12265 SW KELLY LANE•
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122'5 SIN KELLY LANE
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CI 1 Y OF T I G A R ---- MASTER PERMIT
PERMIT#: MST2003-00199
�I�;+ DEVELOPM!�NT SERVICES DATE ISSUED: u/11/03
ma 13125 SW Hall Blvd.,Tigat: OR 97223 (503) 639-4171
,LI I t ADDRESS: 122":.'5 SW KELL l LN PARCEL 2S103CC-09500
SUBDIVISION: WHISTLER'S WALT' ZONING: R-4.5
BLOCK: LOT: 042 JURISDICTION: Ht i
REMARKS: New SF detached, Path 1. ,
BUILDING
REISSUE: Df•.1199 STORIES: 7 — t LOOR AREAS REQUIRED SETBP.CKS REOUIQED
CLASS OF WORK. NEW HEIGHT: 23 FIRST: 1,€10 if BASEMENT: BOO if LEFT: 1, SMOKE DETECTORS: Y
TYPE CIF USE: SF FLOOR LOAD: 4o SELOND: 1/90 if GARAGE: 630 of FRONT: 15 PARKING SPACES:
TYPE OF CONST: 5N r WELLING UNITS: I THIRD. if RIGHT: 5
VALUE: 807.805.40
OCCUPANCY GRP: R3 11r,RM: 4 BATH: I TOTAL: 3.400 if REAR: 15
PLUMBING
SINKS: I WA1 r:R CLOSLTS: 3 WASHING MA:H• 1 LAUNDRY TRAYS: RAIN DRAIN: 140 TRAPS:
LAVATORIES: 4 0,9HWASHERS: I FLUOR DRAIN'S: SETH°°I INES: 1110 SF RAIN DRAINS. I CATCH BASINS:
TUB/SHOWERS: 3 GAR:AGE 015P: 1 WATER HEATERS 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
_FUEL TYPES _ FURN<TOOK: BOIL/CMP c 3HP: VENT FANS: 3 CLOTHES DRYER: 1
,,AS FURN>.100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
AAX INP. btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
_RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISLELLANEOUS ADD'L INSPECTIONS
1001 SF OR LESS: I 0 -200 amp: 0 - 200 aMo: W/SVC OR FOR: PUMP/IRRIGATION: PER INSPECTION:
EA 1D6'L 5009F: B 201 - 400 amp: 201 - 000 amp: tat W/O SVC/FOR. SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 0011 amp: EAADOI-BR CIR: SIITNALIPANEL: IN PLANT:
MANU HM/SVC/FDR: 601 • 1000 amp: 601+ampa•1000v: MKI.JH LABEL:
1000+amp/volt.
PLAN REVn•W SECTION
Reconnect only: >600 V NOMINAI.: L.9 AREA/SPC OCC
>=4 RES UNITS: 9VCIFDR>•225 A.:
ELECTRICAL•RESTRICTED ENERGY _
A.SI °.SIDLHIIAL 6 .OAIMERCIAL
AUDIO!<STEREO VACUUM SYSTEM AUDIO&STEREO. FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM OTH: BOILER: HVA,,. LANDSCAPEIIRRIC: PROTECTIVE S13NL.:
GARAGE OPENER CLOCK: INSTRUMF'4TATION: MEDICAL: OTHR:
HVAC' DATA/TELE COMM: NURSE CAI"LS. TOTAL A SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,3.'4.90
This permit is subject to the regulations contained in the
DON MOIRSSETTE HOMES INC DON MORISSUITE HOMES INC Tigard Municipal Code,State of ON. Specialty Codes and
4230 GALEWOOD STE #100 4230 GALEWOOO ST,STE 100 all oche.'applicable laws. All work will be done in
LAKE OSWFC 0,OR 97035 LAKE OSWEGO,OR 97035 accordance'w th 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:
Oregon law requires you to follow rules adopted by the
Phone: 5113-387-7538 Phone: Oregon Utility Notification Center. Those rules are sei
forth in OAR 952-00 In through 952-001-0080. You
Rear T TC'387;t7 >3t may obtain :opies of these rules or direct questions to
OUNC by calling(503)246-1967.
REQUIRED INSPECTIONS
Erosion Control Insp 8' Post/Beam Structural Mechanical Insp Shear Wall lnsp Insulatior Insp Appr/Sdwlk lnsp
Grading Inspection Post/Beam Mechanica Plumb lop Out Exterior Sheathing InsF Rain drain,Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Roof Nailing Mechanical Final
Footing Insp Crawl Drain/Backwater Electrical Rough:n Gas Lino Insp Water Line Insp Plumb Final
Found3tron Insp PLM/Underfloor I-,aming Insp Gas Fireplace Water Service Insp Building Final
./...230t.
Issued By : 1.Lll it i j12_'
� fPermitter? Signature)!, G-
Call (503) 639-:175 by 7:00 F;.m. for an inspection needed the next business day
IINIMIIM.MPIIIS
CITYOF TIGARD SEWER CONNECTION PERMIT
1111. DEVELOPHallMENT Tigard, OR 97223 (50
639-417113125 SW DATE ISSUPERMIED: SWR2003-00164
SITE ADDRESS; 12265`siW !::LLY LN PAR;F_L: 2S103CC-09500
SUBDIVISION: \\'IIISTLLR'S W:1I K
BLOCK:
ZONING: R-4.5
LOT: 0-12. JURISDICTION: 'fl(,
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.
