13725 SW SANDRIDGE DRIVE a
1
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13725 SW Sandridge Drive
Ci1TY OF TIGARD 24-Hour
BUILDING Inspecticn Line: (503) 639-4175
MS11 --
INSPECTION DIVISION Business Line: (503)639-4171
BUP -
Received Date Requested�. �` -- ___ AM PM BUP
Location ) ? ?'AS S.W S A TIb W 0 611E Suite MEC
Contact Person — Ph( ) _ - PLM
�� \10�Z_'b_ — __. Ph(_. b - D SWR
Contractor.; � - �'�-�F-�-�--
BUILD_ING Tenant/Owner _ ELC
Footing E,C
Foundation Access: ELR O 0 Q r77
Ftg Drain
Crawl Drain ---• -- -
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear --
Int Sheath/Shear
Framing _ . -
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Roof
Other:
Final _
PASS PART FAIL
PLUMBINGt -.w -- - --
Post&Beam
Under Slab - -- -- ------ - ------- _-
Rough-In
Water Service - ---- - -- - — -
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain ------ -
Shower Pen _-
Other'--- - ---- - ----
Final
PASS PART FAIL
MECHANICAL _
Post&Beam
Rough-In
Gas Line
Smoke Dampers - -
Final
eS PART FAIL
TRI
Rough-In
UG/Slab
w o ta
rkee ------- -.a_ - ---
arta
Reinspection fee of$ _-�_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
c PART FAIL
SITE Please call for reinspection RE: F-1Unable to inspect-no access
Fire Supply Line
ADA
Dote s zot
Approach/Sidewalk s --�- -
Other: /
Final DO NOT REMOVE this Inspectic 1 record frbrn the jda site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST —�=?
INSPECTION DIVISION Business Line: (503)639-4171
BUP --. ..-
Received Date Requested — AM ---PM _ BUP
Location —_ 7a ,S- -Suite MEC
Contact Person - --- ---- Ph PLM --- --
Contractor____-- —_-- ------_ _---- Ph( ) -- -- SWR ---__--
BUILDING Tenant/Owner ,__ _--- __ __—__ ELC _-
Footing ----- ELC
Foundation Access:
Fig Drain ELR �
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam - -- - - --- - -- --- - ----- ___
Shear Anchors
Ext Sheath/Shear --
Int Sheath/Shear
Framing ------- --- .._.--- - ------ ----- ---
Insulation _
Drywall Nailing -
Firewall
Fire Sprinkler - --- --"— ------- - -
Fire Alarm
Susp'd Ceiling
Roo, lnfy�
h, � _ ��a O U "b � �_ n 7
Other:- --__--T- -_- r
Final
PASS PART FAIL
PLUMBING _ — ----- ----
Post&Beam
Under Slab --
Rough-In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain - ----- ---"
Shower Pan
Other:
Final -------------.
PASS_ PART FAIL
Post& Beam —
Rough-In -- - - - --- -- -------
Gas Line
I Smoke Dampers — _ --- -- -----..— - ---- ----
Final
PASS PART FAIL ----___ ---------
ELECTRICAL - - -- ------ — ----- ----- -----------
Service
Rough-In — ------- - —-- -- — -
UG/Sla
Fire Alarm n
G
PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S - -- Please call for reinspection RE: -- El Unable to inspect-no access
Fire Supply Line
x7�
ADA --
Approach/Sidewalk Date � Ext
Other: - ----
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGaARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST.
INSPECTION DIVISION lousiness Line: (503) 639-4171
BLIP
Received ^7 �Dattee'Requested �— AM PM BLIP _
Location _.f J /cam _ C�_� 4 Suite—_______ MEC ---_
Contact Person _ -___ ____. �q — _ h(— ) —�J�q �/3t'o� PLM
Convactor- ---- - Ph SWR
BUILDING Tenant/Owner _ ELC
Footing E L.0 -
Foundation Access:
Ftg Drain EL.R
Crawl Drain _
Slab Inspection Notes: 51T -
Post&Beam --- - -- _ ---
Shear Anchors
Ext Sheath/Shear -----
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -- -
Firewall
Fire Sprinkler ----- -�-
Fire Alarm
Susp'd Ceiling
Roof
Other: —
Final
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service ---
Sanitary Sewer
Rain Drains ---
Catch Basin/Manhole
Storm Drain - -_---- —
Shower Pan r -
Other:
n
PART FAIL
MECHANICAL - --
Post& Beam
Rough-In -- --- —
Gas Lane
Smoke Dampers -- -- —
Final
PASS PART FAIL -
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage --
Fire Alarm
Final F-1 Reinspection fee of$--_. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - - ❑ Please call for reinspection RE:_— _—_--—.. [] Unable to inspect-no access
Fire Supply LireI��
ADA
Approach/Sidewalk Date lns,pecto►
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST "
INSPECTION DIVISION Business Line: (503) 639-4171 - -�
BLIP - -- -- - --
Received Date Requested �+ __ AM _ PM BLIP -
Location /.3Sw .S�.nid - —- - ---Suite_- ---- MEC —
Contact Person - -- -- - - Ph l-- ----) �/�l- X1.3 � (__ PLM
Contractor Ph( _ ____ SWR
Tenant/Owner - -- - - - ELC - - -- -- -- -
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain _
Slab Inspection Nole,, SIT - - -
Post& Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler ---- -
Fire Alarm
Susp'd Ceiling --_—
Roof
Final^ -- '�
PART FAIL - ----------- -- --
PLBING
P�3-sf&Beam
Under Slab -
Rough-In
Water Service - - --- —
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain — -
Shower Pan
Other: _ ------ --- ---
Final
PASS _PART FAIL -
MECHANICAL
Post&Beam
Rough-In ---- -- - - --- ----
Gas Line
Smoke Dampers -- —
Final
PASS PART FAIL -- -- - _
ELECTRICAL
Service --
Rough-In --- - --- -- — -�- --_ --- --
UG/Slab
Low Voltage —
Fire Alarm
