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9720 SW NACIRA LN
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CITY Of TIGARD
Residential Ce rtii cuie of Occupancy
Permit No.: Mgr Zce S- cc, 415-40 Address: 1'7ZO / A14C /cert 1-A4 --
Owner/Contractor.
Date of Final Inspection: i& ' dY Inspector:
"6s structure has been found to be in substantial compliance with the provisions of • tate of Oregon One di Two Family Dwelling
ijprcialty Code and is hereby approved for occupancy.
CITY OF T I G A R D PLUMBING PERMIT
.1", DEVELOPMENT SERVICES PERMIT 1: PLM2004-00362
Ai- 4i. 13125 SW Hall Blvd., Tigard. OR 97223 (503)639-4171 DATE ISSUED: 8/9/2004
SITE ADDRESS: 09720 SW NACIRA LN PARCEL: 1S135CD-13500
SUBDIVISION: GREENBURG PINES ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS. URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device.
FEES
Owner: Description Date Amount
VISTA NORTHWEST INC [PLUMB[ Permit Fee 8/9/2004 $36.25
PORTLANDD,, 97291
PO BOX 91459 [TAX]8%State Surcharl 819/2004 $2.90
OR
Total $39.15
Phone: 503-531-0505
Contractor:
SELBY PLUMBING INC.
20565 SW TV HWY#373
ALOHA, OR 97008 REQUIRED INSPECTIONS
Phone: 503-730-3437 RP/Backflow Preventer
Final Inspection
Reg 9: LIC 150252
PLM 34-397PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws All work will be done in accordance with approved
plans. This permit will expire if work Is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR
952-0 - 100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 699. \ / --
Issu B. � ; ' / p' i Permittee Signature: ' t.
Call( 1 • 939-4175 by 7:00 P.M. for an Inspection needed the next business day
,
Building Fixtures
Plumbing Permit Application i()It til 1 It 1 t sI tl\l
City of Tigard Recto-°° . In Permit No
13125 SW Hall Blvd.,Tigard,OR 97223 Phu, eviaw
Phone 503 639 4171 Fax 503 598.1960 W�ty. Other Perrot Na
an F
24-Hour inspection Line 503.639.4175 !1J. 4i1..
Internet. www www ci ti or us Nass ied/Meth: EINS Sea Pipe 2 for
iWd Notified/Method: Supplemental Information
c, ,4,,,,„ . 1,»` Zy •' ' • ,^ ,
:11
❑New construction ❑Demolition For special iforma ion sue checklist
----- Desscri.non ] Qty 1 Ea 1 Total
❑Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft for each utility connection)
,. . k,,sift a /iy t "n i SFR(1)bath 249.20
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath +00
❑Accessory building 0 Multi-family SFR(3)bath 399++
Each additional batn'►ntchen 45++
❑Master builder 0 Other: —
Fire sprinkler(_____sq ft.) Page 2
`u.'= Site utilities
Job site address: 7707,09_ 5',"2...,y/y5; :"/.."_05).../....4/aCatch basin or arra drain 16.60
~
Drywell,leach line,or trench drain 16.60
City SatdZlp: r,���'l� -Suite/bldg./apt.no.: Project name:�r� ,r�,� Footin _ in(no linear ft ) Page I
J i '..1".ctured home utilities 11000
Cross street/directions to job site: -- ` -
Manholes _ 16.60
i.
Rain drain connector 16.60
Sanitary sewer(no linear IL:_) Page 2
~
Storm sewer(no linear ft.:,__,J Page 2
Subdivision: I Lot no.:
Water service(no linear ft.: Page 2
1M:tare er lienTax map/parcel no.:
Absorption valve 1660
.
