8800 SW MAPLE COURT }inoo eldeW MS 0088
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CITY'bF TIGARD BUILDING INSPECTION DIVISION T `L
24-Hour Inspection Line: 639-4176 Business Line: 639-4171
� �.3 BUP'
Data Requested AM PM _ BLD
Location g/��G� �� �- [ , -- Suite _ MEC
Contact Person Ph , L" 75 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Waal ELR
Fnoting CC SS.
Foundation Z C�/ �j FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: -
Slab — SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear 1 Q
Framing \
Insulation
Drywall Nailing � �f -•� C'�.
FirewallJz
`-
Fire Sprinkler
Fire Alarm
Susp'd Ceiling w`- �_
Roof
Misc: _ _ — ---_
Final
PASS PART FAIL_ - - -
PLUMBING
Post&Beam
Under Slab
Top Out
Water Service _
Sanitary Sewer
Rain Drains
7PXFm
C PART FAIT_
MEZANICAL
Post&Beam -- —
Rough In
Gas Line
Smoke Dampers
Final
PASS PAR r FAIL
IL ELECTRICAL — --�
Service
N Rough In
UG/Slab
Low Voltage
J Fire Alarm
0 Final
PASS PART FAIL -
J SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
,7 ire Supply Line [ ]Please call for reinspection RE: — [ ]Unable to inspect-no access
ADA
Approach/Sidewalk c--� 0 1
Other Date Inspector
Final
PASS PART FAIL I DO NOT REMOVE this Inspection record from the job site.
CITY OF T,"GARD BUILDING INSPECTION DIVISIONMST 14.,22 - Dd -7324-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested "3 AM PM BLD
Location 0 FU - Suite _ :MEC
Contact Person �� Ph — PLM _
Contractor _ Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR _—
Footing Ices ;� FPS
Foundation —
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
Susp'd Ceiling -- —
Roof
Final
PASS PART FAIL — - — — ---
PLUMBING
Post&Beam
Under Slab _ _—
Top Out _
Water Service
Sanitary Sewer
Rain Drains —
Final
PASS PART FAIT_
MECHANICAL
Post&Beare — -- —
Rough In
Gas Line — �-
Smoke Dampers
Final -- —
PASS PART FAIL
ELECTRICAL —
IL Service
Rough In
t`- UG/Slab — --
v� Low Voltage
Fir !arm -- --- -- —
J
_� _ ASS PART FAIL
:71
3
J Backfill/Grading -- — —
Sanitary Sewer
Stone Drain [ )Reinspection fee of$ _required before ne t inspection. Pay at City Hall, 13125 SW Hal!Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RF: [ J Unable to inspect-no access
ADA /
Approach/Sidewalk
Other Date rL Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the JoL site.
I _
CITY OF TIGARD BUILDING INSPECTION DIVISIONx
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST _
BLIP
Date Requested LZ X.: PM BLD _
Location Y-n f L Suite MEC
Contact Person (� )( i1 _ Ph 45 PLM
Contractor Ph SWR _
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation �_ -Z_ �� FPS
Ftg Drain
SGN
Crawl Drain Inspection Notes:
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framingcal �oG ,
Insulation
Drywall Nailing .t/EGr> ZE,^zAL —CedAzQ lAV-1.2
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
R oof
Mis
ISaC;-- - -
PASS PART -
PLUMBING
Post&Beam
Under Slab
Top Out _
Water Service
Sanitary S(--or �-
Rain Drains
Final -
PASS PART FAIL
MECHANICAL
Post& Beam ----
Rough In
Gas Line - -
Smoke Dampers
S PART FAIL
ELEMICAL '--
Service
(L Rough In
UG/Slab
F- Low Voltage
U) Fire Alarm
Final
J PASS PART FAIL
_m SITE
Backfill/GradingLu
-- --
Sanitary Sewer
Storm Drain [ 1 Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE:
Fire 1'vpply Line [ ]Unable to inspect no access
ADA
Approa,-,h/Sidewalk Date 9-1-7— e-14
Inspector Ext
Other _
Final
PASS FART FAIL DO NOT REMOVE this Inspection record from the Job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST - 73
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
�7BUP
Date Requested d ' Z -2- 4M PM BUD _
Location �'�Z — Suite _ _ MEC
Contact Person ( , 7nc Ph 0 1 q ��o -7S PLM