Find Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
61ft- _-�- Please call for reinspection RE:-__-_ _- _-__--_ n Unable to inspect-no access
Fire Supply Line _
ADA
Approach/Sidewalk Date ,_ / /O . Inspector-- Ext _
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD _ MASTER PERMIT
PERMIT #: MST2002-00063
DEVELOPMENT SERVICES DATE ISSUED: 2/20/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SIT E ADDRESS: 13725 SW SANDRIDGE DR PARCEL: 2S105DD-PC031
SUBDIVISION: PACIFIC CREST SUBDIVISION ZONING: R-7
BLOCK: LOT:031 JURISDICTION: TIG
REMARKS: SF dwelling. Model home. Path '1
Receive TIF credit for demo of an existing residence. No credit for Parks SDC as parcel was
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS tEQUIRED
CLASS OF WORK: NLV4 HEIGHT: 31 FIRST: 1,552 of BASEMENT: 924 00 of LEFT 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.425 sf GARAGE: 725 of FRONT: 20 PARKING SPACES: 2
TYPE OF CONST. 5N DWELLING UNITS: 1 FINBSMENI: of RIGHT: 5
VALUE: E 382.202.50
OCCUPANCY GRP: R3 BDRM: 4 BATH: 4 TUTAL: 2 978 DO of REAR: 43
PLUMBING
SINKS: I WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: I RAIN DRAIN: 100 TRAPS:
LAVATORIES: Fi DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS:
TUBISHOWERS: 5 GARBAGE DISP: 1 WATER HEATERS 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: V?NT FANS: 5 CLOTHES DRYER: I
13.A5 FURN>•100K: I UNIT HEATERS: h'1r17S: I OTHER UNITS:
2.
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS. 1 0 200 amp: 0 200 amp: WrSVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION:
EA ADO'L 500SF: 0 201 400 amp: 201 400 amp: 1 s1 WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR.
I.IMITED ENERGY: 401 600 amp: 401 900 amp: EA ADDL OR CIR: SIGNALIPANEL: IN PLANT:
MANU HMISVCIFDR: 901 1000 amp: 901�amps•11000v: MINOR LABEL.
1000•omplvott: PLAN REVIEW SECTION
Reconnect only: >•4 RES UNITS: SVCIFDR>•225 A.: >900 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
_ A.SF RESIDENTIAL B COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO IL STEREO: FIRE ALARM- INTERCONVPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER CLOCK: INSTRUMENTATION MEDICAL: OTHR:
HVAC: DATAITELE COMM: NURSE CALLS TOTAL 0 SYSTEMS:
TOTAL FEES: $ 6,583.82
Owner: Contractor: This permit Is subject to the regulat+ons rontained in the
D.R.HORTON HOMES D R HORTON INC Tigard Municipal Code,State of OR. Specialty Codes and
5125 SW MACADAM AVE STE 149 5125 SW MACADAM all other applicable laws. All work will be done in
PORTLAND,OR 97201 #145 accordance with approved plans. This permit will expire If
PORTLAND,OR 97201 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 rule,adopted by the
Oregon Utility Notification Center. Those rules are set
Rep N: LIC 130959 forth in OAR 952.001-0010 through 952-001-0080. You
may obtain copies of these rules Or direct questions to
DUNG by calling(503)246.1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Wtr Proofing Bsm't Wa Footing/Foundation Dr; Electrical Rough In Gas Line Insp Water Line Insp
Grading Inspection Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Appr/Sdwlk Insp
Sewer Inspection Post/Beim Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final
Footing Insp Underfloor Insulation Plumb Top Out Exterior ShFathing Insf Gyp Board Insp Mechanical Final
Foundation Insp Crawl Drain/Backwater Electrical Service Low Voltage Rain drain Insp Plumb Final
11N LI.EN1l�I
Issued By : _ __ Pel mittee Signature :
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TI CARD SEWER CONNECTION PERMIT_
DEVELOPMENT SERVICES PERMIT#: SWR2002-00095
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/20/02
SITE ADDRESS; 13725 SW SANDRIDGE DR PARCEL: 2S105DD-PC031
SUBDIVISION: PACIFIC CREST SUBDIVISION ZONING: R-7
BLOCK: LOT: 031 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached.
Owner: --
FEES
U R. NORTON HOMES Type By Date Amount Receipt
5125 SW MACADAM AVE STE 149 —
PORTLAND, OR 97201 PRMT CTR 2120/02 $2,300.00 27200200000
INSP CTR 2120102 $35.00 27200200000
Phone: 503-222-4151 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. T Permittee Signature: -j LM.��1 bkVtittt►+1rwti
Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next business day" –T—
Building Permit Application
City of Ti � Date received: Q n2 Permit no.: o -D 3
City of Tigard
Address: 11125S a I�d,qLY(EQ13 ProjecUappl.no.: Expire date:
Phone: (503) 639-4171 Date issued: By:jj Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use apprc � OF 11� �_ I&2famny:simple Complex:
GDTNO
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family *'New construction U Demolition
U Addition/alteration/replacement U'fenant improvement J Fn, sprinkler/alarm U Other:
JORSITE INFORMATION
Job address: 0-72,051 56 40A -iBldg. no.: Suite no.:
Lot: Block: Su division: /� 'Tax map/tax lot account no,: ,SS I h�"D
Project name: I
Description and location of work an premises/special conditions:
OWNER 'ORrSPE :'AL e 1
Name: �I'i D C h (Floodplai*,septic capacity,War,etc.)