Owner: _ ___ __
FEES__� �
DON MOIRSSETTE HOMES INC
4230 GALEWOOD S'E #100 Description Date Amount
LAKE OSWEGO,OR 97035 (SWINSI'( Swr Inspect 6/11/03 $35.00
(SWINSI'I Swr Inspe.' 6/11103 $0.00
Phone: 503-387-7538 (S\\'USA( Swr Connect 6/11/03 $2,300.00
(SWUSA( Swr Connect 6/11/03 $0.00
Contractor: — —
— — -- Total $2,335.00
Phone:
Reg #:
Regr!in3d Inspections
This Applicant agrees to comply with all the rules and r!gIIations of the Clean 'Yater Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Aor';icy does not guarantee
the accuracy of the side sewer laterals. If the^ewer is not located at the measurement given, the in!;taller shall prospect
3 feet in all directions from the distance given. If not so located,the installer shell purchase a"Tap and Side Sewer" Perm
'
Issued by: / ' 2.t _ ,_f�� Permittee Sic nature:# 6f1
*_
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
simmmosomriiiNsiolMOINInair r
............... .mm7
a Mechanical Permit Application
Date received: _,J4pU'ri
Permitno.:11y7/lCo?+_OCyY
vlaCityof Tigard yProject/nip'.no.: Expire date:
CityofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: �y: i,.."; Receipt no. - _
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Buildingpermit no.:
TYPE OF P RMIT /
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
,(Jew construction U Addition/alteratio.)/replacement U Other:
JOB SITE I 'ORMATION COMMERCIAL VAPATION SCHEDULE
•
Job address: . _ ty \,/\/ r. (,.1.1 r � Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite nOrd value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$ .
Lot: pp Block: Subdivision: VA-7.21-(f' ((1, *See checklist for important application information and
Project name: juri:,diction's fee schedule fnr rc•;idential permit fee
City/county: ZIP: _ . :1&2 FAMILY DWELLING-PERMIT FEE SCHEDULE'
• Description and location of work on premises:_ AND COMMERICAIJINDUSTRIAL EQUIPMENTSCHEDULE
_ _ lee(ce.) Iota!
_
Est.date of completion/inspectior Description — Qty. Res.only Res.only
Tenant improvement of change of use: — I1' AL:
Is existing space heated of conditioned?CI Yes ❑N') Air handling unit _ CFM _—
•Is existing space insulated?U Yes 0 No t rotion niOfexings existing
p an requ �) _ _
P� ArteraUon Of existing HVAC system J
ti1ECIIANICAI. C TRA('I()It Boiler/compressors
' State boiler permit no.:
Business name: / L; = 4 �& 14 J ,
•., at _ HP Tons BTU/H I
Address: It♦ . a irP/vr.,o a p amper .sect smo e.electors
City: „ Li ,_ State.go ZIP: • WM 'eat pump(site p an requir .) 1
Phone:,. _ A Fax: E-mail: nsta ►rep ace rmace7burner : I '
�
- --- Including ductwork/vent liner O Yes 0 No
CCB no,:
�J0L-73, � !. -- nsta /rep ac re ocate seaters-suspen.e.,
City/metro tic. no.:N/A wall or floor mounted
Name(please print): °Vir•�^ r vent for a..fiance other than furnace
)" I \( 1 JV 'e geration.
trN ,\ ' I'I It tittnti
Absorption Unita _ BTU/H
nor_ a, . `,..\ ---u__ Chillers____ HP
Address: Corn ressors HP —
-i— --- - ,v roarnenta e ust an. vent at on:
Cite: _CT_
_ ZIP: Appliance vent
Phone: Fax• E-mail: Dryer exhaust
O\\ I I( Hoods,Type I/Illres.' ren/hazmat
hood fire suppres.;ca system
Name: '�,T�;' Rir� Exhal st fan with singlt duct(bath fans)
Mailing address: ! �� �� spell gust systema art frIm eatin,orAC
' State a ';11��• sect piping aro stn set on(up to out els)
City: i. rw���
Ty,�+e: LPG _ _ NG _ Oil
Phone: 17- ,i/Fax. I I -mail: - uctpipin eac a..itiona over•out eta _
ENGINEER recess piping(schematic required)
Name: 'lumber of outlets
.___. ,)ther Its'ie 1 appliance or eqi Ipment:
Address: ___ __ Decorative fireplace __ _
City: — State: ZIP: ns type —__
Phone; Fax: '-mail: I o..stove/pel—el_Tp____
r Other:
_Applicant's slgnatu' p, • . M- Date: t,_i ngil iter: _ _,
Name(print): ii'TIC I ___ — -. _--
s Permit fee $
'NO all jurisdictions accept credit cads,please can juts.Letson for more information Notice:This permit application
O Visa l0 MasterCard Minima m fee —
expires if a permit is not obtained
Credit cad number E.nir� within 1120 days after it has been Plan review(at %) ___
Name of-•rdholder u shown on credit card accepteu as complete. State surcharge(8%)....$ —
S TOTAL $
Cardholder signature Amount , 440-4617(6, UYCOM)
IIIIMMMIWOMIZMMENIMMINIMMINIMNIMIlb
u-)P AOC)?..)-- do f
• C
Building Permit Application
i,; e. Date received: c,iN D! Permit no.' yr'ir,-. ,t"
.q� City of TigardRE o t 1 p 9
Address: l3125 SW Hall Blvd,Tigard,OR 97223 Pr+'jecUappl.no.: Expire date:
City njrigard Ce
-
Phone: (50.1) 639-4171 MAY 1 4 ?UO3 1 1 T Gate issued: ;I y: 1 P.eceiptno.:
Fax: (503) 598-1960 Case file no.: Payment type:
CITY OF 1 IGARD
~
Land use approval: - ► . e 0 I&2 family,Simple Complex:
L] I &2 family dwelling or accessory U Commercial/industrial U Multi-family ,, New construction U Demolition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other:
`-, J0111 SITE INFORMATION '
Job address -- -- (� c_�
� :, \ J . I t 11 • Bldg.no.: Suite no.:
Lot: "I) Block: Subdivision: ‘-_-_,.4(_C.1 5 Tax map/tax lot/account no.:
t. Project name: r ' —
, 114—
\ Description and loc tion of work on premises/special conditions: I
OWNER FOR S' :CIM. .t OR1> ATION;VS1E,CIIIi :Kl.ltil
Name: � '' t' ^�" � Chlor ,ae iccirpacity,srdar,etc.)