W" `'+:, :+tt Backflow preventer / Page 2
Backwater valve 1660
Clothes washer 1660
Dishwasher 16.60
Drinking fountain 1660
' Ejectors/sump 16.60
Name: 1 /.S, '1 1/00.-, Expression tank 16,60
Address: '. 71/4-2/5‘5-lit Fixture/sewer cap 16.60
City/State/ZiP: 97 . Floor drain/f oor sink/hub 16.60 —
Phone: -) /t..7,--2.27- — Fax:( ) Garbage disposal 16.60
• Hae bib _ 16.60
' Ice maker 16.60
Business name: r
Interceptor/grease trap
_
Contact name: Medical gas(value:f ) Page 2
Address: Primer 16.60
City/Sate/ZiP: Roof drain(commercial) 1660
Sink/basin/lavatory 16.60
Phone:( ) Pax::( ) —
`
Tub/shower/shower pan 16.60_
E-mail: Urinal 1660
•(;4 ,'. !,1.,.,. ,, . t t
;(,..1
. .,'� 7"."`,‘
a..s I ., ,ji w. . Wafer dont 16.60
a--^-
Business tame: Wttlsr hater 16.60
.,51��3 y� �11Y1� -
Address:
Other
City/State/ZIP: _ Subtotal
Minimum permit tee $72 50 dTs•
Phone:( ) Fax:( ) Residential backflow minimum permit fee. $36 25 •
Plan review (25%of permit fee)
/
CCB Lic.: / ! Plumbing Lie.no.:
State surcharge(8%of permit fee)
Authorized signature:I %� - ��
TOTAL FEE 3�. / S
r
Print name: As.00' f 46'411,-..6.0
'Date: - This permit application expires if a permit Is net obtained within
— 180 days aft.r It has been accepted as complete.
•Fee methodology set by Tri County Building Industry Service Board
i\NndinePor,it\PIMP Permit App dec I Ln) 440 4456171ebM'OM RI
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression S stems:
';:'�+.- !'"' 51*.'IMt.i.IG. { r h 'r! .1,:;..:-.:! 'i4 ec
Footing drain- 1.100' IlMil 5500 0 to 2,000 _ $115.00 —
Footing drain-each additional Iii' 46 40 _2,001 to 3,600 $160 00
3,601 to 7,200 $220.00
Sewer- 1st 100' SS 00 —r
7,201 andireater $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical Gas S tems:
Water Service-each additional 100' 46.40 n
'
Storm&Rain Drain-1st 100' '5.00 '+SI 00 to$5,000.00 Minimum fee$72 50
Storm&Rain Drain-each additional 100 46.40 $5,001 00 to S10+r i 00 $72.50 for the first$5,000 00 and$1.52 for each
,1 " ;PAi� ��. additional$100 00 or fraction thereof,to and
r:a. 43ittMr ". • 't+. '�aigii.•:p including SI0,000 00
Commercial Back Flow Prevention Device 46.40 $10,001.00 $25,000.00 SI4R`0 for the first$10,000 00 and SI 54 for
Residential Backflow Prevention Device each additional$100 00 or fraction thereof,to
1minimum permit fee$36.25) 27.55 and including$25,000.00
Rain Drain,single family dwelling 65.25 $25,00 i i to$50,000 00 $379 50 for the first$25,000.00 and SI 45 for
Inspection of existing plumbing or ■ each additional S100.00 or fraction thereof,to
and including S50,000 00
specially requested inspections-per hour 72.50
r $ I 1100 and up $742 00 for the first$50,000(X)and$ Øfor
Subtotal: each additional$100.00 or fraction thereof
Fixture Work:
Are you capping,moving or replacing existing fixtures.
"yes",please indicate work performed by fixture. Failur o
accurate' re. .rt fixtures could result in Increased sew f *.
i . -; .