Mailing address: ias 11 &2 family d"elling: Z ?
?? s
City: �' State:p ]ZIP: Valuation of'work..........,r?..............�'.....'.... $� '
Phone: • 5Faz: p ? mail: No.of bedrooms/baths................................. _.-7
Owner's representative: �1; 'Total number of floors.................................
Phone: jajjFaxJmail: New dwelling area(sq. ft.) .................. ....... G
APPLICANT Garage/carport area(sq. ft.)......................... _ —
Name: Y v-1 Covered porch area(sq. ft.) .........................
Mailing address: 6&wf A5 A�10V L Deck area(sq. ft.) ........................................ <'
City: I I State: I ZIP: Other structure area(sq.ft.)......................... _
Phone: Fax; E-mail: CommerclaUlndustrial/multi-family:
Valuation of work........................................ $----
Existing bldg.area(sq, ft.) ..................
Business name: Y'i"s h
New bldg.area(sq.ft.)...............I.. ...........
Address: (� S ------
City: State:p ZIP: ZDI Number of stories.................... ...... ..........
Phone- - �S Fax: �• E-mail: Type of construction..........,.:�..,.....,.,.. ......
CCB no: Occupancy group(s): Fxisti
---.�
/�JOr;'�iO� -- - - - _ New:
City/metro lie.no. Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: 00S A W 1, junsdiction where work is being performed. If the applicant is
Cit State; IZIP exempt from licensing,the following reason applies:
Contact person: Iq kj EgX IL Plan no.: -- — —
Phone: 1'ax: F-mall:
Moro
Name: ��U/� :untact person: �,( t L- Fees due upon application ........................... _—
Address: 1"f h. __ Date received:
City: Stute:QR ZIP: p/'� Amount received ......................................... $
Phone: Fax: Please refer to fee schedule.
hereby certify I have read and examined this application and the Not all juri bcoons accept credit cards,please call junsdiction tot more tntomrauon
attached checklist. All provisions of laws and ordinances governing this u visa J MasterCard
work will he complied witl , whether specified herein or not. 'resit card nambet -- rr t
_ r
es
Authorized signature: Date: �� New of cardholder as shown on credit card
- s
Print name: Cardholder signalurc Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. ")-01 3(~'OM)
Electrical Permit Application
ME 1?atereceived: Permit no.: -T eQI-_,2,04
City of 'Fig Project/appl•no Expire date:
r 7tt of l :�:nf Address: 13125 SW Hall Blvd,Tigard, ()R "7223 Date iEsued: By: Receipt no
Phone: (503) 639-4171 �.�_Pl "I
Fax: (503) 598 1960 Case file no Paynirni t%PC
Ci 1-Y UF L I(jAKD
Land use approv*tgj raw_ MIg0_ _
TYPE 6F PEkMIT
U 1 &2 family dwelling or accessory U Commercial/industrial 0 Multi-family U Tenant improvement
New construction U Add ition/alteration/replace ntenl U Other: 0 Partial
XIIIIIiSITL INFORMATION
Joh address: Bldg. nu.: Suite no.: Tax snap/tax lot/account no.:
Lot: Block: Subdivision: ( CG — Gb31
Project name: �(G � t� Description and location of work on piciiii
Estimated date of cont letion/inspection:
1
Job no: t r�• Mat
G -- Ik%cription Qty. (ea.) Total no.lns
F3usiness flame: New residential•tinkle ormulti-farnI4 Per
Address: SW VR rt I,IA dwelUnkunit.Includes attached garage.
City: Slate: ZIP: Service included:
Phone: - Fax: Email: 1000 sq it (Ir less 4
Each additional 500 sq.ft.or portion thereof
CCD no.: Elec.bus. tic. no: 10 Limited energy,residential 2
Oily/metro tic.no.:
LimitedP^ergy,non•residendal 2
homeormodulardwelling
S••�n, amllut Lr• •r _
5lgnafuRo sit erviringdeetrklan(required) Ila1i Serrleranrfeederc••:�stollation,
Sup,elect.name(pnot) PROPERTY I in nsr
she•salon or relocatlnu:
OWNER 200 auras or less 2
L!Lrn 201 amps to 400,:mps — 2
Name(print): 401 amps to„r amps 2
Mailing address: _ Q 601 amps to I(xx)amps 2
City: State: ZIP: Over 1000 amps or volts 2
Phone; Fax- E-mail: Reconnect oniv I
Owner installation:The installation is being made on property I own Temporary services or reeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
21x1 amps or less 2
ORS 447,455,479,670,701. -tot amps to 400 amps _ 2
Owner's si mature: Date: 401 m 600 ams _ 2
Branch circuits-new,alteration•
or extension per panel:
Name 5 VkIM A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City; h///AGS — StAte ZIP: Q B. Fee for branch circuits without purchase
Jd��n of service or feeder fee,first branch circuit: 2
Phone: I X410fl, E-mail: Each additional branch circuit:
Misc.(Service or feeder not included):
U Service over 225 amps commercial U licalth cote tacdnv Each pump or irrigation circle 2
U Service over 320 amps-rating of 1&2 U Htvantouslocation Fach sign or outlme lighting 2
family dwellings U Building over 10•(x)(1 square feet four or "ignal cncwt(s)or a limited energy panel,
U System over tsm votes nominal more residential units in one structure alteration,or extension* — 2
U Building over three stories U Feeders,400 amps or more •Uescn tion —
U Mcupant load over 99 persons U Manufactured structures or RV park FAch additional lmpecNon over the allowable in any of the above:
G EgressAightingplan U Other. Per inspection
submit_sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
- $
Not all jurisdictions accept credit cards,please call jurisdiction for mrma
ore infotion. Notice:This permit application Permit fee.....................
U Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $
Credit card number -- within 180 days after it has been State surcharge(8%) ..•.$
Expires accepted as complete. TOTAL .......................$
Name of cardholder as shown on c tic
_ E
Cardholder signature Amount 416.4615(&WICOM)
Mechanical Permit Application
Date received. Permit no.// .2
pm
City of TigaraILL; Project/appl.no.: Expire date:
CirynjTigord Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: pt no.:
Phone: (503) 639-4171 i ,
Fax: (503) 598••1960 C'11 Uf I IUAKU tease file no.: Payment type:
Land use approval:$UILDING DMSIC?I` ___ Building permit no,:
7❑ I &2 family dwelling or accessory ❑Commercial/industrial ❑Multi-family ❑Tenant improvement
❑New construction U Addition/alteration/replacement U Other:
It 1 1
Job address: Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite r ,: value of all mechanical materials,equipment,labor,overhead,
profit.Value$
Tax map/tax lot/account no.:
I,ot: Block: Subdivision: I(Gf *See checklist for important application information and
Project name: ,jurisdiction's fee schedule for residential permit fee
r
City/county: ZIP:
Description and ocation of work on premises: __ Fee(ea) Total
Est.date of completion/inspection: —_ Description Res.only Res.only
AC:
Tcnant improvement or change of use: Air handling unit _CFM
Is existing space heated or conditioned'?U Yes U No t Air conditioning(site p an require )
Is existing space insulated?❑Yes ❑No A teration oexisting A_system _
CONTRACTOR Boiler/co pressors
State botler permit no.:
Business name: HP Tons__BTUM
Address: it smo a amper uct smo a etectors
City: State: ZIP: p0 eat pump(sue p an require )
nstn rep ace fumac urner
Phone: Fax: E-mail' —_—_-- Including ductwork/vent liner U Yes O No
CCB no.: Install/replace/re_ ocateeaters-suspende ,
City/metro lic.no.: wall,or floor mounted -
-— ens fora lizince other than furnace
Name(please print): of ge•rat on:
1 Absorption units_ BTU/H
Chillers. __ _ HP —
Name: N1 L 01 C V SO _ Com ressors _ HP
Address: 5 `7 y�,� nv onmenta ex ust an rent at on:
City: y State: ZIP: : D Appliance vent
Phone Z- / Fax: fA- 1-39i Email ryerex aunt
533s, ype / res. ttc a azmat
hood fire suppression system
Name: Exhaust fan with single duct(bath fans) _
Exhaust system o nrt rom eattn or AC
Mailing address: 0 t/ ue piping an st u1 on(up to outlets)
City: a state:OlC ZIP: fy 7C l.Pf, Na Oil
Phone: 27, 7hax: / E-mail: Fue i ing each ad ttional over out cis
rocessp p ng(schcmaticrequired)
G Number of outlets --
Name: ter listed appliance or equipment:
Address: C� Decorative Fireplace
City: _ State: ZIP: 1,01 nsert-t e
0o stov pe et stove
Phone: FaK; 1--snail: othet:
Applican"s signature: Date: ter:
Name (print):
Permit fee _..................$ _Not all Jurtsdictlons accept credit calla,pietim can tunurktiun for more information. Notice:This permit application Minimum fee................$
❑visa ❑MasterCard / / expires if a permit is not obtained plan review(at _ %) $ —
Credil cord number __, -- Gxptres within 180 days after it has been Slate surcharge(8%) ....$ _ --
---— accepted as complete. TOTAL .
Name of cardhot r as shown on credit card s .....•.•••...••• $ ---------
Cardholder uputute Amount —
4404617(6MCOMI
Plumbing Permit Application
,-1 =CEI` / bate received: Permit no.: �t�,n
City Of I 1 '•fru... V Sewer permit no.: Building permit no.: r
Address: 13125 SW Hall Blvd,"Tigard,OR 9722.
Cirvu(Tignrd phone: (503) 639-4171 Projecdappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Teceipt no.:
cu Y Ut l 10AlK% ,,e rile no Payment type:
Land use appruV .-6P4GTAV4F1C1:_
OF PE!tMIT
U I &2 family dwelling or accessory U Commercial/indust lal U Ivlultl-tanuly U Tenant improvement
New construction U Addition/al teration/rr-place ment U Fond servict- U Other: _.
10 ILU 717MM, 1"02 M1011171
���j Description (Xv. Fee(ea.) Total
Jud address: —�L1�_ — Ne-A I-and 2-family d"ellings only:
Bldg.no.:: Suite It .. (Includes Itlntt.fureachutifihcunnection)
Tax map/tax lot/account no.: S1-`R(1)bath
Lot: Block: Subdivision: (� , CY1044' 5FR(2)bath
Project n c: 4 "$�" SFR(1)bath
City/county: � (i�
ZIP: Each additional hattt/kitchen
SitDescription and I Catcchh basin
/alion of work on premises:r b
Catch drain _
Est.date of completion/inspectioltPLUMBING Urywells/leuch lineftrench drain
Footing drain(nu. lin.ft.)
t Manufactured home utilities
Business name. J4me, Y�v�ml�►� — Manholes
Address: ( $2 yVj 1110AVJ Rain drain connector
Cil State: ZIP: n Sanitary sewer(no.lin. ft.)
city: sewer(no.lin.ft.)