-' Mailing address: 'I ,��'. . _ t; . . ' art , I &2 family dwelling:
City: ZIP: • - ' Valuation of work $
Phone: 47 Fax: 1-7 •, :-mail: No.of bedrooms/baths �.i �t j
Owner's representative: VEL (--1 6:0 v:1 t.K.... Tonal number of floors ........-
Phone: Fax: E mail: New dwelling area(sq, ft.) r :'� J
• APPLICAN Garage/carport area(sq.ft.) (. -' CO
Name: t A , i - r ,t Covered porch area(sq. ft.)
Mailing address: 4 'nill ' L u Z^NVt� DeA area(sq. ft.)
City: _ crate: GIP: - Other structure area(sq.ft.)
Phone: Fax: -IE-mail: —f Commercial/industrial/multi-family:
. , ('ONTIt-('TOR • Valuation of work $_ -____ __
Business name: - it ] Existing bldg. area(sq.ft.)
'��' — New bldg.area(sq. ft.)
Address: -�'(,•�y', Z Ira! -------
Number of stories
_
City. _ State: ZIP:
Phone. Fax: E-mail:
Type of construction
2 - Occupancy group(s): Existing:
CCB no.:
Sr J..3 _ New:
=–.--...
City/metro lie.no.: Notice:All contractors and subcontractors are required to be
AR('1111 ICI/DISl/:NI It licensed with the Oregon Construction Contractors Board under
Name: (.1411_......_____ .„... l provisions of ORS 701 and may be required to be licensed in the
Address: ' - - 0,5 -ry . , J 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 F.t E-mail:
Name: Contact person: Fees due upon application $
Address: _ Date received: _
City: _ 15tate: ZIP: Amount received i 1_
Phone: _ Fax: I E-mail: _ Please refer to fee schedule.
I hereby certify I have read and examined this application and the 'Not all jundictionr accept credit cnti,please can jutidiciion fir more Informatioon
attached checklist. A rovisions of I.ws and ordinances governing this Cl visa Cl MasterCard
work will be compli• wi ,whether. cified Nerern r,7t.r- Credit ted number _ __I_�_.—
/�/� p�� Expires
Authorized si nature: , 'I .��� ��`Jyyy,I��� i li&t. _ 14 IIL_ — Name of cardholder as shown on credit card $ p
Print name: �a 4 G.-f '.i"i I f' K_- — c'ardhol.kr signature Amount
1
Natice:This permit anolicalion expires if a permit is not obtained within ISP days after it has been accented as complete, 440-4613(6/00/COM)
........ Imm...........m... .........mmi
/ One-and Two-Family Dwelling
kl,411,. Building Permit Application Checklist Reference no
Associated permits:
City cfTigard ('it Of Tiand
.7 O Electrical O Plumbing Cl Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171 — —
Fax: (501) 598-1960
' THE FOLLOWINGFITEMS ARE"REQ IREI 'FOR PLAN REVIEW - Yes No N/A
. „r
I Land use actions completed.tics jurisdiction crucna I,.r concurrent reviews. —
2 Zoning.F' id plain,solar balance points,seismic soil',designation,historic district,• i,.
3 Verificati of approved plat/lot..
4 Fire distrit approval required._
5 Septic system permit or authorization for remodel. Existing system capacity __ _
r permit. --.__.
7 Water district approval. _ ,( ----
8 Soils report.Must carry original applicable stamp and signature on file it-with application. )(
9 Erosion control U plan U permit requirr>d.Include drainage-way protection,silt fence design and location of ,/ `
catch-basin protection,etc. /l\ __..___
10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed
if copyright violations exist. _
II Site/plot plan drawn to scale.The plan must show lot and building s,tbac k dimensions;property corner elevations(if
there is more than ' 4-ti.elevation differential,plan must show contou,-lines at 2•ft.intervals);location of easements and
driveway:fi otprim .f structure(including deers);location of wells/septic systems;utility locations;direction indicator,lot x
area;t-uilding coverage area;percentage of covet age;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location.
13 Floor plans.Show all dimensions,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 as floor beams,headers,joists.sub-floor,
wall construction,roof'construction.More than one cross section may be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing.roof slope,ceiling height,siding material,footings and fc;indation,stairs, Y
_ fireplace construction, thermal insulation,etc. `
1. _
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Fell-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate deli?Is and locations;for r
non- rescnptive path analysis provide specifications an,.calculations to engineering standards. f K
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member siring,spacing,and hearing
locations.Show attic ventilation.
IS Basement and retaining walls.Provide cross sections and details showing placement of rebut-.For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all'seams and multiple joists
over Ill feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor' iof truss design details. c
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 ,hear wall,roof truss)shall be stamped by an engin_er or
architect licensed in Oregon and shall be shown to be aprl . :hdc to the project under review. �
.DICTIONAI.SPECIE CS ,
23 Five(5)site plans are required for Item 11 above. Site plans must he 8..1/2"x 11"or 11"x 17". X
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 bt'ilding plans will be accepted.
27 _ —
28 _
Checklist must he 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, 440-461et6100/cOM)
imik
i Plumbing Permit tkpplication
D.te ter-ived:t) q 61 Femur no. rjjgr,rl re.f ?
Ii City of Tigard
Address: 13125 SW Hall Blvd.Tigard,OR 97223 -rpermit na.: Building permit no.:
Cif),of Tigard Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
., TYPEOFPERMIT '
0 1 &2 family dwe'ling or accessory 0 Commercialindustrilt U Multi-family 0 Tenant improvement
►' ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JO: or . s t u •TION ' a .01,1 a i 1 ( 1, . ,',. `nttormation useehecklist)
Job address: L C 0.{r_ /� ( r _ Description Qty. Fee(ca.) Total
�'� New 1-and 2-family dwellings only: ~`
Bldg. no.: Suite no.. (includes 10011.foread,utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot , - Block: Subdivision: allailti '� SFR(2)b tth _.-_
Project name: SFR(3)b Ah
City/county: ZIP: Each additional bath/kitchen
. Description and location of work on premises: Site utilities:
Catch basin/area drain
Est.date of completion/inspection:
Drywel:s/leach line/trench drain
Footing drain(no.lin. ft.)