Contractor Ph SWR
BUILDING 1'enanUOwner ELC
Retaining Wall ELR
Footing Access:
Foundation � � —z— FPS
Fig Drain SGN
Crawl Drain Inspection Notes:
Slab _ SIT
Post &Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing t 'i-Al= S7—.- ti 0 sr
Insulation
Drywall Nai,4ng
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: --
inal
PART FAIL --- —--
ING
Post&Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final —
PASS PART FAIL
MECHANICAL
Post&Beam —
Rough In
Gas Line -- — ---
Smoke Dampers
ASS ( PAT FAIL
ELECTRICAL — — �—
p, Service __-
0e Rough In
F'- UG/Slab
N Low Voltage
Fire Alarm _
J Final
_m PASS PART FAIL
SITE
a Backfill/Gram g -- — -�
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: [ ]Unable to inspect-no access
ADA
Approach!Sfdewalk Date
Other _ — Z-�� t;L_Inspector w Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
JIM'S PLUMBING
PO BOX 7160
ALOHA, OR 97007
Plumbing Signature Form
Permit#: MST2001-00073
Date Issued: 3/9/01
Parcel: 1 S135AA-06500
Site Address: 08800 SW MAPLE CT
Subdivision: MAPLE RIDGE ESTATES
Block: Lot: 020
Jurisdiction: TIG
Zoning: R-12
Remarks: SF/A Path 1
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plLImb+ng permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this completed fort" is received
OWNER: PLUMBING CONTRACTOR:
WINDWOOD HOMES INC. JIM'S PLUMBING
12665 SW NORTH DAKOTA PO BOX 7160
TIGARD, OR 97223 ALOHA, OR 97007
Phone #: 503-625-6526 Phone #: 649-4034
Reg #: I_IG 71860
PI M 34-186nb
a
AN INK SIGNATURE IS REQUIRED ON THIS FORM
i
X
Signature of Auth zed P tuber
If you have any questions, plPs-se call (503) 639-4171, ext. # 310
CITY i0 F TIGARD MASTER PERMIT
PERMIT#: MST2001-00073
DEVELOPMENT SERVICES DATE ISSUED: 3/9/01
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171
SITE ADDRESS: 08800 SW MAPLE CT PARCEL: 1S135AA-06500
SUBDIVISION: MAPLE RIDGE ESTATES ZONING: R-12
BLOCK: LOT:020 JURISDICTION: TIG
REMARKS: SF/A Path 1
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRFO
CLASS OF WORK: NEW HEIGHT: 12 FIRST: 956 of BASEMENT: of LEFT: 3 SMOKE DETECTORS: V
TYPE OF(ISE: SF FLOOR LOAD: 40 SECOND: of GARAGE: 220 of FRONT: 10 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: at RIGHT: n
VALUE; $87,67900
OCCUPANCY GRP: R3 BORM: 2 BATH: 2 TOTAL: 95600 at REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH:. 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: 1 GARBAGE DISP: 1 WATER HEATERS 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS-
OTHER FIXTUPFS:
MECHANICAL
FUEL TYPES FURN<100K: 1 BOIL/CMP<3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN>-100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX IMP: htu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP ERVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS _ ADWL INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: WISVC OR FOR: 1 PIIMPnRRIGATION: PER INSPECTION:
EA ADD'L 5005IF: 1 201 400 amp: 201 - 400 amp: 1st W/O SVrfFDR: 00 SIGN/OUT LIN LT- PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 -600 amp: EA ADDL BR CIR- SIGNALIPANEL: IN PLANT:
MANU HM/SVC/FDR: 601 - 1000 amp: 601-amps-1000v: MINOR LABEL:
1000•amplvolt
PLAN REVIEW SECT.ON
Reconnect enlV: '-
-4 RES UNITS: SVCIFDR>*225 A.: >60n V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPFIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA7TELE COMM: NURSE CALLS: TOTAL f SYSTEMS:
TOTAL FEES: $ 5,603,28
I owner: C^ntrector: This permit is subject to the regulations contained in the
WINDWOOD HOMES INC WINDWOOD HOMES INC
Tigard Municipal Code,State of OR. Specialty Codas and
12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA all other applicable laws. All work will he done in