•
x,'� r',, "` Comments regarding fixture work:
Baptistry/Font
Bath -Tub/Shower
hi V - -- -- —
-Jacuzzi/Nniirl++i I
_____,
Car Wash -Each Stall ,
Drive Tltn, - --- —
Cuspidor/Water Aspirator - —___. ---
Dishwasher -Commercial
-Domestic — ---— -Drinking Fountain - — -
_Eye Wuh
Floor Drain/sink -2" -- i
a — Car Wash Drs.,()wimple -Domestic
Disposal -COM. - ial
1ndy.trial Note: If the fixture work under this permit results In an
Increase of sewer EDlfs, a sewer permit will be issued and
Ice Mach/Refrig Drains
Oil Separator tOts Station) fees assessed for the sewer increase must he paid before the
R e Vehicle Dump station plumping permit can he issued.
CI Shower -(sang
U' -Stall
Sink -BarRivat
.� °ry ouaoaryTota
Bradley cul isometric or riser diagram is required if fixture quantity
Service total is>9.
Swimming Pool Filter =
Washer-Clothes � -H
Water Extractor flan Review
rWatci Closet-Toilet
.
Plan review is required if fixture quantity total Is Q.
Urinal
Other Fixtures -
I Suiki eirmit vtl4 PwriAA enc vos
•
C TY OF TIGARD _ MASTER PERMIT
PERMIT 0:.41116r, DEVELOPMENT SERVICES DATE ISSUED: 0/15033 ooa5o
"'AX I-�.' 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171
SITE ADDRESS: 09720 SW NACIRA LN PARCEL: 1S135CD-GP006
SUBDIVISION: GREENBURG PINES ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
REMARKS:
BUILDING
REISSUE: 1795 STORIES: 2 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK. NEW HEIGHT: 21 FIRST 1 044 if BASEMENT if LEFT: 5 SMOKE DETECTORS. Y .
TYPE Of USE. SF FLOOR LOAD: 40 SECOND 971 •f GARAGE 420 of FRONT: 20 PARKING!PAC!. .
TYPE OF CONST: SN DWELLING UNITS: I TRIO 41 RIGHT: S
VALUE: 201,145 00
OCCUPANCY GRP: R3 SIAM I BATH: 4 TOTAI 2.095 •I REM: 15
PLUMBING
SINKS 1 WATER CLOSETS WASHING MACH: I LAUNDRY TRAYS: I RAN DRAIN. 100 TRAPS
LAVATORIES 5 DISHWASHERS I FLOOR DRAINS: SEWER LINES. 100 SF RAN DRAINS 1 CATCH BASINS
TUSISHOWERS 4 3ARBAOE DISP• + WATER HEATER!: 1 WATER LINES 100BCKFL W PREVNTR GSEASF TRAPS
OTHER FIXTURES
MECFIMNICAL
FUEL TYPES FURN<100K BOIVCMP<DIP. VENT FANS 4 CLOTHES DRYER: 1 ---
,As FURN>-100K I UNIT HEATERS HOODS 1 OTHER UNITS: 1
MAX INP• btu FLOOR FURNANCES VENTS. 1 WOOOSTOVES OAS OUTLETS: 4
_ ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MIICELLANEOU$ ADM INSPECTIONS
1000 SF OR LUSS: 1 0 700 4n, 0 700■mpW/evc OR FOR. PUMP/IRRIGATION- PER INSPECTION:
EA AMY 50013F.F. 1 701 400 np 701 - 400 rnp Is W70SVCF DR• 51O117OJT LIN I.T PER HOUR:
LIMITED ENERGY. 401 - 100 if i, 401 • 000 rnp EAADDLBR CIR: MIONAJPANEI IN PLANT:
MANU HN/SVC/FDR.