Phone: - C' hax: E-mail:
CCB no.: Plumb.bus.reg.no:'3 -( Water service lin.ft.)
Fixture or Item:
City/metro lic.no.: Absorption valve
Contractor's representative signature: - �_ Back now preventer
Print name: L Date Backwater valve
Basins/lavatory —
Name: AJf L D/G_�A Clothes washer
Dishwasher
Address: /2ZA 6W Drinking fountain(s)
State, ZIP: Ejectors/sump --
Phone: -?LZ I'ax: E-mail Expansion tank
Fixture/sewer cap v _
floor drains/floor sinks/hub
Name(print): Q, �'�DI 4Th N�H7rS Garbage disposal
Mailing address: Hose bibb
City: state: ZIP: 1 lee maker
Phone: I Fax 177-41 P71Email: Interco tor! rease ten
u%ener instal lation/residential maintenance only: 'The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),hasin(s), lays(s)
Owner's si nature: Date: Sum
011021111111111 Tubs/shower/shower pan
rinal
Name: ater closet
Address: Water heater _
City: l State: ZIP: Other:
Phone: Fax:`dj 7 E-mail: Total
Minimum fee................$
Na ell
jurisdiction accept ued0 cards,please call ptriMlicuun for more mfommuoa NntlCe:Y Iti9 perTrllt application
J Visa ❑MasterCard expires if a permit is not obtained Plan review(at _ 96) $
Credit card nunthet within 180 days after it has been State surcharge(8%) ....$ _
Expires
_ accepted asrnmplete. 'TOTAL .......................
Natne nl mdholder as shuwn nn credit cud _ S
t:erdholder stgnmure ---i Amount 44OA016(M)DWOMI
PA,C:IFIC CKES"I" SUBDiV1SlON
LO"I' 31
Cl`ry OF •1 IGARD THE APPROACH SHALL BE
A MINNMUM OF 8"xl2'x2O'
OF CLEAN PIT GRAVEL
ST LME SHALL BE LESS THAN 2 TO
s4► W. EL-579' LANDSCAPING FOR THE ENTIRE LOT
SW IS LETOE DRIVE SHALL BE FINISHED OR THE LOT
SURROUNDED BY EROSION CONTROL
Ei l
a EROSION CONTROL. FINISHED SLOPES
TREE RECEIVED
DRIVEWAY 5 2y
______
``— �IIY OF I l(JA?JJ
I3UILDINO DMSION
SQFT. a 146-_
i
Ln /
1
I 1
PLAN : 3902C r--
LIVING 3902 SQ !Z
I �
i
NOTE
2. FOUNDATION DRAINS TO
1 ACKYYARD SOAKAGE TRENCH
SEE ATTACHED DETAIL _
I,ROOF DRAINS TO STORM
LAT. IN STREET.
-------------------------------------------
---
CITY
IT . OF TIGARD --'— ELECTRICAL PERMIT-
(V_
� Y RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2002-00077
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 5/6/02
SITE ADDRESS: 13725 SW SANDRIDGE DR PARCEL: 2S105DD-PC031
SUBDIVISION: PACIFIC CREST SUBDIVISION ZONING: R-7
BLOCK: LOT: 031 JURISDICTION: TIG
Proiect Description: All encompassing low voltage.
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: ALL ENCOMP X HVAC: PROTECTIVE SIGNAL:
114STRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:____,_
Owner: Contractor:
D.R. NORTON HOMES U.R. NORTON
5125 SW MACADAM AVE STE 149 4386 SW MACADAM AVE.
PORTLAND, OR 972.01 PORTLAND, OR 97202
Phone: 503-222-4151 Phone: 503-590-0206
Reg #: LIC 130859
_ FEES _ Required Inspections
Type By Date_ Amount Receipt Low Voltage Inspection
PRMT CTR 5/6/02 $75.00 272002.0000 Elect'I Final
5PCT CTR 5/6/02 $6.00 2720020000
Total $81.00
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
952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or ' ct questions to OUNC at (503)
246-1987.
Permittee Si nature
Issued by � ��� r � '�� c�- _ G_ _- g
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
Electrical Permit Application
---- _— –� "Dateeived– -"PermnitG.c�, a _ t ,., j
City of Tigard Pro)ect/appl.no 5xpiredate:
City of Ti zard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: i Receipt no.
Thane: (503) 639-4171 — _
Fax- (503) 598-1960 Case file no.: Payment type:
Land use approval:
0 I &2 fainily dwelling or acceasoty J Commerciallindustt ,.i J 'Multi-family J Tenant improvemem
U New construction J Addition/alteration/replacenteIII a Ocher: — _. O Partial
Inb address: - R.„i nti . iSui:e nn.: Tax t iapitex_InNaccouut no
Lot; BloL.k 5uhifivision:
PmJect name: csu_iptinu and location of work on premises:
Estimated date of coin letion/ins cutin:
Job no: I ee Max
ea) rola/ no.ins
Business nwyw: . Dncri tion t?f,.
- v :Veru rsysldentlal•singk ur muitl-frmIls per
Address: { tal-V __4Ajj1 dwellingunit.includes stlaritedqurage.
