6136 PLM 11558 This permit is issued subject to the regulations contained in the Tiga,d Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or If work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon. 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. IssuedB Permittee Signature: -- Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day f , . _ ,00 - o66_ , Plumbing Permit Application Dateree.eived:!/.?'',%° Permltno.: GPA1'.CjW (,rty of Tigard IV � Sewer pernilt no.: Building permit no.: Address: 13125 SW Ila ll Bt ; 2_ Phone: (503) 639.4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 v �� 9 Dateissucd: By: Receiptno.• ' Land use approval: �r 1�I1" Case file no.: Paymeettype: 1 0 I &2 family dwelling or accessory ❑Commercial/industri;d O Multi-fvnily O Tcnant improvement New construction ❑Addition/altemti(-)n/ieplacernent O Food service U Other: .______ 1 1 1 ! ) Job address: /ol, y lit t/I 1101�_' L-eo)C,' Description Qty.j Pec(ea.) Total Bldg,no.: Suite no.: New 1-,and Z-fsmliy dwellings only: Tax map/tax lot/account no.: 5�. r (Inaudes100ft.for cacti utility conned ion) SFR(1)bath Lot: ��U. Block: SubdivisionC� Uf 1* //VW SFR(2)bath �— - Project name: aA_0. HC it tn,,,t SFR(3)bath City/county: F IglrIQ U'Aslti ZIP:' Each additional ba 'schen S Description and o a►.'�Pn of work on premises: 5iteutWtlea: I3/9e�cWo10 pe-6 f Catch basin/area drain date of compledon/inspection: ,3 3r V Drywells/leach line/trench drain t 1 1 ' Foot�drain(no.lin.ft.) Manufactured home utilities Business name: Prb C�rctSs _IG Zn C" __ Manholes Address: q Rain drain connector City: tw /�r"U L G State:C) ZIP: 17 Q 2() Sanitary sewer(no.lin.ft.) Phone �_ Fax:/oga—Q87 E-mail: Storm sewer(no.lin.ft.) CCB no.: / Plumb.bus.reg.no: Water service(no.lin.ft.) City/metrolic.no.: aFixture or item: Contractor's representative signature: Absorption valve p g Back flow reventer _g, ' Print name: / U Date: " Backwater valve PERSONCONTACT Basins/lavatory Name: bt ,y _. Clothes washer Dishwasher _ Address:' Q Q� Drinking°ountain(s) City:_ ku Stat :CCK-' ZIP: 97070 E ectors/sump . Phone: _ Fax:H8c) r/ ►•mail: Expansion tank I 1 Fixture/sewer cap Name(print): an /yy SSE'f - Floor drains/floor sinks/hub Garbage Mailing addresC) StV �t oOGL 5t- � Noe bibblsposal s: 3 City: � ,_(,7gAA'_ State:gp_ ZIP. r]b3 Ice maker _ Phone: ax: E-mail: Interceptor/grease trap Owner instal lationlresidential 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 propetty i own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ Owner's signature:_ Date:_ Sump Tubs/shower/shower pan Urinal Name: Water closet Address: _ _ Water heater City: State: ZIP: Other: Phone: Fax: Email: Tots Nd dl jurisdiedotu accept credit curie,p'aue call jurisdiction roe mom inromution. Notice:This permit application Minimum fee............... $ i S Q Visa D MasterCard expires if a permit is not obtained Plan review(at .,_ A) $ Cr"t Gerd eumtxr -- `- f within 190 days after it has been tState surcharge(g96)...,i Expires :vae or cudaalder uih��wo on cre—'dit�cva'�- � s accepted as complete. TOTAL .......................$ ca'dholder d{nature Amount 4404616(6f00/COM) PLUMBING PERMIT FEES: p, _ p ICE" -;TOTAL �•� NewS and 2-family �. �? ,•- . 