en 1000 WHO 001•rnp•-100ov MINOR LABEL
1000••mn/voll
PLAN REVIEW SECTIUN
R•ronn•ct only
•.4 RES UNITS SVCIFDR'.S7S A •ISO V 4OMINAL CLI AREA/IPC OCC
_ ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO S STEREO VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM INTERCOMIPACING OUTDOOR LNOSC LT
MMus ALARM: OTH BOILER: HVAC LANDSCAPEIRMO PROTECTIVE MGM
GARAGE OPENER. CLOCK• INSTRUMENTATION MEDICA- OTFNI:
HVAC DATNTELE COMM NURSE CAUL!' TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,280.28
INC NORTHWEST INC This perma Is subject to the regulations contained in the
VISTAVISTA BOX NORTHWEST
BOX NORTHWEST VTigard Municipal ode.State of OR Specialty Codes and
V
PORTLAND,OR 97291 PORTLAND„OR 97291 al other ce with
laws. plans work h be permit it
accordance with appioved This will expire N
work is not started within 180 days of issllanoe,or if the
4. work Is suspended for more than 180 days. ATTENTION
Oregon law requires you to follow rules adopted by the
N PNons 503-331-0505 PSbOn 503-531-0505 Oregon Utley Notification Center Those rules are set
forth In OAR 952-001-0010 through 952-001-0090. You
} Ra B' LIC 75507 may obtain copies of these rules or direct questions to
OUNC by calling(503)248-1987
a REQUIRED INSPECTIONS
0
UI
J
Issued By : Psrmlttee Signature : -._
Call(S 3) 639.4175 by 7:00 p.m. for an Inspection needed the next business day
CITY OF TIGARD _ SEWERCCNNECTION PERMIT
DEVELOPMENT SERVICES PERMIT N: SWR2063-00338
" DATE ISSUED: 10/15/03
13125 SW Hall Blvd., Tigard,OR 97223 (503) 639-4171
SITE ADDRESS; 09720 SW NACIRA LN PARCEL: 1S135CD GP006
SUBDIVISION: GREENBURG PINES ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG -
TENANT NAME:
USA NO• FIXTURE UNITS:
CLASS OF WORK: DWELLING UNITS: 1
TYPE OF USE: NO. OP BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks:
Owner:
FEES
VISTA NORTHWEST INC
PO BOX 91459 Description Date Amount
PORTLAND, OR 97291 (SWUSAJ WI-Connect 10/15/03 $2,400 00
[SWUSA]Swr Connect 10/15/03 $0 00
Phone: 503-531-0505 (SWINSP]Swr Inspect 10/15/03 $35 00
[SWINSP]Swr Inspect 10/15/03 $0 00
• Contractor:
Total $2,435.00
Phone
Reg #
Required inspections
a
rx
t—
a� This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued The total amount paid will be forfeited If the permit expires. The Agency does not quare itee
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" Perrn
Issued by: 77Permitter Signature ' ./�..
Call(503 d39-4175 by 7:00 P.M. for an Inspection needed the next huslness day
. -�0'r1 /0-9 ns 14W" swR a.00- - ou 338
Building Permit ApplicationI t►I2 t►1 1 It 1 I 1 1\1 1
Received Building
Date/By: q 1; 03 Permit No•I 7 _'• -CO C.
City Of TigardA
�:M, • Planning Approval Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: 8/ 1V'+; Permit No.:
Post-Review land Use
Phone: 503-639-4171 Fax: 503-598-1960 t 'I
Internet: www.ci.tigard.or.us t� 'IL-
--� Date/By: Case No.Contact Juni ®See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method _ -_Supplemental Information
TYPE OF WORK_ RLQUIEED DATA:
Zre;construction _,–im Demolition 1&2 FAMI!V DWELLING
,_Addition/alteration/replacement _Other:
CATEGORY OF CONSTRUCTION Note Permit feu'are based on the torr I value of the work performed. Indicate
2-Family dwelling Other:
cial/Industrial the value(rounded to the nearest dollar) )f all eouipment,materials,labor,
.iCoverhead and profit for the work indicate I on this application
Accessory Building rMulti-Family
Master Builder _Other: Valuation S SDI,70i
JOB SITE t ORMATION and LOCATION No.of bedrooms: ___ No.of baths•_ y
Job site address: l - -- . . ,... Total number of floors L
New dwelling area(sq.R.) ZDS4–
Suite#: Bldg./Apt.#: Garage/carport area(sq.ft.) JI 24'—_
Project Name: Covered porch area(p.R.) /v U
Cross street/Directions to job site: Deck area(sq fl.) —
Other structure area(sq.R.)