. l'LLINIII;1NG '1 0N'IRACTOIt Manufactured home utilities
Liuslnett name. h.��A.A..Lv k-)1-L)ti_11.-AL3. ., Manholes -- --
Address: M�jam_ ow , Rain drain connector _ u
Enli� • . /.tI ZIP: Sanitary sewer(no.lin. ft.)___ -
Phone(cW--5L-f if Fax: E-mail: Storm sewer(no.lin. ft.)
CCB no.: Z Plumb.bus. reg. no: - _ Water service(net. lin.ft.)
Fixture or item:
City/metro lic. no.:N/A
'°-
�� ' Absorption valve
Contractor's representative signature_- ' Back flow presenter
Print name: j`, 11111 IN i - 11). ' fir >' Backwater valve
C'ON l',1Cl PERSON f Ba;ins/lavatory
Name:._ f\`'1P -V--L i e - Clothes washer
Dist washer
Address: Q , Al. Dnnkinl fountain(s)
City• __ State_ ZIP: Ejectors/sump
Phone Fax: E-mail: Expansion tank
' (fl N I:R Fixture/sewer cap
Name(print): .�'t11_ Floc r drains/floor sinks/hub --
g - Vritill 'al � Garbage did. sal
Mallin address: Hose Bibb
City: . l Statej7 •Z� Ice maker
Phone: i " - _ • i Fax: 7-7h.1 E-mail: _ Interce.tor/grease trap ---
Owner installation/residential maintenance only: The actual installation Pnmer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I ow;i as per ORS Chapter 447. Sink(st,basin(s), lays(s) - _ .
Owner's si•natureDate: Sump —
PNGINEtR' Tubs/shower/shower pan —
Unnal _,
Name: ___ Water closet
Address: _ Water heater
City I State: ZIP_ Other -
Phone: 7 Fax• E-mail: Total I____
'Na all)unsdictions steps credit cards,pirate call)unedicuor fa more information Notice:This permit application Minimum fee s --
0 visa 0 MasterCard _e'pires if a permit is-0t c buined Plan review(at %) $
C.edit card number _ / / within I80 days after it has been State surcharge(8%) ....$ _ —
Exptres TOTAL S -----
Name of cardholder as shown on credit card
accepted as complete.
_ S
Crdhoider signature — Amount 444416(Mfl OM)
Electrical Permit Application
- -- - Datereccived: fi X14\(-.,,4) Perms no.:i 1,j1 Pey7 - I'1?
,Iit City of Tigard Project/appl.no.: :F.xpit edate:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: _ By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: _ Payment type:
Land use approval:
I ' si' ' xi1id_
U I &2 family dwelling or accessory ,.l Commercial/industrial U Multi-family O Tenant improvement
L. New construction U Addition/alteration/replacement 0 Other._ U Partial
JOB SITLr INEORMA ON • •
Job address: j /(,/ - c- t`' L.t ���Suite ❑o.: Tax m:.p/tax loliaccoun(no.:
Lot: Block:lSubdivision; ' , Z ���_��
--- ------------------------------
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
( ( )N IRA('I Ol( API'I.N' t If)v • . FEE•SCHEflLLE
Job no: Fee f11ax
Business name: L- _ii. Description
- Description Qty. (ea.) Total no.Inca
New residential-Angle or multi-family per
Address: ''�jI u I MI I Mr. ) aea1 . F-_Ar dwelling unit.Includes attached garage.
City: lik L4 ' State:r" ZIP:ci"7,;,.?3 Sen-kebscluded:
Phone: �j• I 1 . Fax: E-mail: too°sq.ft.or less - 4 _
s Each additional 500 sq.ft.or portion thereof
CCB no.: Elec.bus. lie. no: • (,.• -Limitedenergy,residential 2
r"" mitedenergy,non•reidenal 2
2..........-.....D
_
Each manufactured home or modular dwelling
sure of supervising electrician/required) Dote G Service and/or feeder 2
Sup elect name(print) - 1 A. License no j„3. Serviceaorfeeders-Installation,
alter atlnn lr i elocution:
PROI'I RI1' UW,111:R 200 amps dr less 2
—
201 amps to 400 amps 2
'!ar.le (print). _ `�~ i � 1 \ l • 401 amps to 500 amps ------ 2
Wiling address: • ,) 7 tee �tIa. Vin \ 601 amps to 1000 amps 2
cry: LcO IState ZIP: A �_ Over 1000 amps or volts 2
rrhone: Ir- - r `7 * - mail: Reconnect only _ 1
r � � Temporary acarines or feeders Owner lnsrufluthrs-
ten:The installation is being made on property I own Installation,alteration,or relocation:
which is not intended for sale, lease,rent,or exchange according to 200 amps or less - ____-_� 2
ORS 447,455,479,670.701. 201 •amps to 400 snips _ _ 2
Owner's si•nature: Date: ao 1 to 600 amps 2
ENGINEER i Branch clmits-new,alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder PA,each branch circuit 2
City: State: I ZIP: B Fee for branch ciccuiu without purchase
of service or feeder fee,first branch circuit: 2 ._
Phone: fax: F -nail: Each additional branch circuit:
4. ' . t • fit, at apply) Misc.(Service orfet:dernslincluded):
U Sen -t over 22.5 amps-commercial 0 Healthcare f.-titty Each pump or irrigation circle , 2
D service over 320 amps-rating of I&2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuitts)or a limited energy panel.
