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12409 SW HOLLOW LANE u A CD N O O ; r d a c� 12409 SW Hollow Lane CITY OF TIGARD 24-Hour Inspection Line: (503)639-4175 BUILDING MST - INSPECTION DIVISION Business in.• (533)639-4171 BLIP _— Received _ Date Rbquest — 3 AM__-- PM _ BUP Loc4tion __ �6_ —Suita MEC —_ Contact Person --- Ph(- ) -- PLM Contractor_ — _ Ph( —) �' d SWR _— BUILDING enatlVOwner ____ _ -_-- i" ELC - ---- Footing ELC - Foundation Access: E!_R Ftg Drain --- Crawl Drain 5iT Slab Inspection Notes. Post&Beam --� -- --- -----Shoat Anchors Anchors Ext Sheith/Shear y-__- Int Sheath/Shear Framing Insulat,on _---_ ------ Drywall Nailing - - -- - - ^�- Firewall ---------- Fire Sprinkler --' Fire Alarm -_ ---------- Susp'd Ceiling ---__--�_-------� �- -----___ Hoof -- Other: - Final PASS PART FAIL_ Post KBeam Under Slab --- Rough-In _ _ - Water Setvi,;e -- - - Sanitary Sewer _ Rain Drains Catch Basin/Manhole Storm Drain --- Shower Pane - _- - Other: PASS PART FAIL MECHANICAL _- Post& Beam Rough-to - - -- - --- -_ Gas Line _ -- Smoke Dampers Final _----__----- PASS PART FAIL ---- - -ELECTRICAL _�_ - -- --- -- - -` Service Rough-In UQ/Slab --_ Low Voltage -- -----_-.. --- Fire Alarm Final Reinspection fee of required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL Unable to inspect-no access SITE _ _ (1 Please call for reinspection RE: --- ---- Fire Suppiy Line ADA Date InspectorExt -------- ---- Approach/Sidewalk Other:_ Final DO NOT :REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 Z z MST INSPECTION DIVISION Business Line: (503) 639-4171 --77 // BLIP ----- ----- _- Received - - tl. Date Requested _LL_�_ AM-- - PM -_ BLIP 3 Location —_� o� 2 Suite �+__ MECContact Person — --- - -- Ph ) a —�d 37 PLM ------ Contractor — -- Ph(- ) ---- SWR - - - - -- BUILDING Tenant/Owner ___. ELC - - Footing ELC — Foundation Access: Ftg Drai,i ELR Crawl Drain SIT Siab Inspection Notes: - ------ __ -_ -- Pogt& Beam - - - - ---- ---_,.---- - Sherr Anrhorg Ext Sheath/Shear Int Sheath/Shear Framing -- --- - - - - Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'c Ceiling -- -- - - -- Roof ��,PAS - PART FAIL G _ _ -_ - -- -- —f - - -- - Post& Beam Under Slab ---- - _ - - - - -- ------ --- - Rough-In Water Service --------_. T-- --— -- -- Sanitary Sewer Rain Drains ------ — - - ----`-`- - -- Cate;,Basin/Manhole _ Storm Drain ( - --- -- —. — — ---- 3hower Pan Other:--- ---- — - ------- -- (TA79P PART FAIL _MECHANICAL - -- Post& Beam —� 'dough-in Gas Line Sm ke Dampers ASS _,PART_ rAIL AL Service Rough-In - - --- UG/Slab Low Voltage -- -------- - _�. - Fire arm AS PART FAIL C� Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. L ] Please call for reinspection RE:.--. U Unable to inspect -no access Fire Supply Lino / ADA ( ExE 7 Approach/Sidewalk De :_- 1' . _!!__ Inspector Other:— Final DO NOT REMOVE. this Inspection record from the Job site. PASS PART FAIL y y n a H �A Q a c b C C F �0 CITYOF T I G A R D _ ___ MASTER PERMIT PERMIT#: MST2002.00222 DEVELOPMENT SERVIVES DATE ISSUED: 5121/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12409 SW HOLLOW LN PARCEL- 2S103CB-06900 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 61_OCK: LOT:018 JURISDICTION: TIG REMARKS: Construction of new SF detached residence. Path 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBArKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,510 of BASEMENT: of LEFT: 7 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 4n SECOND: 1,520 of GARAGE: 409 of FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: SN DWELLING UNITS: FINBSMENT: of RIGHT: 5 VALl1E: S 300.898 00 OCCUPANCY GRP: R3 SDRM: 5 BATH: 7 TOTAL: 3,190,00 of REAR: 15 PLUMBING SINKS: 1 WATER CLOSET& 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS: TUSISHOWERS: 4 GARBAGE DISP: I WATER HEATERS: I WATER LINES: 100 SCKFLW PREVNTR: I GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<10OK: BOIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYEn: 1 GAS FURN>•100K: I UNIT HEATERS: HOODS: I OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES. GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1� 0 700 amp: 0 - 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 0 201 400 amp: 201 400 amp: lot W/O SVC/FDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 500 amp: 4111 500 amp: EA ADDL OR CIR: SIONAUPANEL: IN PLANT: MANU HMISVCIFDR: 501 1000 amp: 601+ampa•1000v: MINOR LABEL, 1000•amolvolt PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS SVCIFDR>•225 A.: >800 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL _ B.COMMERCIAL AUDIO 6 STEREO: V•:UUM SYSTEM: AUDIO S STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0tH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATArrELE COMM: NURSE CALLS: TOTAL N SYSTEMS- Owner: Contractor: TOTAL FEES: $ 5,498.37 DON MORISSETTE HOMES DON MORISSETTE HOMES This permit Is subject to the regulations contained In the 4230 GALEWOOD STREET 4230 GALEWOOD STREET Tigard Municipal Code,Stale OR. Specialty Codes and SUITE 100 SUITE 100 all other applicable laws. All work will be done in LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 accordance with approved plans. This permit will expire if work Is not started within 180 days of issuance,or If the work Is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg 0: LIC 35533 forth in OAR 952-001-0010 through 952.001.0080. 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 Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final Footing Insp Crawl Draln/Backwater Electrical Service Low Voltage IPlater Line Insp Final Inspection Foundation Insp Footing/Foundation Dr, Electrical Rough In Gas Line Insp ANpr/Sdwlk Insp Post/Beam Structural PLM/Underfloor Framing Insp Gas FlrFplace Electrical Final Issued By : Permittee Signature : V Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day CITYOF TIGAIRD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00149 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/21/02 SITE ADDRESS; 12409 SW HOLLOW LN PARCEL: 2S103CB-06900 SUBDIVISION- QUAIL HOLLOW- EAST ZONING: R-4.5 BLOCK: LOT: 018 JURISDICTION: 'FIG TENANT" NAME. USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS. INSTALL TYPE: LTPSWR IMPERV;jORFACF: Remarks. Se'Ner Connection permit for no.w SF detached residence. Owner: —_ --.- FEES _ DON MORISSETTE HOMES 4230 GALEWOOD STREET Type By Date Amount Receipt — --- SUITE 100 PRMT CI R 5/21/02 $2,300.00 27200200000 LAKE OSWEGO,OR 97035 INSP CTR 5/21/02 $35.00 272007.00000 Phone: 274-5223 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 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" Perm Issued by: _ Permittee Signature: A y`4 . �c/ `t l A Call (503)639-4175 by 7:00 P.M. for an inspection needed the next business day der -may- U Z,_ a Building Permit Application date received: t ✓ (J�. Permit no.: -f ; a. City Of Tigard Address: 13125 SW Hall blvd,Tigard,OR 97223 Phone: (503) 639-4171 ProjecUappl.na.: Expire date: City Tigard Date issued: P t no.: By:i t� Recei/ � Fax: (503) 598-1960 �!• Case file no.: Payment type: Land use approval: 1&2 family:Simple Complex: c . ;Job 2 family dwelling or acce,sory U Commercial/industrial J Multi-lamely &Nev,construction U Demolition �. dition/alterdtion/replacement U Tenant improvement U Fire sprinkler/alarm U Other: _ dress: c 'Cl '� Bldg.no.: Suite no.: Lot: 1 Block: Subdivision: i >v- Tax map/tax lodaccount no.: Project name: �/• - �r� Description and location of work on premises/special conditions: 1 ` Mailing address: ;71&2 family dweWng: t� City: , State ZIP: Valuation of work........................... ...... Phone: f - Fax: -•7 -mail: No.of bedrooms/baths..........ft•...-... ........ _ - OwnP.'s representative: JE* �Gt'1✓I�� _ Total number of floors................................. Phone: Fax: -mail: New dwelling area(sq.ft.) .......................... ' Garagelcarport area(sq.ft.) -_ Name 1 Covered porch area(sq.ft.) ......................... 1.t — Mailing address: — Deck area(sq.ft.) ........................................ City: — ZIP: Other structure area(s . ft.)........... ............. Phone: Fax: E-mail: Commercisilindavtrial/multi-family: fohit Valuation of work........................................ $ 7Business : Existing bldg.area(sq.ft.) . .. ....... ...........New bldg.area(sq.ft.)........................State ZIP: Number of stories...................................... Phone: Fax: E-mail: Type of construction........................... CCB no.: Occupancy group(s): Exis' g: J-b� _ New: -- — City/metro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: �In � provisions of ORS 701 and may be required to he licensed in tete Address: C4 jurisdiction where work is being performed. If the applicant is City: State: ZIP: exempt from licensing,the following reason applies: Contact person: Plan no.: - —� Phone: Fax: I 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 mid the Na all jurisdictlau accept credo cerdr,please call junidkdon for mae IntormWom attached checklist. A rovisions of I ws and o�finances goventing this U Vias U Mastercard work will be compir . ,whetiier, cifil l flerelfi t. Credit card numher: E I Authorized si natu 1 l.:tF `I l �- Name ar as down on credit e � � S Print name: _� Cardholder dpwurc - Amount Notice:This permit application expires if a permit is not obtained within 190 days after it has been accepted as complete. 4444613(6MCOM) One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: -- CiryofTigard �lt f Tigard Associated permits: City OI O Electrical O Plumbing ❑Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 OOther Phone: (503) 639-4171 1Fax (501)1 98-1960 J THE FOLLOWINIP1 1 ! ' PL AN REVIEW les No N/A 1 Land use actions completed.;icc junsdicuon cntena lin u,,.curtent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plattlot. _ 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 carry original applicable stamp and signature on file or with application 9 Erosion control O plan O permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. — 4 10 _. Complete sets of legible plans.Must be drawn to -ale,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 k/ if copyright violations exist. J� 11 Shelplot plan drawn to sale.The plan must show lot and building setback dimensions;property comer elevations(if there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft intervals);location of easements and driveway;footprint of structure(including deck.,);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 bolt,,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimension,,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such a,floor beams,headers,joists,sub-flown, wall construction,roof construction.Mott than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction. thermal insulation,etc. _ 15 Elevation viers.Provide elevations fur new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater chap four foot at building envelope. Ful!-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 floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining malts. Provide cr03s sections and details showing placement of rebar. For engineered systems,see item 22,"Engineer's calculations." 19 Berm calculations.Provide two sets of calculations using current code design values for all beams and multiple joists i over 10 feet long and/or any beam/joist carrying a non-uniform load, 20 Manufactured floor/roof trnas 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 wa!I,rtK)f truss)shall be stamper'.by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. 23 Five(5)site plans are required for Item 1 I above. Site plans must be 8-1/2"x I I"or I I"x i 7". 