DD
_.r COhIMER., At-USE CKL15
�iCl_�r/.t: c jr,/,re:�— 6 -.
Subdrvtslon Lot#: —� -- - .. __..-- -----
Taj map/parcel #: Note Permit fees*are based on the mud value of the work performed. Indicate
DESCRIPTION OF WORK the value(rounded a the nearest dollar)of 1 equipment,materials,labor.
__ _.-._--- _ _- --. — - ---� overhead and profit for the w indicat on this application
~ Valuation S__
- -- Existing building area(sq. .
.. New building area(sq.R.
Number of stories ________
J-OPERTX OWNER • TENANT .... --- Type of construction
Occupancy group(s): Existing:
Name: L�1j.,,,,-,0:__44_--A-7-."4- r.,:3.4 ',fief- --
Now:
Address: l ' 2/0t5-7 __ _
city/state/Zip: pr—�,, 77z}/
Phone' r -�,�' Fax: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
APPLIC ❑ CONTACT'PERSCTIV It provisions of ORS 701 and may be required to be licensed in the
Business Name: 4,445 _ jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing,the following reason applies:
Address: —
City/State/Zip: -- —
Phone: Fax:
E-mail: " i•
.7'^ ., a
Business NamC: Fees due upon application f__
Address:
City/State/Zip: Amount received (—
Phone: I Fax: Date received
CCB Lic. #: �'" - — -- -
Authorized Notice: This permit applleaAlln aspires If a permit h mmol obtained within
Signature: Date: 100 days after It has been accepted es complete.
(cy-�' .4.V /Jnilrl •Pee methodology set by 1-ri-Css.ty Building Industry Service Board.
(Please print risme)
I\tsstt\Permit Forms\RldgPennilApp.doc Jlro3
•
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
City" Tigard Cit of Ti' : rd AssociatedIxrml's
City U Electrical U Plumbing U Mechanical
Address: 13125 SW Ifall Blvd,Tigard,OR 97223 UOther:
Phone: (503) 619 71
Fax: (503) 598-19' t
111E FOLLOWING ITEMS ARS' RI'QI 1111 1) 1 OR 1'1 e\ Itl \ II N les No \I1
'. Land use actions completed. Sec jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar ha Ince points,seismic soils designation,historic district,etc.
3 Verification of approved pia ot.
4 Fire district_ appr al required.
5 Septic system permit or auth in ation for remodel. Existing system capacity _
6 Sewer permit.
7 Water district approval. _ _
8 Soils report. Must carry origi al applicable stamp and signature on file or with application
9 Erosion control U plan U •rmit required. Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 3 Complete sets of legibl• plans.Must he drawn to scale,showing conformance to applicable local and stats.
building codes. Lateral design etails and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans wit cross references between plan location and details. Plan review cannot be completed
if copyright violations exist. __f
I I Site/plot plan drawn to scale. r plan must show lot and building setback dimensions;property corner elevations(if
there is more than a 4.ft.elevatio , differential,plan must show contour lines at 2-fl.intervals);location of easements and
driveway;footprint of structure(i,eluding decks);location of wells/septic systems;utility locations;direction indicator;lot
arca;building coverage arra;pe ntage of coverage;impervious area;existing structures on site;and surface drainage_
12 Foundation plan.Show dimcns ins,anchor bolts,any hold-downs and reinforcing pads,connection details,vett
size and location.
13 Floor plans.Show all dimension ,room identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbin fixtures,balconies and decks 30 inches above grade,etc.