O System over600 volts non'n,J more residential units in one structure alteration,or extension' --, 2
O Building over three stories 0 Feeders,400 snips or more •Description - —
O Occupant load over 99 persons 0 Manufactured structures Of RV park Fitch additional inspection over the all'stable In any of the above:
O Egress/lightingplan 0 Other -- Per inspection __- L I I l
Submit-_,_sets of pyres wish any of the above. Invesugatlon fee
The above are not applicabhe to temporary construction service. Other—
Not all lunulicnom accept credit canis,please cut jurisdiction for more information' Notice:This permit application
O Visa 0 MasterCard
Permit fee $
expires if a permit is not obtained Plan review(at — %) $
Credit care samba- — _ / / within ISO days after it has been State surcharge(8%) ....S
Expires as complete. TOTAL S
--- Name of cardholder u shown on credit card
S
Cardholder signature ---- Amount 410-4615(6/CO/COM)
05/28/2003 13: 41 503-387-7E,17 VEIJTUPE PAGE 62
r____________ ____—_____. —"----1
DON •
MOI\WWfl EORoOD RTRZUT LOT: 42
�' ♦ K s 0 8 If i s oDATE: 04/20/2003
aoa) aeti - 7ae •, roxk Feoo)taey - Yoea
PROPERTY: WHISTLER'S—WA IX
CITY: TIGARD
SCALE: 1"=20`
PLAN No.: 199
STANDARD ELEVATION
1
EL.321' 67,x' 4.
F.
PMIv,4TIS470 DD
I ►r7�Q E �P�p , • 43.
1
WO�IOn � i �j;Ji �
s
1-- ---- i I ..i_______.
n 32k,D1✓ o7r.• y
�' u
___----4
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_____
5� •q. ft. i
4 bdrm. 7
1 X12 ??"'ibath 11:-'4 ' 4
FFE. 33I.5 0. ''
U
IS'l
%-- ti 4 ....- 330
,.- 630 sq. rt. ,.---
3 ear 9Dr:---- io. a'-o'
PPE-. 331' r,
--33;
-
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t1 14 PLS . . , __ - 4_t • .......• i.., •.S.T',.�,., - _ ;34
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b I 131 61.00' / —. __. ._ ____ _
1226.5 SW. KELLY 1ANE A
LEGENV LOT COVERAGE
L-CT ARTA F,,A34 FT
o --1 ncr� Iz�aran� BUILDING AREA 2 300 50 rr LOT '42 ,
.Rev rix,..t_F• PERGEN?Ape`
GE• 33.1% 6034 . ft.
...„..
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Requited Setacks:
`;ide: .2.— Su,ot :-,....ti.7. _.____ _ t',•:)1. ..15-::- \
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ved
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Electrical Permit Application FOROFFICE USE-ONLY .
Received -leculcal
---- - -- - Date/By: 7 7/0&.3 iii- Permit No.:/7-1/ta(O.3-CV I`7`1
Planning Approval Sign
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223Date/By: _Permit No.:
Phone: 503-639-4171 Fax: 5(03-19g:19611'' Post-Reviev Land Use
/NM,A' '1'' Date/By: Case No.: _
Internet: www.ci.tignrd.o~.us �,�;,. '1 I Contact Juris.: See Page 2 for
24-hour inspection Request: 503-639-4175 Name/Method:_ Supplemental Information.
/ ! -:7 ) (I(^A /777.4"771-.
TYPE OF WORK PLAN REVIEW(Please check all that apply)
"'uction �■ Demolition .
0Service over 22' •mps- 0 I Icalth-care facility
New constrcommercial 0 hazardous location
Addition/alteration/re.lacement iU Other: 0 Service over 320 amps-rating of 0 Building ova, 10,0°0 square feet.
CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in
Ks; I &2-Famil dwelling Commercial/Industrial 0 System over 600 volts nominal one structure
-�' -- 0 Building over three stories 0 Feeders,400 amps or more
• Accessory Building Multi-Family_ 0 Occupant load over 99 persons 0 Manufactured structures or RV park
• Master Builder Other: 0 Egress/lighting plan , 0 Other: ,. _
JOB SITE INFORMATION and LOCATION Submit -_sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1.2 2.145' `j LA) k z!' L,Q _ FEE*SCHEDULE
Suite#: _ Bldg./Apt.#: __Number of inspections per permit allowed
Project Name: pi-iii ,44/2/ss> -H 6/14 t..5-3141 Description Qty Fee(ea.) Total
New residential-single or multi-family per
Cross street/Directions to lob site: dwelling unit.Includes attached garage.
Service Included:
1000 sq.ft.or less 145.15 4
Each additional 500 sq.ft.or portion thereof_ 33.40 1
Limited energy,residential 75.00 2
Subdivision: /44/45/210.25 /VW< Lot#: `J 2 _ Limited energy,non residential _ _ 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
service and/u,feeder 90.90 2
DESCRIPTION OF WORK
--- Services or feeders-Installation,
alteration or relocation:
_. --- -
200 amps or less 80.30 2
-
_..-_---__.._ - ---- 201 amps to 400 amps _ _ 106.85 __ 2
401 amps to 600 amps _ 160.60 2
70 PROPERTY OWNER "(1`''�7TE�N�ANT ---- -601 amps to 1000 amps -_ - 240 60 2
^ • Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: - __--___
- -� Temporary services or feeders-installation.
------ -- alteration,or relocation:
City/State/Zip: - - ----_--- -___-_- - 200 amps or less - __ 66.85 1
201 amps to 400 amps 100.30 2
Phone: _ _ _ Fax: . 401 to 600 amps 133.75 2
0APPLICANT CONTACT'PERSON Branch circuits-new,alteration.or
Name: ,poAI MDx/55L77.1 iijfJ12� 1/✓� eztensir,tper panel:
A.Fee for branch circuits ssnh purchase of
Address: 4.2_3 r A L __2s- - service or feeder fee,each branch circuit 6.6s 2
City/State/Zi : Net---4 5 1w ,f6�J 614;52(45 -B.Fee for branch circuits without purchase of
p �_.- kservice or feeder fee,first branch circuit 46.85 2
Each additional branch circuit 6.65
Phone: -30- == ';‘-'34/r"';‘-'34/r" I Fax: 2 -74 41_ 2
B-mail: Misc,(Service or feeder not included):
Eac'i pump of irrigation circle 53.40 2.