TIGARD,OR 97223 TIGARD,OR 97223
accordance with approved plans. This permit will expire K
d work is not started within 180 days of issuance,or if the
work is suspended for more than 160 days. ATTENTION:
F. Phone: Phone: 700-4375(M) Oregon law requires you to follow rules adopted by the
UD Oregon Utility Notification Center. Those rules are set
}
Reg 0: LIC 50196 forth in OAR 952-001-0010 through 952-001-0080. You
LL may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
m REQUIRED INSPECTIONS
W Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Shear Wall Insp Gyp Board Insp Electrical Final
Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Ins[ Firewall Insp Mechanical Final
Fooling Insp Crawl Drain/Backwater Electrical Service Low Voltage Rain drain Insp Plumb Final
Foundation Insp Footing/Foundation Dr. Electrical Rough In Gas Line Insp '."later Line Insp Final inspection
Post/Beam Structural PI-M/Underfloor Framing Insp Insulation Insp Appr/Sdwlk Insp Building Final
Issued By A.,)-I'k1 1 '' Permittee SignatureCall (5 3) 639-4175 by 7:00 p.m.for an Inspection needed the next business day
CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-00040
L,
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUED: 3/9/01
SITE ADDRESS; 08800 SW MAPLE CT PARCEL: 1S135AA-06500
SUBDIVISION: MAPLE RIDGE ESTATES ZONING: R-12
BLOCK: LOT: 020 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection fcr new SFA dwelling.
Owner:
FEES
WINDWOOD HOMES INC. Type By Date Amount Receipt
12655 SW NORTH DAKOTA
TIGARD, OR 97223 PRMT CTR 3/9/01 $2,300.00 27200100000
INSP CTR 3/9/01 $35.00 27200100000
Phone: 503-625-6526 Total $2,335.00
Contractor:
Phone:
Reg#:
Required Inspections
a
M
rrn
t
J
m
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
J 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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow ru!es 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 by calling(503) 246-1987.
Issued by: Permittee signature:
Call ( 03) 639-4175 by 7:00 P.M.for an Inspection needed the next business day
10/09'00 1101 I38:.53 KIA 503 598 1960 CITY OF T(G,tRDr j-007'zg Q003
O -OGfO/d
Building Permit Application REMENOM
City of Tigard Datereceived: Permitno.:,q /.-Q
City oJTignrd
Address: 13125 SW Nall Blvd,Tigard,OR 97223 Prolectlappl.no.: Expire date:
Phone: (503)6394171 Date issued: By: Rcccipt no.:
Fax:(503)598-1960
Case file no., Payment type:
Land use approva' _ ldc2family simple Complex:
&2 family dwelling or accessory ❑Commerciallutdustrial Q Multi-family Et 1�ew construction ❑Demolition
C1 Addition/alteration/re:placement U Tenant improvement U Fite yuinkkr/alarm U Other. f`
Job addmas:
Fild1j.no.: Suite
Lot:_ Co Block: Subdivision: �J, !�.,G 2 j;Ck lgTax tM lot/accoerat no.: /S 3 SAH
Description and location of wodc onhes/rpecial conditions: S: / q SSG fin
`4 / G
Name:
Mailing address: / 5 :� r,.2, y�Ja,�. 1&2&8*dwdbr.
City: r` /f./L Slate." 7P: n, '. Valuation of work...................
S 1
Phone: i .6 S Fax:' E-mall: No.of bedrocnu/baths..:'........ :.......
Owner's n tative: Total member of floors.............
Phone: 'CLt az;,. C 1: New dwelling area(sq.It.)...9*'..........
Garagelcarport area(sq,ft.).... -t.......... �
Name: rch overed C
_ger► Po area(sq.ft)....r...............
r-
Mailte address: n-i.rz Deck area(sq.ft.)....................:...................
City: j'y/y1 L,- '- State: ap: Other structure area(sq.ft)....,r ...........
Phone: 5/ znLy- Fax: Email: Consexelttlfl:.dtraMaUtesltl-tulle:
Valuation of work........................................ $
7Adsr
ame: S�Q,n�' Existing bldg.area(sq.ft.) ............... .........