14 (Voss section(s)and details.Sho all framing-member sizes and spacing such as floor beams,headers,joists,Fuh-floor,
wall construction.roof construction More than one cross section may he required to clearly portray constriction.Shoo
details of all wall and roof sheathin' roofing,roof slope,ceiling height,siding material,footings and fou , ,. airs,
fireplace construction, thermal insul tion,etc.
15 Elevation views.Provide elevations or new construction;mini is . ations for additions and remodels.
Exterior elevations must reflect the a,tual grade if . .c in grade is greater than four foot at building envelope.
Full-size sheet addendums showin f( i e evations with cross references are acceptable.
16 Wall bracing(prescriptive or lateral analysis plans.Must indicate details and locations;for
non•prescriptive path . 'sic rovide. ciflcations and calculations to enfineering standards.
17 Floor/roof f .Provide plans for I foors/ro of assemblies,indicating member sizing.spacing,and hearing
Iocah ow attic ventilation. _
18 Basement and retaining walls. Provide c oss sections and details showing placement of rehar. For engineered �^
systems see item 22."Engineer's calculate Ins."
19 Beam calculations. Provide two sets of cal. lations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist ca ng a non-uniform load.
20 Manufactured floor/roof trims design detal .
21 Energy('ode compliance.Identify the presc alive path or provide calculations. A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or pro 'ded,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be shown t' be applicable to the project under revi .
II ItlSl)l( I ION 11.tiro-:(II It S
23 Five(5)site plans are required for Item 11 above. •ite plans must he 8.1/2"x I I"or II" x 17".
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. "Mirrored"building plana will he not accepted. _
26 "Reversed"building plans must meet criteria outlined in the Permit & System Development Fees document.
27 "Drawn to scale"indicates standard architect or engineer scale.
28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List.
Checklist must he completed before plan review start date. Miner changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 4404614(MIw'oM)
I
Electrical Permit Application 1 f►1(OI 1 lC 1 1 U f),I 1' -
Received Electrical
Date/By: Permit No_
CieJ of Tg
i and Planning Approval Sign
A` Date/By Pernv No
13125 SW Ilall Blvd. Plan Review Dthet
Tigard,Oregon 97223 Date/By: Permit No. -
Phone: 503-639-4171 Fax: 503-598-1960 Pnct-Review land Use
`• Date/By:ontact - ('ase No
Internet: www.ct.tigard.or.us xa 41' !7attact Luria ® See lige 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information.
TYPE OF WORK _ ''', `'. ; ,t!�. l' �� 1. i. that'_' .led
E■.New construction Demolition ■ Service over 225 amps- • Ilealth-care facility
I. Addition/alteration/replacement Other:
commercial ov 0 Hazardous over 0on
❑Service ova 320 snips-rating of ❑Building 10,000 square feet,
.,,TEGORY OF F CONSTRUCTION I&2 family dwellings four or more residential units in
'CI- & 2-Famil dwelling Commercial/Industrial 0 System over 600 volts nominal one structure
0 Building over three stories 0 Feeder:.400 amps or more
'■ Accesso Building Multi-Family Occupant load over 99 persons Manufactured structures or RV park
�■ Master Builder Other: Egress/lighting pins Other.
JOBS E INFORMATION and LOCATION Submit sets of pienswith any of the above.
The shove are not ap1nlic.:,le to temporary construction service.
Job site address: - ' -"Z;61-.6l,/ - FEE!
Suite#: _ Bldg./Apt.#: Number of Iorp'xtona per permit allowed
Project Name: - Description Qty Foe(ea.) Total T
Cross street/Directions to job site: New reddentlat-single or mala family per 1
dwelling sell.Includes attached Raregr.