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 plans may be in blue or black ink. Red ink is reserved for department use only 440-014 revtrc(JM) Mechanical Permit Application Date received: Permit no.Y, City of Tigard Project/appl.no.: Expire'ifyofTigard Address: 13125 SW Hall B!vd,Tigard,OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: _ Fax: (503) 598-1960 1 Case rile no.: Payment type: Land use al proval: Building permit no.: U I �2 family dwelling or accessory U Cornmercial/industrial U Mulu-family U Teaant improvement >(New construction 0 Add iuon/alteration/replacement U Other. �_- 01117111131 s 1 1 1 e I Job address: \, L V-\ Indicate equipment quantities in boxes below.Indicate the dollar Bldg.no.: Suite no.: _ value of all sr.echanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: A 1131mic: I Subdivision: Zi *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: Z1P: I as Description and location of work on premises: — •i MA I IF110111611REIM. r !11.1 Fee(ea.) Total Est.date of completiordinspection: Description Qty. Res,only Res.OWE Tenant improvement or change of use: it VAC: Is existing space heated or conditioned?U Yes U No Air handling unit _CFM Air con iuoning(sitepanrwr ) Is existing space insulated?O Yes U No A tterauo o�existln A system of er compressors Business name: Sure boiler permit no.: NP Tons BTU/H Address: Tiru`amo a ampere/ uct smoke detectors City U State ZI°: eat pump(site p an requir ) _ Phune: ��- far; E-mail nst rep ace macrJbumer T Including ductwork/vent liner U Yes O No CCB no.: - Install/replace/relocate heiters-suspen e , City/metro lic. no.: N/A _ Y wall,or floor mounted Name(please print): &in"�tELL__ t_-L- ent for a lance other than furnace e gest on: -NJ Absorption units BTU/H Name: `��CL� Chillers HP Address: -- Com rcssors_— HP ' ae onmenta exhaust an vent ton: City: Y State: ZIP: Appliance wmi Phone: Fax: E-mail: i erez aust I s,Type I res. tc a ►azmat hood fire suppression system Name: rAl- _ Exhaust fan with single duct(bath fans) _ Mailing address: ) N, aust System ap;rt ome_au�n or AC City: tie piping an distribution(ui p to A outie!s) State T.1P 1 Type: LPC NG Oil Phone: 7- f,tt E-mail: Fuelpipingeac a itiona over outlets Process piping(Schematicrequired) Name: Number of outlets _ - --- — -- ter listedappliance or equipment: Address:— Decorative fireplace CI[Y� ___ __ St-te: ZIP: Insert-type Phone: ray: .mail stovelpel let stove cr: 4f+plfront's sfpnafu Date: Other. Nirme(print): (�; Yt_f Fir.-I� _ Nx all Jun"cuons accept credit cudc pleaue call Junsdicuon for more Infoemauon Permit fee ....................$ U Visa O MasterCard Notice:This permit application Minimum fee................S expires if a permit is not obtnfncd Credit card number _ _- _,(_`L Plan review(at _ %) $ -- Expires within Igo days ager it has been State surcharge(8%) ....S Nurse of cudhoider u rhowo on credit card accepted as complete. -- _ s TOTAL .......................E _ Cardholder signature Amount 440-J617(6A000`rI , Pluinbing Permit Application Date received: 78ujl�ding no.t Y-, City of Tigard Sewer permit no.: peemitno.: Address: 13125 SW Hall Blvd.Tigard,OR 97225City of Tigard Phone: (503) 639-4171 Project/appl,no.: date: Fat: (503) 598-1960 Date issued: By: Receipt no.. Land use approval: Case file no.: Payment type: TYPE OF PERIMIT U 1 &2 family dwelling or accessory ❑C:ommerciaUindustrial O Multifamily O Tenant impt-vement ew consuucuon C) Addition/alteration/replacement O Food service U Other. FEE 1 L( ( y J I,� � V � C i Description ��. Fee ea. Total Job address: -- New 1-and 2-family dwellings only: Bldg.no.: Suite no.: _ (lodudestoo ft.for each utility connection) Tax map/tax lotlaccount no.: SFR(1)bath Lot Block: Subdivision: • f i " _4 SFR(2)bath _ Project name: SFR(3)bath _ City/county: ZIP: FAch additional batit/kitchen Description and location of work on premises: SiteutHitles: Catch basin/area drain _ Est.date of completionfinspection: DrywellsAcach line/trench drain Footing drain(no.lin. ft.) Manufactured home utilities _ Business name: J_U Manholes Address: Rain drain connector CityState• ZIP: Sani sewer(no.lin. ft.) _ Phone: .