New bldg.acv(sq.ft.)....�. ......
` G.<�4m Stere:_ 7JP: Number of sttxira....................
.................
Phone: Fax: E-mail: Type of canslntction.......... ....... .............
CCB no.: .��<' Occupancy group(s): , ting;
1•
City/roetrtr sic.no-: Notkc All contractors and subcontractorsare required to be
licensed with the Oregon Construction Contractors Boars under
Name: - ���z -/ ��� pmvisiora of ORS 701 r, 1 may be squired to he licensed in the
Jurisdiction where work is being performed.If the appliLant is
Ci �� / Smt , exempt from.licensing,the following reason applies:
Contact person: Cult Plan no.: [/ ---
Phone:. Fax: / - E mau: —
Name: ,C�$ ( Contact oetson: bc ir Fees due ulym application............ .....$
..........
Address: 'a,2 _ Date received:
City: State• , ZIP: Amount rtccived ...........S
a - E-mail:
j Phone: xz� . Please refer to fee schedule.
I hereby certify l have read and ex.rained this application and the Na Ni IuitAc- reept M-arch,pe*,as j.,„,s,,M fa MM iw m d
attached checklist.All provisions of taws and ordinances governing this o wt■ 0 Mut rCard
work will be complied with,whethff_specified herein or not. CrFaf andtrwba
_ 64 �
Authorized signature: �`- Darr: l^ 1/' rC -- N. of .. ,—annea�e
Print name: _ $
-� waoair.e _— Agorrl
Notice.:This permit application expires if a per-cit is not ohmined within 180 days after it has been accepted as complete. 441,46113 MMX-0M1
10/09/00 MON 08:55 FAX 503 598 1.960 CITY OF TIGARD 6m 005
Mechanical Permit Application
Date received: Permit no.:
City of Tigard ProJecdappl.ao.: i3xpirta.te: •�
Cifyo;�gard Address: 13125 SW Hall Blvd,Tigard,OR 97213
Phone:(503)639-4171 Date issued: By: Receipt no.:
Fax: (503)598-1960 Case fileno.: Payment type:
Land use approval: permit no.:
Q't 17 tutnily dwelling or accLAmwy 0 Comax2vio induatrW 0 Multi-hmily 0 Tenant improvement
w construction ❑Addition/alteradoohepixanent 0 Other.
Job addmss: ItdicaW Nulpmtmt quantities in boxes below.Indian the dollar
Bldg.no.: Suite no.: _ ndue of all medunical mgcdllt,aWdPmmk WIN,ovedwad,
Tax lothconunt no.: /,5 s3 /�(� ! , J„e
59110ft Value$
Lot Black: SuMiviaitm: PLLT/L py "See checklist for important application information and
Pio' °alt>c_ A 44, "'S-6 f!> +t-J'tf3 1udodkSm's the schedule for tssidential permit fes.
City/county:T '.44Z LR zfl''
Description and location of work on penises:(~
Fsa(•.) Taw
Ek date of cr,!&tiodmspection. p4L 144a.
swy
Tenant improvement or change of use: t
le existing space heattd or conditiomed7 Q Yta Q K0
Air unit t77M
Is existing space insulated?0 Yes Ja Na
A.s stem
Br�sinUts name: (,V �,d __ G State boiler paink no.:
EQ' Toes BMIH
Adtineas: sal-!. HP
'Y2 r State:.-4A ZIP: Heat punip(IM pin requW
drrctwwVvtat Wren O Yes Q No
CCB no.: �••�L p�^
Cit
ylnwtm lic.no.: _ wall,oa floor m xmted
Name(please print): D#zWX tart or an ftw4ce
Abwrpdoa uWta BTWH
Nary: ✓lam ���;slf� r{}S Chalkn„ _ HP
Address: r.1y A1' L., HP
Ck
'' Sn, L State: Zlp: Applianaevent K;
Phone' /�-�r1d�•- Fax: S-mail•
Hooft Type t
Isood f1m suppression system
Name: , / T.A= A-Alit,. Bxh"fanduc (bath fans)
Mailing address: !'151 Z., ,yt O A.Crp' ust systm som ftm mating a t. _
City: — L/✓' State^ ZIP up to 4 outlets)
Phone: ,;,;I- �t Fax: � Email: mna own LPG odMIland ovaon -
C regrt
Name` r4twber oroutlen _
Address: MAW ff"
a�►�suce ar
Dtrcontiv,,iueplace
City: State: 7.1P
Phone: Fax: E-mui1: ry etatov`e
Applicant's signature: Dime:
Name(pint):
Na an jris4,►ms wcw«mu CMIC pkw dl jou sefim for mat infF>r w"L Permit fee.....................$
Notice:This permit application
❑Mw O MasterCard Notice:
if a permit is not obtained Plan
ni fee..,---—**.'.'-
Ce.. .... .....S
cnr cadPlan nevievi�w(at
g, , within 110 der after it has been .