City:- �, State: 1 Z(f - Servlcelncluded �
i'hn'1e� r. 100(1 y (Lfr�less
F-mail —_
:(3
-- Focl SW sr h additionait nr pnnto•t�bere•+'
CCB no.: l: l lec bus.lic, no: lArnitedener v,residentia, l 2
C icy/melro 11C.)t,,.. - Urnitedenergy.non-c!o(lenrtal —
f-” l �^ Fach manuractumd hame or modulat dwelling
5ignatutt of supervising electttclan(requlredi Bate Service and/or feeder Z
!Gen Ices or feeders-Installation,
Sup.elect mmne(print) l-,react nx alitratltnt or relocation:
2VU aro s or icss
Name(print): --T� _ 201 amps to VK)arms ?
401 ata•s In 600 amps
Mallin address: ___ F)!amps to iocxl atni,
Cit : State: ZIP. 0%er 1000 amps or volts 2
Phone: Fax: I E-mail:
Temporary eenlca+or reedem
Owner installation:The.installation is being made on property 1 own Installation,alterition,orrelocation:
which is not intended for sale,lease,rent,or exchange according to zoo amps or Iasi 2
ORS 447.455.479,6 hl )I am is tr dOQ ams 2
Owner's si+tlaturc;
ranch circuits•new,alteration•
or extenslon per panel:
Name: _ _ A Vice for stanch cirmi,widt purcha+e 4
service or� feeder fee,each branch citron
— tn Pee far branch circuits withoutpurchwe
Cil!]: Sate
_ t,f service or fecdcr fee.rirst bnuich circuit 2
F inn l Eachaaditirnatlirenchsrcut
Isc.(3erviceot feeder not inrlu ):
Each um orini ationtirt.;e 2
03ervtsosei2:5amps.cowinerciai jtieawi.corebJltty ----
not outlineltghting
U Sen is over 320 anter-rat ng Of IFC? O Hazstdous locanon ti, nal cncult(s nr n limited ener ty panel.
ImnilldwellinKs �BuBdinguver10.000ayuarefeetfouror �,Irtentnores,tnslon• 2
O System neer f x)volth nommsi more residential units in one structure -- �— —
a Suildbtu overthrce storteit J Fetders,400 amps or mtott •L�ecrn non
J occupant Iond over 99;tenao J Manufactured struclutmor Itv perk Fick additlona Inspeellon over the%howahie In any of the above,
-1 Lpreg"A plan >Other _ — -- — perms ecu m __ j IJT
Subndt sets of plant nith.nv of the above. Investig.uen fee _
The above are not applicable to Icmptrrar}construction service. Other
Permit fee... ...... .......... --
�, vrtulicdnra iti:rept mat c lis,mese call)unal orlon tot rrwte I'* t1r 1 Notice:Ira
rttmlt application plan review(at , %) g
:.t visa O MestcrCnnd e�cpires If a pernut is not obta�ned
within 190 days&Per it has heerl State surchatee(R7(•) ....S
Credit reed n,anhe' --— --- --- _. 10T�AL ........ ..... .. .. $
." 'n` accepted as cotnpletc. ---------
-!Vane of t a h c t ac Chown an ctedtt torr-- _S
C hMdtr d tare trwunt 441146I11NC0lMM)
/^ CIT_Y I OF TIGARD ELECTRICAL PERMIT
\ PERMIT#: ELC2003-00399
DEVELOPMENT SERVICES DATE ISSUED: 6130103
13125 SW Hall Blvd..Tigard. OR 97223 (503) 639-4171 PARCEL: 2S105DD-05500
SITE ADDRESS: 13725 SW SANDRIDGE DR ZONING: R-7
SUBDIVISION: PACIFIC CREST
BLOCK: LOT : 031 JURISDICTION: TIG
Project Description: 1 branch circuit to hot tub.
RESIDENTIAL_UNIT_— _TEMP SRVCIFEEDERS — v MISCELLANEOUS
1000 SF OR LESS: _ v _ 0 200 amp: PUMP/IRRIGATION:
EACH ADD'I_ 500SF: 201 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/FDR: 601+amps - 1000 volts: MINOR LABEL. (10):
_ SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: — W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: _ >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only_ _ SVC/FDR —225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MIKOLOJ PHILLIP MICHAEL RAFFAELL CONSTR
13725 SW SANDRIDGE 15170 SW KIRK RD
TIGARD,OR 97224 OREGON CITY,OR 97045
Phone: Phone: 632-6720
Reg #: LIC unn�S 12'_
SUP
- _ FEES
Description Date v Amount Required Inspections
11-11'RMTl L{L.('Pcrnnt n 11)01 $46.85 --
ITAxj M'o siate'lax r tic t $3.75 Elect'I Final
Total $50.60
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 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules ordirect questions to OUNC at(503)
246.6699 or 1-000-33 4344 '
Issued By• ��1 �� l'"C� Permit Signature:
L /l 1/(/ �_
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale, lease, or rent
OWNER'S SIGNATURE: DArE:__ --
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: — .__ __ —_— DATE: -----
1.WENSE
ATE ---LICENSE NO: -- t
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FORONLY
Glcctrical
s
DatclB : i' -U -� '� Permit No.L- -�
Cit of Tigard �-' (' Planning Approval Sign
City —Date/By: Permit No:
13125 SW Hall Blvd, Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/By: _ Case No.
Internet: www.ci.tigard.or.us Contact Juris.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: mental Information.
TYPE OF WORK _ PLAN REVIEW(I'lease check all that apply___
New constructionEl Demolition Service over 225 amps- I Icalth-care facility
commercial ❑Hazardous location
E]Add ition/alteration/replacement ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
_ CATEGORY OF CONSTRUCTION I &2 family dwellings four or more residential units in
i & 2-hamily dwelling__ Commercial/Industrial ❑System over 600 volts nominal one structure
171Building over three stories ❑Feeders,400 amps or more
Access0 $Uildlri Multi-Tamil
-. ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Other: ❑Egress lighting plan ❑Other._
JOB SITE INFORMATION and LOCATION Submit_sets of pians with any of the above.