� l Fax: (•mail: Storm sewer(no.lin.ft.) Water service(no.lin.ft.) CCB no.: [ "7 Plumb.bus. reg•no: — Fixture or Item; City/metro lic. no.: N/A Absorption valve Contractor's representative signature Back Clow nreventer Print name: Pr U Backwater valve. I BasinsAavatory Clothes washer Name: ,{�� s �, �,- -n -- Dishwasher _ Address: �[ " 1r "V Drinking fountaints) _ I City; State: ZIP: Electors/sump _ Phone: Fax: E-mail: Expansion tank Fixture/sewer cap Name( riot! Floor drains/floor sinks/hub P ` Garbage disposal Mailing address: Hose bibb City _ "1 State ZIP: lee maker Phone: —7_ Fax: 7-7(Gi E-mail: Interceptor/grease tra Owne,r taUadon/resldendal malntendnce only: The actual 'mstallation Pnmer(s) will be madt,b� me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property 1 own as per ORS Chapter 447. Sink(s), basinls), lays(s) Owner's signature.: Date: Sump 111111111 Tubs/shower/shower pan Unnal Name: Water closet Address; ___ Water heater City — State: ZIP_ Other. Phone. E-mail. Total No all lunstlicti"accept cne&cxdt,ple.0 call lunfdicuon for more mfarnnuon Minimum fee................ Nutlet:llns permit application Plan review(al — °R) S — O Visa O MasterCard expires if a permit is not obtained Cmurl cxd number __� within 180 days after it has been State surcharge(8a6) ••••$ _ - eap°efTOTAL ....................... accepted as complete. ` Name of cardtwldtr v rhown wl.refill cud � S Cudholdes 111nalum Am.wnl 1u}.•1616(&MAMNl Electrical Permit Application Date received: Permit no.: ✓� -. City of Tigard Project/appl.no _ Expire date: CifyojTieard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (5031 639-4171 — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval DE 1 x' El I &2 family dwelling or accessory O Cornmerciallindustrial O Multi-family 0 Tenant improvement New construction U Addttion/alte.ratiun/rcplac m.nl CJ Othcr: _ _ C]Partial / { 1 1 Job address: t ;�( L ( I . Bldg.no.: Suite no.: Tax ma tax lot/account no.: Lot: Bleck: Subdivision: i Project name: Description and location of work of premises:' Estimated date of compledonlinspection: FEE SCIIEDOLE Job no: Fee INalr Business name: Ca� New residential- Description pn (d) Total NO.tut Address: L ," dwelling wilt.includes attached guwe. City: stateV- 7- 1P: SerH«included Phone: ,�5- 1 Fax: E-mail: 1000 sq.k or less 4 Each additional 500 sq.ft or portion thereof CCB no.. Elec. bus.lic. no: Urnitedenergy.residential 2 Limited energy,non-residential 2 Each manufactured home or modular dwelling Warr n to ervr rn!rtecrnc+an(rr sired) Date Service and/or Ceder 2 Sup elect name(print) 1 License no Se►ricnor[eeder-bstallatlon, al teration tion or relocation: 200 amps or,less 2 41MIU.1 ijo r 201&nips to 4W amps 2 Name (print ` 40lamps to000arnp: 2 Mailing address: 601 amps to 1000 amps 2 City: State ZIP: Over IOW amps or volts 2 Phone: '-mail: Reconnect only I Owner installation:1-he installation is being made on property I own insitTemporary services or feeder- which is not intended for sale, lease,rent,or exchange according to 200 amp or lesaltlrwtiMl,OrRlncat{tier: 2W amps or less 2 ORS 447,455,479,670,701. 201 amps to 400 amps __ 2 Owner's signature: Date: 401 to 600 amps 2 emich circuits-t—,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each ira itch r.nrcuit 2 City: _ State: ZIP: 8 Fee for branch circuits without purchase of service or feeder fee.first branch circuit: 2 Phone: Fax: E-mail: Each additional branch circuit: _ ' i MVI 19 1 Misc.(Service or feeder not included): O Service over 225 amps-commercial q Health care facility T Each pum or irrigation circle 2 O Service over 320 amps-rating of 1&2 O Hazardous location Each sign or outline figfiung _?