Service Inclsded:
1000 sq.R.or less 145.15 4
Each additional 500 N.fl.Of portion thereof 33.40 1
.% Lot#: Limited energy,residential 75.00 2
Subdivisio - -r _. Limited energy,iron rasidemial- - 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,
alteretlon or relocation:
- 200 amps or less 110.30 2
201 amps so 400 amps 10615 2
401 amps to 600 amps - 160.60 2
Allinirifi VV j ❑TENANT _ __ :: 601 amp to 1000 amp 240.60 2
Over 1000 amps or volts 434.63 2
Name:;j,jf-/t/ ., I -- Reconnect only 66.05 2
Address: /y,/i / Temporary services or feeders-installation,
Q alteration,or recation:
City/State/Zip: 972 1 -maylo200 amps a lea 66.05 -- 1
Phone:5- -r�� ,S— ] Fax: 201 amp a;00 amps _ 100.30 2
—.... 401 to 600 a133.75 2
' -[,�X"ONTALT 'IEt'0i! '- amps
circuits-new,alteration.or
Name: exteod.n per peel:
Address: — A.Fee for branch circuits with purchase of
_-_- service 0,feeder feed ach branch circuit 6.65 2
City/State/Zip: B.Fee rot branch circuits without purchase of
service or feederfee that branch circuit 46.15 2
Phone: Fax:
Eirh additbrrl branch circuit 6.63 2
E-mail' Ih..c.(Service or feeder not included).
a ro , s ,r d Each ptanp or irription circk -- 33.40 2
'.. '. - Each s or outline lighting - 33.40 _ 2
i- Job No: _� 6". Signal circuit(,)or a limited energy panel,
fn alteration,or extension Pyx 2 2
Business Name: ,v,.1,5 AFtG , Description
Address: 7-_,. S f f? ./14.
Clt /$t9tC/Zl r: D p Lath additional!sweeties over the allowable ton of the above:
m Y 1 h 1e_7? /712 3 i jar hour(mid.I hour) —
t7 Phone:tsJ _'s.-� Fax: _ fie: Mil
CCB Lic.#: �� Lic. #: op 45j other: ice`
Supervising electricia , �. .... Subtotal $
signature aired: • _ Plan Review(25%of Permit Fad S
Print Name let- - ti Lic. #:1,23 Z3 47. State Surcharge(8%of Permit Peel_ $ _
TOTAL PERMIT!'Et f
Authorized 'i Notice: This Is teat permit application*spires If a permit at obtained within
Signature: -/i(// _—, �e�� 110 days ager It has been accepted as v ample,..
•Fre methodeloo set by Tri-('sooty Building Industry tervir.Board.
(Please print name)
i 1Dsts\Permit Fairs\EkPermitApp doe 01/03
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: _
Fee for tl!systems $75.00
Cheek Type of Work Involved:
ElAudio and Stereo S terns*
Burglar Alarm
c iaragc I hxtt Opener
El Ileatmg,Ventilation• All Conditioning System*
7–
E1Vacuum Systema*
Other —— -- — —
COMMERCIAL WORK ONL
Fee for tad system S/7
(SE!'OAR 915-260-260)
('heck Type of Work Involved:
0 Audio and Stereo Systems
0 Roller Controls
nClock Systems
0 Data Telecommunication Installation
0 Fire Alarm Inatallation
IIVA(
ElInstrumentation
EiIntercom and Paging Sys
0 landscape Irrigation 'ontrol*
0 Medical
nNurse('ails
Outdoor I dscape lighting*
Protecti Signaling
a of
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i\INtr\Permit Forms\FkPemetAppPg2 doe 01/01
isuilciing r fixtures
I (m 11"'" I.u ' n' `)"
Plumbing Permit Application
Received Plumbing
Date/Hy: Permit No.:
City of Tigard a y.g Approval
_ ;t No.
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Da : • : Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review lend Use
, 1 Date/B : Case No.:
Internet: www.ci.tigard.or.us .P4 •i�' Contact Juni.: See Page 2 for
24-hour Inspection Request: 503-639-4175 J Name/Method: - Supplemental Information.