CONTRACTOR- Each sign or outline lighting 53.40 2
Job No: 2 T?'1 2- Signal circuit(s)or a limited energy panel, Page 2 2
alteration,or extension lS
Business Name_; LL.c_
Description:
Address:_ �, [), Or ,ST lj y- ---- Each additional Inspection over the allowable in an�of the above: -
City/State/Zip: ALG' ____`� i Per inspection per hour(min. I hour) 62.50 -
Phone: 3 110 'Si Fax: 2. - ' Investigation fee: - -^ ___
Other: _
CCB Lic. #: 13x'2` 22 Lic. #: 3�/- L/ - Electrical Permit Fees* _-
Supervising electricia - Subtotal 1 $ __-___ _
signature required: , i")_ Plan Review(25%of Permit Fee) $
Print Name: bha/ Yoivb A L. • #: • State Surcharge(8%of Permit Fee) $
TOTAL PERMIT FEE $ _-
Authorized Notice: This permit application expires if a permit Is not obtained within
Signature: __--____ -___..__ Date:_________- 1110 days after It has been accepted as complete.
•Fee methodology set by Tri-Count. Building Industry Service Board.
-- ---- (Please print name) -------
is\Data\Permit Forms\ElcPermitApp.doc 01/03
J
•
,ctrival Permit Application - City of Tigard
• .ge 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check 7 ype of Work Involved:
❑ Audi, and Stereo Systems*
!lurglar Alarm
Oarage Door Opener*
I I heating.Ventilation and Air Conditioning System*
Vacuum Sys,ems*
L Other
COMMERCIAL WORK ONLY:
Fee forma system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
El Audio a-t Stereo Systems
El Holler Controls
El Clock Systems
1-1 Data Telecommunication Installation
El Fire Alarm Installation
El IIVAC
Instrumentation
DIntercom and Paging Systems
Landscape Irrigation Control*
Medical
ElNurse rails
0 hitdoor landscape Lighting*
El Protective Signaling
L_i ()ow,
Number of Systems
* No licenses are required. t eencz.s are required for all
other installatla.'e
i:\Dsts\Permit Forms\ElcPcrmit AppPg2.doc 01/03
ELECTRICAL PERMIT -
CITY OF TIGARD RESTRICTED ENRGY
441"I' 13125 Ali
DEVELOPMENT alllvd., rSERVICES(503)d. OR 97223 639 4171 DATE ISSUED:#: E PERMIT6 03 3 00206
—
SITE ADDRESS: 12265 SW KELLY LN
PARCEL: 2S103CC-09500
SUBDIVISION: WHISTLER'S WALK ZONING: R-4 5
BLOCK: LOT: 042 JURISDICTION: TIG
Project Description: Installation of all encompassing low voltage.
A.RESIDENTIAL B.COMMERCIAL
AUDIO & STEREO:
BURGLAR ALARM:
AUDIO & STEREO: INTERCOM & PAGING:
BOILER: LANDSCAPE/IRRICAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
__--TOTAL # OF SYSTEMS_
Owner: Contractor:
DON MORISSETTE HOMES INC BRIGHTEN ELECTRIC
4230 GALEWOOD STE #100 PO BOX 5964
LAKE OSWEGO, OR 97035 ALOHA, OR 97007
Phone: 503-387-7538 Phone: 5n3-.456_8628
Reg #: Sbll'4-25942111W
1.1t 132222
t I I 1,1..4s-tt
FEES Required Inspections
Description Date Amount Low \voltage Inspection
III 1'1011111R Permit 7/16/03 $75.00 Elect') Final
11 \\18%State Tar 7/16/03 $6.00 .
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 plars. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for mc e than 180 days ATTENTION: Oregon law require:,
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set fortp in OAR 952-001-0010 thrn.
Issued by �� 41' �r' ,p l /� Permittee Signature l
i..Rt tt e Stgr tun. ,� ��jr
OWNER INSTALLATION ONLY i
Th' installation is being made on property I own whi.:h 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
al Permit Application FOR OFFICE 115E ONLY
Elect, ac — Received / Llecu,cal
Date/By: '2 ii/(/c '' Permit No.: .P.- c'/
Cit of TI aCii Planning Approval Sign
City g 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
n L l A Date/By: Case No,:
Internet: www.ci.tigard.or.us .� e e 2 for---- -
b J r I Contact Julia.: I tics Page 2 for
24-hour Inspection Request: 503-639-4175 ' - Name/Method: 1 Supplemental Information.
TYPE OF WORK PLAN REVIEW(Please check all that app1Y) _ l
New construction -- III Demolition Service over 225 amps- I Icalth-care facility I
commercial
0 Hazardous location
• Addition/alteration/reply-ement 1II Other: ❑Service over 20amps-rating of ❑Building over IO,000 square feet,
CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in
IN 1 &2-Family dwelling Commercial/Industrial 0 System over 600 volts nominal one structure
0 Building over three stories 0 Feeders,400 amps or more
■ Accessory Building Multi-Family 0 0,,,upant load over 99 persons 0 Manufactured structures or RV park
■ Master Builder Other: 0 Egress/lighting plan 0 Other: __-
JOB SITE INFORMATION_ and LOCATION Submit_sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 221.5 SiA) 14 eu y LA) _ I FEE*SCHEDULE _ __-
Suite#: Bldg./Apt.#: Number of inspections per permit allowed
Desert tion Qty Fee tea.) Total III Name_W fq/Srj�>125 w/1/A; — 19,3,4) ��d�lJ`J �Ne' residential-simple or multl.famlls per
Cross street/Directions to job site: /21„.r— dwelling unit.Includes attached garage.