_ funilydwellings 0Building over lo,000square feet lwror Signal circuit(s)or a limited energy panel. O System over 600 volts nominal more residential units in one struct ire alteration,or extension2_ O Building over twee stories O Feeders,400&zaps or more 'Description. _ O Occupant load over 99 persons O Manufactured structures or RV park r+ch additional inspection over the■llowable in anv of the above: O EgressAighting plan O Other -- --- Per inspection 1-�—� Submit!_sets of ptans with any of the above. Invesugation fee _ The above are not applicable to temporary construction service. Other Not all jurisdictions xccep credit cants,please call jurisdiction f.A ntr!r information. Notice:This permit application Permit fee.....................$ O Visa O MasterCard expires if a permit is not obtained Plan review(at _- %) S _ Credit card n:mblr _ ___ ___L_L_ within 1.80 days after it has been Stag surcharge(8%) ....S Upimt accepted as complete TOTAL Name of rat Ider u shown on credit card Cardholder signature Amount 440-4615(&MCOM) IlkDON • MORISSETTE OBE : x. 9'71 a a m z a I X C 0 2 P 0 2 A T I D 4230 GI. LE VOOD 9T. 9VITE 1 00 LOT: 18 L5oa 3A7- 7538' FAISX aox 07036 DATE: 4/15/02 'PROPERTY: QUAIL—HOJIZW 8TANUARD 5-:LEVATIGN PITY: TIGARD S''ALE: 1 s=20' PLAN No.: 170 Hu c I 2'19 214 14' 8' F'4TI0' 1 1 so lir 1 3,19* ' 4 bdrm. ' 2 IST bath LIDLI F.F . 2805' 1 - - , : .a 5, 0 -- .406 a ft 2 car da r. ZELKOVA cret 0 ` '• ' SERRATA, 1- 218 / DP1V3wdt ` I . 180 ;Approach •��(�► s" 282 r 12409 IOLLO UJ L yl�G/oz LOT 018 5,100 aq. ft. —"�z>a;;s<.'z�:x �zx;zr: mxzmzrz:z=sxra;zerrae^zzKnnxzzzznz;;^�:::>;';:�x••,z .,..:; ,,.. - :.. ... ::x:;�z�xz`:�;.rx:x-azzxaanzsix+aKatra :IXI M`ILI CITY OF Ti GA R D _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2002-00228 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/18/02 SITE ADDRESS: 12409 SW HOLLOW LN PARCEL: 2S 103CB-06900 SUBDIVISION: QUAIL HOLLOW - FAST ZONING: R-4.5 BLOCK: LOT: 018 JURISDICTION: TIG CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNrRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _^^ _FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Backflow preventer for irrigation _` FEES Owner: _—_ --- —`� .r Type By Date Amount Receipt DON MORISSETTE HOMES pRM4 CTR 6/18/02 $36.25 27200200000 4230 .HALEWOOD STREET 5PC2 CTR 6/18/02 $2.90 27200200000 SUITE 100 LAKE OSWEGO, OR 97035 Total $39.15 Phone 1: 274-5223 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSOIlVILLE, OR 97070 REQUIRED INSPECTIONS Phone 1: 682-6076 RP/Backflow Preventer Reg #: LIC 6136 Final Inspection PLM 11558 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. 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: r Permittee Signature: '} Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day 'D I Plumbing Permit Application --1— _.—�— Datcrcccivt:d: !J�— Permit no City o Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,TtzI,:d,DU 47 Circ ajTigard phone: (503) 639-4171 J Project/eppl.no.: Expire date: Fax: (503) 598-1960 Date issued: By:r�F Recelptno.: Land use approval: case file no.: Payment type: U 1 &2 family dwelling oi accessory Q Commerciallindustrial U Multi-family U Tenant improvement `*New construction O ndditionlalteration/replacement U Food service ❑Other: _ 1 INFORMATION 1 t Job address: /v1 yr "I i [-�_ / (_ c 1)cs.criptiou _ (1ty. Fee ea.) 