The above are not applicable to temporary construction service.
Job site address 1 J�t_�— t _
FEE*SCHEDULE
Suite#: !_ Bldg./Alit_#_ _ _ Number of Ins ections per ermit allowed
Project Name: Description Qty Fee teat Total
------------ New residential-single or mulll-family per
Cross street/Directions to job site: dwelling unit.Includes attached garage.
Service Included:
I(XX)sq.ft.or less 145.15 4
Each additional 500 sq.0.or portion thereof _ 33.40 1
Subdivision: _ _ -— Lot M _-_ Limited ener residential 75. 0 2
- Limited end non residential 75.000 2
IIax map/parcel M Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
'- — Services or feeders-Installation,
aIteration or relncatlon:
200 amps or less 80.30 2
- ------- ---- -- --_. 201 amps to 400 amps 106.85 2
401 ams to 600 amps 160.60 2
PROPERTY OWNER -- TENANT 601 ams to 1000 amps 240.60 2
Over I(W amps or volts 454.65 2
Name:_ (_ 1 { /(' >`" J __—_-- Reconnect only - --- 66.85 2
AddreSS: Temporary services or feeders-installation,
- --- - - ---- alteration,or relocation:
Cit /State/Li I 1 2f R)am s or less 66.85 1
Phone: Pax: 201 Amps to 400 ams _ 100.30 2
APPLICANT CONTACT PERSON 401 to 600 ams 133.75 2
Branch circuits-new,alteration,or
Name; extension per panel:
--�---- - A.Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 6.65 2
City/State/Zip: _ - n.Fee for branch circuits without purchase of
service or feeder fee,first branch circuit 46.85 2
Phone: Tax: — Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump ui inillation circle 53.40 2
------ - Each sin or outline lighting 53.40 1 2
Job NO: Signal circuit(s)or a limited energy panel.
/ i alteration or extension Pae 2 _ 2
Business Name:
- t __ Description
Address: K _
,- . Each additional Inspection mer the allowable In an of the above:
Cit /State/Zi l ' ' 1 ` G'-%�5 Per±!pcctionper hour Lmin I hm w t — 62.50
Phone; Fax: Investi ation fee:
-1-- - _ Other: - -
CCB Lic. M Lic. #: ; - � — —
"' Electrical Permit Fees"
Supervising electrician _ Subtotal S �v r
Signature required:_ Plan Review 25%of Permit Fee) S
Print Name: Lic,#: L- 5 State Surcharge(8%of Permit Fee) S
-- TOTAL PERMIT FEE S
Authorized t Notice: This permit application expires Ira permit Is not obtained within
Signature _-,�_ r-f-, U�*1 �41.� tt: _ 180 days after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
--(Please print namc) --+-
i:U)sts\Permit Forms\ElcPermitApp.doc 0F03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental ls:
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ $75.00
Check Type of Work Involved:
Audio and Stereo Systcros*
Burglar Alarm
(iarage Door Opener*
LJ Heating,Ventilation and Air Conditioning System*
El Vacuum Systems*
E] Other —_ —_—_.--_--
COMMERCIAL WORK ONLY:
Fee for g rh system.. ...................................................... S75.00
(SPE OAR 918.260-260)
Check Type of Work Involved:
Audio and stereo systems
Boiler Controls
Clock Systems
Date Telecommunication Installation
Eire Alarm Installation
IIVAC
El Instrumentation
Intercom and Paging Systems
ElLandscape Irrigation Control*
Medical
E] Nurse Calls
n Outdoor Landscape Lighting*
lJ Protective Signaling
Other----- -- -- -----
Number of Systems
No licenses are required. I.icemes are required tot. all
other installations
i:\Dsts\permitPomis\ElcPemiiiAppPg2.doe 01/03
C"OF HARD Electrical Permit Application p1�,I� 4 u a 00;S
13125 SW HALL BLVD. Recd ny
Gats Red
TIGARD OR 97223 Date to P.E.
I'honet(503)839-4171,x304 Print or Type rfttw to DST
Inspection (503)639-4175tar y
Far.(503)684-7297 Incomplete or illegible will not be accepted
1. Job Address:-- -� 4. Co"Wiete ree Schedule Below:
Name of Development _ _ Number of Inspections per Pon,It ellmwed
Nnrrm(or name of txisiness) l --17'.- r, 5 iJ Service included! Item's Coat Sum
AddiesS._,, "3_7 r - 4e. Reeidsntlal-Par Unit St1p.00 _ •
1000 q R-or fess
Gicy/Statea/Zlp.__.._ r,!G R Each ioitoonat Soo su.R or
portion thwouf 325 00 t
Curnmerm al❑ RewdeMlal giri I rnitnd Lrwgy --
Fw:h Marlin"Dome of Modular
DwnUM Service at r larder 500.00 --- 7
2a. Contractor installation only: 4b SwvlL*s or Feede s
(Atdch copy of all currant licenses), D w , A e�r�l tnsta4ailm,alteration,r»rak"tkm
Elm-Irir:al Contractor _ '4 if 200 artgs or loss
12.4 ?of- w loo amps fa0.00 2
CrtYa (1 State fj e r'... _gyp -
401 runts to 000 amp• $120.00
Plrone No02C amps w lnoo ants __ $w,00
G-3.�=f-� �"� c.«IooO amps or v(>Alb __. 5340.00 7 �
Jut)N0._---- r- __._�. 7 rtar.rrnmrt only _ fS0.00 _ 2
F!ec.Cont.lJoe.No ,3 Exp.Date-1
OR State CCB Rag.No..�_f`-t l�Exp.nxte. 4c.Twrr�pora+y Awk*s or FeaMns
COT Business Tax or Metro No _L72�Fxp.Date - rnctarlatilif alteranerl,rx rekaehrm
200 anrpt car rasa — fs0.w 2
( 201 warps In 4'10 WMM STSM 2
Siynatilre of Supr. Eler'n_ 'I A-r � C-�'+� 401 amps to so0 at" sloo 00 r ---- 2
Lhor ow amps to IDOW vias.