..b u m raid'— accephed w complete. State suchfirge(896)....$
s 'fMAY........................S r
Amorrot
+4o417(hoar MO
10/09 '00 MON 08:56 FAX 503 598 1960 CITY OF TIGARD Q006
Electrical Permit Application
Dateteuived: Permit no.:
City sof Tigard Projcct/appt.no.: Expiredate:
coyafTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued:
Phone: (503)639-4171 OY- Re=rtgtno.:
Fax: (503)598-1960 Cafe hie no.: payment type:
Land use approval.
$1&2 family dwelbng or accessory 0 Commereial/industrial 0 Multi-family O Tenant improvement
Ja-Vew construction O Addition/alteration/replacement 0 Other.` U Partin)
Job addrms: no.: Tan mapitax lot/account aio.:/
Lot: Bloa: subdivision:
Roje-x name: /),[LOC e�`11,1 f)L E' Description and location of war as premises:
Estimated date ofIetiWins 'on:
Job tm _ Fw NOR
Business name: �'�� w5 ,, ; :y.-^ D.rer/.yea s T'.asl aw
Address: (j /I^ A''v C NswnaYaalii-tttttalaertaallt4albpr
sl4wtltlgtatttt.tirishe aalneariorttp.
City- Ec _ State_"' ZIP:g7,1-Z, 9er�keitlair�
Phone: _ / Fax:�- E-mail: --_ 1000 I .R or len 4
CCB no.: �.q 1�Elec.txu.tic.no: 13 y- lmr a"dmd 500 R or dwror
,raaidtrtdal 2
Ctty/mrxrolit'rao.; ;+P rc7!c-y 3F Limited ,nodwe 2
tiarb saaadelatat114otaaeraoeater dwd4tq
s _erre of SUM!ising electrician(required) Dun cv swots adfafbtttter 2
sop.elect ebbe(plag: pay Uceetaeml9 � � - •
rliraltatt w rebea6ea:
2
NatdC(print): /, r L/ wrt r 111 .rrJt�L- 401 ria 600 amps 2
2H Mario 400 an"
Mailing address: / N4 601 to 1000 2
Ci : 7- . Slate ZIP: r' � �- Ovr 1000 cr vats 2
Pbom:,/,,-
it"oendonly 1
Owner installation:The installation is being mark on property 10" Teas�Maeradrtnsor "
which is not inttanded for sale,lean,rent,or exchange amortling to 6w atlwlsat,ttttseetatl.R K^
ORS 447,435.479,670,701. 200 a et isaa 2
20l b 400 2
Owner`s a IJate: 401 to 600 amp2
tinrri elrNN16-aaw►,allevaWa,
f aaa4arfaa l4r paasi
Name: It Fal fer beach eirmim wlm pr olms of
A _ serrice or hadsr Pee,each btmch cb=k 2
State: `dlP�.. _ B. Fee a r brrayt ei cults woat pwdum
Phone: Fax: _ E-mail: of taxvice abor feeds fen fire 11 d,oau: 2
Faeh obstloew httnm d suit
morlull mwe.001 Wb0d rtrat
d 0 service ow 225 smpa-eoe»orercial 0 Health-ore recaity Esch or kdpdon chete 2
0 Service,-w 320 sngm r ing of 1 a:2 0 Haznbas location Eseb smear oudift llandn g 2
familydwelliaas 0Budding over l(k=square Im'airas sirdCIeUR(s)tx.+imitedenagypsoel, —
tA 0 symm aver 600 volts nornbW mote 4eddedal swift in am aaacimt+ alteration orestdtaionO 2
Building overtlrm oodes 0 Ferias,400 amp or mots *Dwrl :
0 Ot aVm load aver 99 persons 0 Mmufaetsmd struchm or RV park FA&„
J 0 F-p-tffigWingpim 0 Omer �T..._
m Per
Soimlt—act.of}lane with awy of the ams av i6rbn fbe
C7 The ailma l are oat a cable to tewoorary eaissttrw"M airvka. Othu
Ul
-.1 Net ser p hdicdms--”e-ft sir,pea-11 to sm-Por ataw W;T&Yaa Notice:'Ills permit r,rpiication Permit fec.....................