Service inclined:
1000 sq.tl.or less 145.15 4
Each additional 500 s .fl.orportion thereof 33.40 1
Limited enema residential 1r" 1 / 75.00 2
Subdivision: k4)///57,1725 tu4 tK _ rLot#:__y 2 Limited energynon residential 75•00 ____ 2
Tax map/parcel#: Each manufactured home or modular dwelling
DESCRIPTION OF WORK - service and/or feeder 90.90 2
--- Services or feeders-Installation,
alteration or relocation:
— —
200 amps or less 80.30 2-
._- ---.--- 201 amps to 400 amps 106.85 2
1----- -- 401 amps to 600 amps 160.60 2
-art OPERTY OWNER 1 r TENANT 60i amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary set+Ices or seeders-Installation,
--- alteration,or relocation:
City/State/1:R; — 200 amps or less 66.85
Phone: 201 amps to 400 amps
- 100.30 2
_ _ i Fax: _ 133.75 2
I 401 to 600 amps
❑APPLICANT — -0 CONTACT PERSON 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: _ H.Fee for branch circuits without purchase of
service or feeder fee,first branch circuit 46.85 2
Phone: Fax: — Each additional branch circuit 7:757 - 2
E-mail: Misc.(Service or feeder not included)'
Each pump or irrigation circle 53' 2
CONTRACTOR Each sign or outline lighting S3.46 2-
Job No: _
�� Signal circuit(s)or a limited energy panel. 2
• r
alteration,or extension Page 2
Business Name: , • Description
Address. rg,5�by —_-- _ — — .
Each additional inspection over the all rwablc in ans of the slime:
...i_____
A ---'- 62 SU i
City/State/Zip: A,Loi K �o67 Per inspection per hour(mm. I hour) I
Phone:�d _sag .-251 - 2.J 1 Investigation fee:
,3 • __ Fax: Other: _
CCB Lic.#: )3 2z22_,— Lie. #: _ 0)3 l — Electrical I emit Fees*
Supervising electrician ) Subtotal S ?.c," _
signature required: Plan Review(25%of Permit Fee) $
Print Name:L„(,et Y u,rlg .u'l ;47 .5 — — State Surcharge(8%of Permit Fee) • S G• _
r_
TOTAL PERMIT FEE S r;/ . ,--�c�—
Authorized Notice: This permit application expires if a permit Is not obtained within
Signature: ___ Date:— 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
(Plea to print name)
i`Dsrs\Permit Forms\Elcl'er'aitApp.doe 01/03
Electrical Permit Application -City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
('heck Type of Work Involved:
C, Audio and Sterol Nystcros*
lturglat Alarm
LJt iarage Door Opener*
1] I Icating.Ventilation and Air Conditioning System*
IIVacuum Systems*
iOther--- -- --
COMMERCIAL WORK ONLY: _
Fee for each system $75.00
(SEE OAR 918-260-260)
('heck Type of Work Involved:
[] Audio and Stereo Systems
I I Boiler Controls
n (lock Systems
I- Data Telecommunication Installation
El fire Alarm Installation
n HVAC
n Instrumentation
I I Intercom and Paging Systems
Landscape irrigation Control*
n Medical
I I Nurse Calls
nOutdoor Landscape Lighting*
[_] Protective Signaling
nOther — -- -- —
Number of Systems
* No licenses are required. licenses are required for all
other installations
i:\Dsts\Permit Forms\EICPemntnpp'g2 Inc 01/03
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CITY OF TIGARD PLUMBING PERMIT
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411...iii DEVELOPMENT SERVICESPERMIT #: PLM2003 00460
DATE ISSUED: 8/28/03 I
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103CC 09500
SITE ADDRESS: 12265 SW KELLY LN .5
SUBDIVISION: WHISTLER'S WALK ZONING:JURISDICTION: R-4 TIG
BLOCK: LOT: 042 —
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: W,.TER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINF:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LiNE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install bark flow pieventer __
FEES
Owner: ----- Description Date Amount
DON MORISSETTE HOMES II'I I \lliI Penult I cr 8/28/03 $36.25
4230 SW GAILEWOOD STREET I I.\.\I x' • titate l a\ 8/28/03 $2.90
Total $39.15
Phone :
Contractor:-------:----
LANDSCAPE
—LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : 503-692-5945
Reg#: PLM 7g04
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 ATTENk is TION:not
Ore startedoIdays within 180 suspended
lw requ res ou to follow r�es adopted by the Orego
for more than 180 days. ATT E 9
Issued By: ,_-i >>V t. Permittee Signature: L�.�Clrs 4-A-6-�1� --
_� J �
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next busindss day
Fila^ 27 03 02: 08p dan edmonds 503 -692-0788 p. 2
Pl�umbin� Permit Application R �,R OFFICE Plumbing u ON! ��
-- - - i` Scums No. et' -� 4(�o
Plenum
City of Tigard RECEIVE,-
) D b:M -- - ---- Panel No.: _
13125 SW Hall Blvd �+ Plan Review Other
Tigard,()regret 97223 AUG r 2 r /I '� Batey: Paroit No.: --
Phone: 503-639-4171 Fax: 503-598-1960
Post-Review Land Use
Datelli _ __ _ Case No.:
Interncl_ Www.ci_tigald.or_us I i i _t It�-.-'1 1� contact loris:al See Page 2 for
24 hour Inspection Request; 503-FAS, (%. NamrlMcttnd: - Supplemental Informatlau.
IVI�;I'?M1l -
',F.1,,,tle ` 'TYPE OF WORK `. , . FEES SCHEDULE(for information use"Checklist)
w construction -_+ _Demolition Bes�criptioo aty. Eccles.) Total
J Addition/alteration/replacement C) er. New t-at r.fxmpy awcwng� •
• +',CATEGORY OF.CONSIRUCTION: • - •(�adades leo ft_roc i wmity dn,eetioe�).