License No. `_ Exp Dale 1_� eas a`wqe.
Ilhorle Nn
J.L1.3 cad-BrwreM Clmitfa
New.aftwatlon M eMerxror!por(&rW
2b. For owner installations: a)The tae for wanrh clnnrrts wren
purchase or oerrloe or
fta
Print 0wnet's Narne f'4 11h-p—�'t/ �o L �" v- drarfr —
Fach teener Si.br)
-- � 1 d� b)The I"Ire branch utcwts
State zip-. _ ---. nlfDyaf purchase or
Phon,a No. -- ee►vkw or Mader he.
First branch drruh � .iafetat _7 --
Foch arldtlonal t mmh nftufl 55 00 2
the installabnn m being mane on property I own which is not ✓ `.�j _
intended for silo,lease or runt. 4e.Mascellanerrus (, r? ,�1 .3
isarvrxr or feedw fret+rduded)
Owners Siyriwtura .—•----.-- -- E.mh PMV of rrngatlon chem M)OU = '1
rar:h dye or rxnlrte Ilyhdmy Situ 00 l
;iprlal Q(CU4(L)of at"It"energy
3. Plan Review sec,-tion(if required): t,r,a,,exefarlart a astmnskr, _-_ $40.00 _ 2
Mtfxx Ixtob(101 StooOo _
Please check appropriate ttem and enter fee in section 58.
4 or more rovideirtOaf units In(xtn stnrctr irp 4f.Each able in Inapectftrn over
— Servlr'c and feeder 275 xnlp9(x mule the a SPIKAirn In ally of et.above00
System over 800 vnit,rxsnlnsl Per In�pe(4orl U0
Cloesilled area or eWX.turo containin s lal u u% rMr hour !_ t'S(xt -_
9 fes= '�^� in Plenr
— as drrsc tb.a in N F r, ctmoor S --
Slrrtmh 2 siert+of plans with application mime arty of etre above apply. 5. Fees. L
fr l
Not required for tnrr►ponry corlstrltetlon services. 6a('nblr$orad of ahnw less 5 144
Opt SuMharne(.115 x total toes) t
0 5 �—
NU 1 fc, s+,aoht -
5b.Enter?.5%of lime be for
PERMITS BECOME:VOID IF WORK UR CONSI'MUCTION AUT"OMI7fs[)IS Plan Ravrew If rowNg(Sec:t) 5
NOT COMMFNGED WrTTiiN 190 DAYS.0A IF CONSTRUCTION OR WORK Subrosr S -
IS SUSPENDED OR AtT WDONFt)FOR A PERIOD OF 190 DAYS Al ANY ^ < <�
TINA AFTER WOW IS COMMEr'K=f:O IJ Tnrsl Acz�r><+1 I_
Tufa!bfTrrnee Due
.^a.Yi�(yp�w •.w•.V
CITY 4F TIGARD 24-Hour 4 L�
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 ST
BLIP
Received _ Date Reques ed__ •" _''(ASM'' PM_ ______ BUP
Location - 2- ice.Suite__ MEC
Contact Person -- Ph( ) 6.3 Z' 4,7a- PLM _
Contractor-- ____-- - _-- -- Ph(e ) -7 SWR _
BUILDING _ – Tenant/Owner __-_ —.-- ELC
Footing
Foundation ELC
Access:
Ftg Drain ELIR
Crawl Drain
Slab Inspection Notes: - SIT -
Post&Beam
Shear Anchors
Ext Sheath/Shear -�
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing - - - -- - -- - ---- ------
Firewall
Fire Sprinkler --- - -
Fire Alarm
Susp'd Ceiling -- —
Roof
Other:
Final —
PASS PART _FAIL --
PLUMBING
Post& Beam
Under Slab - - -
Rough-In
Water Service
Sanitary Sewer
Rain Drains -- - -- - -
Catch Basin/Manhole
Storm Drain -- - --
Shower Pan
Other: _ --- - -- ------
Final - - --- ----Final
PASS PART FAIL
MECHANICAL
Post&Beam -
Rough-In
Gas Line
Smoke Dampers -- ---
Final
PASS PART FAIL
ELECTRICAL- _
Service
Rough-In --
UG/Slab
Low Volt e -
Fire Alarm
F
S PART FAIL Reinspection fee of$___ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
A
SITE _- u Please call for reinspection RE: ❑ Unable to inspect-no access
Fire Supply line
ADA
Approach/Sidewalk Date Inspector-,14
Lam`? Ext - -
Other:_
Final -- DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
NERC CONSTRUCTION
ELECTRICAL CONTRACTOR
15170SKIRK PLD
OREGON CITY OR 97045
503-672-6720 FAX 503-6)2.67)2
DATE 7�;//'.d-�
To � �,�, 5'o 3 - C 3 � l
=ROM: Iyi1Kr AFFAF,1,
CC7��MENI-5
..J
WOL ! ..
' Qq p rt-•f�
r
of_4 (i
i '� 2EL92E9 COS iae4jeN iae401W egE :LO EO 9i inC