O Visa 0 MatoCard eve"if a permit is not oksh�ed Plan review(at_•%) $
Creat ewd mamba __ ---L—L— within 110 drys after it has been State W- t W 0%)--•S _
i xpi ., accepted as complete. TOTAL $
—fid r d w�n as
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10!09'00 MON 08:54 FAX 503 598 1960 CITY OF TIGARD Q004
Plumbing Permit Application
I}ale received: Permit no.:
City of Tigard ---
Address: 13sewer permit no.: Auildingpemiltoo.•125 SW Hall Blvd,Tigard,OR 97223 —
Ciryoj7igard Phone: (503)639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Dotelsaued: By: I Receiptno.:
Land use approval: - -- -- Case ale no.: paymeru type: --
ILY f&2 family dwelling or accessory U Commercialrndustrial U Multi-family U Tenant improvement
New woshcretion U Addition/alteration/replacement U Food service U Other:
Job address: Fm ter, ToW
Bldg.no.: Suite no.: ew�- r
(ln•Jtt�iM d lbtrestehaxfllty ao�ation)
Tax map✓tax lot/soommtno.: ! 3 ' / !� ?210 L- f'� / SFR(1)bath
Lot Black: Subdivision: n , �- (2)bath
Project mune: iE1 (3)bath
City/county: Q cv& I ZIP: 7.,y 3Each additional bathikitchen
Description and location of work on ptsrtrisee: S ^Q•J_ Catch Chet ba"
sWarea dein
Est.date of camel ed m
oting drain no. 'a ft)
Business name: L/ un ties
Address: N /J""'1, Rain dritin connector -
f3ty, J t. /l. Statov/L ZIP: -9-2—mawry sewer(no.lin.@.) - -Phone: 6`1Y_[ Fax: 'I, I E-mull: Storm$ewor o.lir[.ft.) _
CCB no. -7l 5 r-7 Plumb.bus.reg.no: 2C./�•/�° [tear trrviCe ao.Fbttwe or lttefa:
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City/metro lie.no.: rJ o (n S.T` valve
cootractor"s represeatative Signature: / _ -
Buft flow venter
Flint name: Date://.fl& Da Back-
she
Name: 97(. 1A A4n4 4 Clothes washer
Address: 3 d X '7/ washer -
Drinking fountain(s) ,
City: A state: ZIP92OC14 ton/
Phone: / L*j 3 ax: ` Fs-mail: tok
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x sewer clip �— --
Name(print): uta ,U ht^A,15 jr;vC.. floor oornkslhwb
Mailing address- —S r-.y --
City: ,+G 4troe�^;, ZIP �Hose�j
tx mater
Phone: jFax:' ,2n &rrsil: Interne tori cease trap
owner installation/residentW maintenance only: The actual installation 'mer($) -will be made try me or the maintenance and rtx*►-r made by my regrtlar oof drain(commercial)
IL entployne on the property I own as per ORS C►-, :r 447. ink(s),basin(s),lays(s) _
B' Owna's si Sum
N Tubs/shower/shower pan
Nam l - Iridal —
.� Addrm: - _ ater cam_---
-� star treater
m city: State:
C7 Phone: Fax: Email: ZZI
W
W Minimum fee...............$
U��" e �`•�`A i ra"VM�!n*n Notioe:.Thus permit application Plan review(at _%) $ --
motercard expire if a permit is not been
Cm� °d
t card 0 "r-- within ISO days after ft has
a$bbeen Sutte,suteltttrge(8%)....$Name of aadAddm r An an avO a -- accepted as complete. TOTAL.......................$
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