1 &2-Family dwelling Commercial/Industrial SFR(2 bath - - 340.00
--. Y R SFR(2)bath 350.00 _
_ ry_�.Building__- ❑Multi-Family SFR(3)hath 3999.00
Acccsso
[j Master Builder 0 Other Each additional bath/kitchen - 45.00
` JOB SITE INFORMATION and LOCATION • Cue twinkler•sq.IL: __Pets?_
Joh site address: f �
Ip . (..t `t'(I LU r l e:• _� •Site Utilt;c� _
' _
Suite#: I Bldg./Apt": Caleb tanaid rea drain 16.60 ____
13rojecl Name: /Alt u /(ri ►.J_r!E!c e/!7- Dirve Vleach line/trench t drain 16-60
Footing drain(no-Boast R) _ Pa:e 2
Cross street/Directions to job site: Mamufasxttrtxd hm
oe ntihries -- 110.00
1-1-/ /,-:-:/ / c J 1-I(.C•_ Mutltoles 16.60 -
Rain drain connector 16.60
Naim sewn(no.linear ft.) Po.e 2 _
- Storm sewer no_linear ft. Pa•e 2
Subdivision:u.'J 1 iSi'/e0-'a L1_'r.r._. c. 1 Lot it: a../3-_ � __- )
r- - r - -Water service(no.biovar IL) - _Pas 2
-I'ax map/parcel#: to - 1i _, -
.DESCRIPTION OF:WORK- :.'; Fixture oirlheQi
. - �-
- - Absorption valve 16.60
1..-anC(.S c c7.10.,2,_ _2r r/c/23.741 C_l i _BadcflnyLpreventer - L Page 2 .77• S_
/3c-4--fc fhcn C/Jjjf c e. _ . Backwater valve 16.60 _____
amities washer 16.60
--� Dishwasher 16.60 _
4 pr f!-di'OPERTY'OWNER . 1 CI TENANT; • .., -- �tinkmn fowl/min 16.60 - -
��eclors/stm�p _- - -- 16.60 -_
Name: Dell mvri sS C-f- !fen"r Fxpanti:on tank 16.60
Address: 14)30 Se
CA, Ga ciLzio cL., Jiro, T Futbuel cap 16.60
City/State/Zip: LgLka. 6S•c, !( O OQc'7 3y FlarrdraoJ3basmk/bub - 16.60
_GarbazedisEasal _ 16.60
Ph•no: _ Fax:. Nage bib -- 16.60
.- _PLICANT': .:- . CONTACFPBRSON'•. 7 Ioe maker 16.60
Name:t7/erL N: cvt' ro-rt) Intenseptixigease trap- - - 16.60
Addrtss: /,?.3Ua .S 0.3 /'1't t 0 r I2.12 Medical leas-values s. __ Pie 2Priiii-e _-
City/5t lte/Zip:Tu rY in eD, . '7D1�eZ, itooIcI 16.60
r63 RooEdrain(commercial) ( I6.60
Ph_ one:503 (09A_ 59t#&1 Fax_5 (ro9e - (J7, -Sink/basin/lavatory __ _ i c
E-mail: - _,•n&show&shower prat-_-_ - __�_ 16.60 - -
_ CONTRACT ORS'' ..,:: lhitnl - --- - 16.60
~
Business Name: Lir/14,S eelpt. OI' -L J7 PIC.. --_Wets closet`-- -- ----- .-`_ 16.60 _.
Address:/,)30C' � V( rh y slang4Water heater _. -____ 16.60
Cit !Stat-JZi Oa- 70(,, Ot
her
c -- -
Phone503 toga __S-9ilcFax.5C-ii �9a :0762$ , . • •PiambingyermltFees*
~- Subtotal S
CCB Li. #: '7 cG Plumb.Licit-_- _ - - ------Permit F-tr�so s
bet ---e-@Ll.�_ ctw-t ODate: d� tic) Residential Hackllaw Minimum Fut ?Cn.
Si attire: _ •- _ -- Plan Review 9.514 of Permit Fee) S
I -
1l Scar renisStates (11%of Permit F•t e) S . 10
(Pleas print name) TOTAL PERMIT FEE s 39_ l S
Notice: Tbk permit ap*Geatinv'lours if a perasir k ant abtaiard within Alt new enenmerrrial IaSIMt9stSt rewire 2 aret of plant with Ivametric or
ISO days atter it has been accepted as complete. riser Jliarua far plan re•iew-
•ree methodology sot by Trl-County Building Industry Service Board. ,
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST 3 --°c) ( / /
INSPECTION DIVISION Business Line: (503)639-4171
BUP
c�
Received - Date Reque ted _ Q - Z . AM_ - PM _-_- BUP
Location ___ I a a(e-5 ---Suite__ ._ MEC -------------_.--
Contact Person ___ _ L -" -__ Ph (____._____)j.2. e9- q-1-37 PLM
Contractor- _ _ -- - - - Pty 1- -.) - -- SWR - - - -
I BUILDING Tenant/Owner __ �_ _____ --_-- ELC
Footing
ELC __
Foundation
Access:
Ftg 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 - — ---- . .
Roof
Ota•-4r: ---- ..
4 Vin.
---•A-S: -ART FAIL
jilaiTir ` - - - ---- -- —
Pos &Beam . )
Under Slab --- —-- - -- - -
Rough•In
Water Service --- -- - --
Sanitary Sewer /1k
Rain Drains -• --
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: -
_ _ S PART FAIL
ANICAL - \
Post&Beam
Rough-In - — --
GarLine
Smote Dampers --- --
mal
S PART FAIL -- --
I.
: . AL
Service - ---- ----- -- - ---
Rough-In
UG/Slab
Low Voltage
Fire Alarm
PART FAIL [ 1 Reinspection fee of$__ .____. required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
ilr$
"4 - L i Please cad for reinspection RE: 1 1 Unable to inspect- no access
Fire Supply Line _ _ �ADA Date .. /"'-� /03_ Inspector ! ' Ext
Approach/Sidewalk U
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
_ - r
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST — —
c� BUP
Received Date Request d / AM_.___ PM -________ BUP
Location / L0 S2g Suite MEC
Contact Person �� ------
— - Ph( ) --- - -- PLM 3 — DD ({(PO
Contractor _ Ph( ) - SWR
BUILDING Tenant/Owner ELC
Footing--- -- - —
Foundation Access: ELC
Ftg 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
Roof G
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
Ot ra
'a • F- Air•
PA PART FAIL CHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final _----PASS PART FAIL ,—_-
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final 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 Line ,_
ADA ,,
Approach/Sidewalk Date— Inspector
_ _u_ - • Ext
Other: V'
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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