41�.;I ,.c PqPRICE'S Tr1L FIXTURES n I�du ) QTY,,, ea ,. MOUNT ( clu�esll. t`T"m-bin xturn y ,, .xar q� Sink - 16.80 -- tt�e dwe'°�f g ane tf�ot�rsot �; a?Xr tE,�) �I nMoutiT 16.60 for each-"t)tility coF�inn""ectlon Lavatory One '1 bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 15.60 Three 3 bath $399.00 Shower Only - Water Closet 16,60 _ SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL TOTAL Garbage Disposal 16.80 Laundry Tray 16.60 Washing Mach(is 16.60 FloorDrain/FbzoconverEslonO PLEASE COMPLETE: 16.60 16.60Water Heaterlike kind 16.80 - 1Quantoy h Work Performed s. Gas piping requires a separate mechanical Fixtu� l;he: New Moved i Replaced Retrloved! MFG Home New WaQrPed ter Service 46.40 Sink Lavaio MFG Home New San/Storm Sr ewer 46.40 Tub or Tub/Showeir Hose Bibs 16.60 Combination _ Roof Drains 16.60 Shower Only =r Drinking Fountain 16.E0 Water Closet Urinal Other Fixtures(Specify) 16.60 Dishwasher Garbe a Dis osal + Laundry Room Tra Machine Floor D ' Floor Drain/Sink: 2" - I Sewer-1st 100' r 55.00 3" Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater -Other Fixtures W iter Service-each additional 200' 48.40 i i' Storm 6 Rain Drain-1st 100' 55.00. _ Storm 6 Raln Drain-each additional 110' 46.40 Commerclai Back Flow Prevention Dov aE 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 ` Inspectlon of Existing Plumbing or Specially 72.50 Re uested Ins eet!onsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 - -- Grease Traps 16.60 �- QUANT"TOTAL >r Isometric or riser diagram is required If Quantity Total is >9 'SUBTOTAL +"'�� ; ;.�a•", �s .�` -�- ^IL ~_ 8%STATE SURCH',RGE 9D "PLAN REVIEW 25%OF SUBTOTAL Required 0iif rudure qty,total >9 TOTAL $39, /5 !Minimum permit fee Is$1 °:state surcharge except Residential Backflow Prevention Device,whicis$r2-'• %elate surcharge "All New Commercial Buildings require plans with Isometric or riser diagram end plan review. I:\dsts\forms\pim-fees.doc 10110i00 Ob L Building Permit Application � Gate received:��- !<<, Permitno.:eel City of Tigard - Address: 13125 SW Hall Blvd,Tigard,OR 9722.3 � Isrolect/appl.no. — Expire date: City ofTigar' Phone: (503) 6394171 r a bdie is•.ued: By: Receipt no.: \ Face': (503) 598-1960 `\�l i Case file no.. Payment type: Land use approval: . —_ 1&2 family:Simp!e Complex: I,--- , 1 & 2 Funily dwelling or accessory U Commercial/industrial J Nfulti fWmly >KNCW -onstruction U Demolition r.1 Additott/alteiation/replacement (:J Tep:.nt improvement U Fire spnnklt.r/alarm J�lthur: 1 1 Job address: �f _t \ _ _ Bldg.no.: _ Suite no.: Lor. Block: Subdivision: ' ,L lam_ - Tax ma tax lot/account no.:_ ; Project name: Description and location of work on premises/special conditions: (11:16, ti _ g (,L'(" I &2 family dwelling: �, J M:ulin address: _ f City: jstatezlp: ct Valuation of work........ ........................ $ Phone: - Fax: mail: No.of bedrooms/baths................................. 4 1\ Owner's representative: Total number of floors................................. _ Phone: — Fax: E-maA: New dwelling area(sq.ft.) .......... ..... .. ......... Garage/carpott area(sq.ft.)...........�. .. IName. Y t ` Coverrd porch areas ft. ( q ) ......................... _—_ MMailing Deck area(sq. ft.) ailing, � t.,r1�C�" �. ,V ........................................ ------�-. ' City: State: ZIP: Other structure area(sq, ft.)... ..................... Phone: F;tx: 1 E-rnail: Commer,laUindustrial/multi-Tamil-': Valuation of work........................................ $ Existing bldg.area(sq. ft.) ........................ Business name: 1- New bldg.area(sq. ft.)................................ Address: Z 1, City: State: ZIP: Number of stories................................. Phone: Fax E-mail: Type of construction.................................... - Gccupancy group(s): Existing: _ CCB no.: �- New: _ City/metro lic.no.: 7Nodce:All contractors and subcontractors are required to b with the Oregon Construction Contractors Board under Name: tri ,( q'Z ns of ORS 70l and may be required to f•A licensed in the L, 4 ,v ion where work is being performed. If the applicant is City: State. ZIP. e:.empt from licensing,the following reason appli�:s: Contact person: Plan no.: _ — -- Phone: Fax: E-mail: `— Name: Contact person: Fees due upon application ........................... $__ Address: Date received: -- City: State: ZIP: Amount received ......................................... $_ Phone: Fax; I E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not sU)unsdicnoru accept credit cant plr-as•cal;iunsdktion for more informitioa. attached checklist. rovisions of I ws and o dinances governing this 0 M13 O MasterCard work will be eompl w"Rk.whether cifiere n P or n t. Credit cad number—. Expires 1 �/ Authorized sl nate 1 ate: Name of cardholder u shown on crit.arid Print name: s t t ICS — Cathoider sidoarure Amount Notice:This permit applicatien expires if a penult is not obtained widiin 180 dans after it has been accepted as complete tta tea ttiVrvCost) M' Cine-and Two-Family Dwelling AA,& Building Permit Application Checklist Referen.eno --- -� Assoc.:.ted permits. CiryojTigard City of Tigard >Electrical o Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97221 J Other: Phone: (503) 639-4171 Fax: (503) 598-1960 l;1%1J1r11VA I Land use actions completed. Sc(.junsdiction criteria for concurrent reviews. 2 Zoning.Flood plain.solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. 4 Fire district approva: required. 5 Septic system permit or authorization for remodel. Existing system capacity L 6 Sewer permit. 7 Water district approval. 8 Soils report.Mus:carry original applicable stamp and signature on file or with application. 9 Erosion eoutrol ❑plan 0 permit requited.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 desigmdetails 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 if copyright violations exist. — 11 Site/plot plan drawn to scale.the plan must show lot and building setback dimensions;property corner 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 location. TI—Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans, lumbing 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,roaring,roof slope,ceiling height.siding material,footings and foundation,stairs, _fireplace construction thermal insulation,etc. 15 Elevation views.Provide elevatic is 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;hcet 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 floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists Y over 10 feet long and/or any beam/joist carrying a non-uniform load. L 20 Manufactured floor/roof trim 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 will,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. .11 1HISDU-1110NAL SPECIFICS 21 Five( re .5)site plans are requid for Item 11 above. Site plans must be 8-lit" x 11"ur l I" x 17". 24 Two(2)sets each are required for Items 16, 19.20&22 above. — 25 Building plans shall not w.ontain red lines or tape-ons. — - — 26 No rolled,reversed or mirrnred building plans will be accepted. 27 28 Checklist must be completed before plan review start date. htinur changes or notes on submitted plans may be in blue or black ink. Red ink is msetved for department use only. 4"14(6AXWONI) _ SENrER�;ONNEGTlO°�! PERMIT CITY OF TtGAf�.D _ DEVELOPMENT SERVICES PERMIT#: S25/01 1-00165 DATE ISSUED: 9!25101 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103CB-07100 SITE ADDRESS; 12392 SW HOLLOW LN SUBDIVISION: QUAIL HOLLOW - EAST ZONINC: R-4.E BLOCK: LOT: 020 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEVV DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection permit for new single family detached rc .idence. Owner: FEES _ DON MORISSETTE HOMES INC Type By Date Amount R ceipt 4`230 GAL EWOOD ST#100 T -- LAKE OSWEGO,OR 97035 PRMT CTR 9125/01 $2,300.00 27200100000 INSP CTR 9/25/01 $35.00 272.00100000 Phone: 503-387-7538 Total $2,335.00 Contractor: Phone: Reg#: Required Inspactior.s 1 his Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days fron 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 riot 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' Perm i Issued by: D/ 5--`t,�� Permit!ee Signature: Cal! (503) 639-4175 by 7:00 P,M. for an inspection needed the next business day MASTE ERMIT CITY OF TIGARD PERMIT : MST2 PERMIT#: M5T2001-00327 DEVELOPMENT SERVICES DATE ISSUED: 9/25/01 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12392 SW HOLLOW LN PARCEL: 2S103C13-07100 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 BLOCK: LOT: 020 JURISDICTION: TIG REMARKS: Construction of new single family detached resjdence.Path 1 BUILDING REISSUE: STORIES; 2 FLOOR AREAS REQUIRED SET13ACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1.510 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: Sr FLOUR LOAD: 40 SECOND: 1.620 of GARAGE: 420 of FRONT: 25 PARKING SPACES: 1 TYPE OF CONST: 5N DWELLING UNITS: I FINOSMENT: of RIGHT: 10 VALUE: 519b.Hi 1 Ou OCCUPANCY GRP: R3 BDRM: 6 BATH: I TOTAL: 3 I'JO n0 St REAR: 20 PLUMBING SINKS: I WATER CLOSETS: 3 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS. LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: t00 SF RAIN DRAINS: I CATCH BASINS: TUBISHOWERS: GARBAGE DISP: WATE^HEATERS I WATER LINES: 100 BCKFLW PREVNTR: I GREASE TRAPS: OTHER FIXTURES: MECHANICAL `FUEL TYPES_ FURN<100K: BOIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1 I,A S FURN>=100K: UNIT HEATERS: Ho TDs: I OTHER UNIT.. I MAX INP: blu FLOOR FURNANCES: VENTS: I WOODSTObFS: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVClFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 - 200 amp: WISVC OR FDR: I PUMPIIRRIGAT ION. PER INSPECTION: EA ADD'L 500SF< r, 201 - 400 amu: 201 400 amp: let WIO SVCIFDR: Ln SIGNIOUT LIN LT: PER HOUR, LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFDR: 601 • 1000 amu: 601+amue•1000v: MINOR LABEL: 1000.amplvolt PLAN REVIEW SECTION Reconnect only; >=4 RES UNrfS SVCIFDR>=225 A. >600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM. INTERCOMIPAGING: OUTDOOR LNDSC LT. BURGLAR ALARM: OTH. BOILER: HVAC: LANDSCAPEARRIGPROTECTIVE SIGNL: GARAGE OFENER: CLOCK: INSTRUMENTATION: MEWCAL: OTHR: HVAC: .. .VTELE COMM NURSE CALLS TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,956.50 Th;s permit is subject to the regulations contained in the DON MORISSETTE HOMES INC DON MORISSETTE HOMES Tigard Municipal Code,Stale of OR. Specialty Codes and 4230 GALEWOOD ST#100 4230 GALEWOOD STREET all other applicable laws ^Ail work will be done In LAKE OSWEGO,OR 97035 SUITE 100 accordance with approved plans. This permit will expire If LAKE OSWEGO,OR 97035 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 adcpted by the Oregon Utility Notification Center Those rules are set Reg M: LIC 35533 forth in OAR 952-001-0010 through 952-001-0080. You may obtain copies of lhese rules or direct questions to OILING by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Mechanica Mechal ical Insp Low Voltage `Nater Line Insp Final inspection Sewer Inspection Underfloor insr.lalion Plumb Top Out Gas Line Insp Appr/Sdwlk Insp Footing Insp Crawl Drain/Backwzter Electrical Rough In Gas Fireplace Electrical Final Foundation Insp Footing/Fc,_-ldation Dr; Shear Wall Insp Insulation Insp Mechanical Final Post/Beam Structural PLM/Underfloor Exterior Sheathing Inst Rat 1 drain Insp Plumb Finzl U - � _. Iss ed By : ,-(� T _r_ Permittee Signature : -- Call (503) 639-4115 by ' 00 p.m. for an inspection needed the next business da;