'Total New 1 and 1-Family duelling%only: Bldg.no.: Suite no.: (includes 100 ft.Ibr each unlit)connection) Tax map/tax lot/account no.: _ SFR(1)bath Lot: jyr jBlock: SubdivisiomC,3.1-CG kf t 31SFR(2)bath -- — - - - Project name: t;(CL(A I+Z)t /.fl.,:) ( SHR(3)bath City/county: ZLP: C �' , J _ Each additional bath/kitchen L)escttion a�n� 'on work on premises: _ Site uNli(lea: �w c c e, Catch basintarea drain Est.date of coma leti.,n/inst ctioll.. f W ,� - l i Drywells/l mch line/trench drain tLUMFooting drain(no.lin. ft,) _ ' — Manufactured home utilities B' iness name: Pry&r-As S [.L�/)Gf SCo t,;�� _ Manholes _ Address:�i9 fy S SW Rain drain connector _ 1; City: e, Stateb ZIP:'-70 V ^ Sanitary sewer(no.lin.ft.) Phone:L-&J\-W7 all Fax: $ -41Q7 E-mail: Storm sewer(no.lin.ft.) CCB no.; (o(a I Plumb.bus.reg.no: Water service(no.lin.ft.) City/metro lic.no.: 003:4'7 Fixture or Item: Absorption valve Contractor's representative signature.: Z_Lei t�e'ti Lt EDishwast..,r w preventer 7 5 Print name. S 'A►'I VIA—` Date: , ! .�. er valve ( Basins/lavatory _ Name: washer ktl tl e rCt 0 - - �.q Q45 S� 1CLnS11 A4k t:sc Address: �f fountains) City: W11rMjj 1C, State:U(Z 7.IP �1 o"J U sum AiAika6 l-q " E-mail: n tank r Fixture/sewer cap _ Floor drains/floor sinks/huh _ Name(print): �sse�_+e_ 1t Garnagedisposal Mailing address:14;130 (>v CialeAuood Sr SiLLIlt I t"UHosc bibb city: LA rt, I State: R ZIP:q 703V. Ice maker Phone: I Fax: E-mail: Interceptor/grease tri Owner installation/residential maintenance only: The actual Installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as p.r ORS Chapter 447. Sink(s),basin(s),Ims(s) Owner's signature: Date: Sunt Tubs/shower/shower an Urinal Name: ,_. \pater closet _ Address: Water heater City: State: ZIP: Other: _ Phone: Fax: E-mail: oral Not all 1miacdoas keeps cmht cards,please call jurisdiction for more information. Notice:This permit application Minimum fee................$ ' • °� - Plan review(at ! 96) $ _ UY,a C1 Muterc'ard expires if a permit is not obtained credit card numbs. — --- —L-- within 1 go days after it has been State surcharge(8%) ....$ — xpires / Name or cardiwlder u drown on credh cup`. $ accepted 3s complete. TOTAL .......................$ -- Cardholder sipm!__ --Amount 440.1616(6MCOM) PLUMBING PERMIT FEES: PRICE' TOTAI New 1 and 2 tamliy.tlwellAna',. `. -I FiXTURES'(Individua{ QTY ea AMOl,NT, (Includes aIl,Qlurtibirig'fixjuresin PRICE '66tAL ---�--- --- -- thedwel ,�.�A d e tlrf100.ft QTY (e r ifOUNT Sink _ s`'" 18.80 foFbif }i iff 01041 Lavatory One 1 bath r $249.20 Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 Shower Only 16.80 Three 3 bath $389.00 Water Closet 18.60 SUBTOTAL _- Urinal 16.60 6%STATE SURCHARGE r, Dishwasher 16,80 PLAN REVIEW 25%OF SUBTOTAL TOTAL 16.60 - __-- Go age Disposal -- Laundry Tray 16.80 Washing Machine 18.80 FloorDraln/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 - -- - - -- •QuanUt b WorkPerforred Water Heater O conversion 0 like kind 16.60 Fixture Type New Moved Replaced Pemoved/ Gas piping requires a separate mocha-lcal ;':Y _Crpped ermit. Sink -� - MFG Home New Water Service 46.40 - ----- 46.40 Lavato MFG Home New SanIStorm Sewer Tub or Tub/Shower Hose Bibs 16.60 Combination _-- _- Root DrainsE 16.60 Shower Only -- 16.60 Water Closet _ _--- Drinking Fountain - Urinal --------- Other Fixtures(Spa '`y) 16.60 Dishwasher Garbs a Disposal Laund Room Tra Washina Machine - _ Floor Drain/Sink: 2" Sewer•1 at 100' 55.00 3" Sewer-each additional 100' 4"00 Water Heater - _ ---- Water Service-tsl 100' 55. Other Fixtures Water Service-each additional 200' 46.40 S ecf Storm&Rain Drain-1st 100' 55.00 Storm&Rain Or •each additional 100' 46.40 F - - Commercial Back Flow Prevention' 46.40 -- Residential Backflow Prevention Ot 116.80 55 -J Catch Basin 6 Inspection of Exiting Plumbing or Spaclaltu 72.50 COMMENTS REGARDING ABOVE: r . uested Inspections ---- Rain Drain,single family dwelling 65.25 Grease Traps 18 80 �- QUANTITY TOTAL ► �` A7 .'S Isometric or riser diagram is required if / KI � *SUBTOTAL 8%STATE SURCHARGE p,yo - "PLAN REVIEW 25%OF SUBTOTAL Requtrnd only it fixture qty.total is?9 TOTAL y *Minimum permit fee is 172 50•a%state surcharge,except ReskJential Backflow Prevention Device,wl h Is$38 25+a%stale surcharge "All New Commerclst Buildings require plans with Isometric or deer diagram and plan review I:\dsts\f,)rms\pi-:-teesAoc 10'10/00