TYPE OF WORKcial FEE*SCHEDULE(for speorMitt),.. -
C_ 1ty.
ew construction Demolition Description t . Fee(ea.) Total"-
• Addition/alteration/re lacement Other: New 1-&2-family dweelllq�il •
CATEGORY OF r s ,, ,. :R • (Indad�100 R.fora ntl eoKIactiIJh._ . ,_
1 &2-Family dwell in MN Commercial/lndustrial - SFR(I)bath _ __ 249.20
.011 SFR(2)bath 350.00
•Accessory Building__ PI Multi-FamilySFR(3)bath 399.00
• Master Builder 1111 Other: Each additional bath/kitchen 45.00
ITE INFORMA ,.- Fire sprinkler•sq Il P e 2
Job site address: .2 11?//4/45, c.2": � s'
Suite#: Bldg./Art.#: Catch basin/area drain 16.60 -
Project Name: _ DrywelUleach line/trench drain 16.E
Footing drain(no.linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no linear ft.) Page 2
SubdivisiofeeZ� Lot#: Storm sewer(no.liner R.) , _ Page 2
Tax ma 'parcel #: Water service no.liner R. P 2
,?` DES (MON OF WORK
�__.--_----_-.--�- _--'. Absorption valve 16.60
_ Backflow preventer - Page 2 4
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
P''" .r•' , 't.1aTi• aumunfe 1 _ _-- Ejectors/sump 16.60
liE=PIr , 4 Expansion tank 16.60
Address: ,, MY Fixture/sewer cap 16.60
Cit /State/Zit: 40 • - Floor drain/floor sink/hub _ 16.60
Garbage disposal 16.60
Phone' X. 1. ax: Hose bib 16.60
li' 'r.' r ''It r` Ice maker 16.60
Name: Interceptor/grease trap 16.60
Address: Medical ps-value: S Page 2
City/State/Zip: Primer 0..--• 16.60
Roof drain(commercial) 16.60
Phone: I Fax: -_ Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
CONTRACT _ ;`'� Urinal 16.60
•
Business Name: -� �Af/ • Water closet 16.60
i Water heater 16.60
Address: _ other:
city/State/Zip: Other:
L53�_
Phone Fax:
LCCB Lic. # 2 Plumb. Lic.a� Subtotal _ $
z '�5���� Minimum Permit Fee 572.30 S I
Authorized Residential Backflow Minimum Fee$36.25
Signature: __ Date Plan Review(25%of Permit Fee) S
State Surcharge(8%of Permit Fee) S
(Please print name) TOTAL PERMIT FEE S
Notice: This permit application expires If a permit Is not obtained within All new commercial b.Ndlep require 2 sets of plans with Isomeric or
IRO days after It has been accepted as complete. riser diagram for plea review.
'Fee methodology set by tri-(nunti RnIIdine Indn,try Service Bard.
i\I)sts\Permit Fru ns\PlmPennitApp doe 01/01
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
tllities ,(?'. F`" . ,,,. Square Footsie: Permit Fee:
looting drain II 100' -.. 55.00 0 to 2 )00 S115.00 --
Footing drain- • h additional 100' 46.40 2,001 to 3,600 $160.00 -
3,601 to 7,200 S220.00
Sewer- 1st 100' 55.00 7,201 and greater S309.00 _
Sewer-each addni,nal 100' 46.40
Water Service- 1st t t' 55.00 Medical Gas Systems:
Water Service each ,ditional 100' 46 40Veluatlop: Permit Fee:
Storm&Rain Drain- t 100' 55.00 SI.00 to$5,000 00 Minimum fee S72.50
Storm& Rain Drain-ea i additional I0 o' 46.40 S5,001 00 to S10,000.00 S72 50 for the first$5,000 00 and S1.52 for each
additional$100 00 or fraction thereof,to and
Flxtuieor Qty. including S10,000.00.
Commercial Hack Flow Pre noon I)vice 46.40 S10,001 00 to$25,000 00 5148.50 for the first 510,000.00 and S1.54 foe
Residential Rackflow Prevent Device each additional$100.00 or fraction thereof,to
1mimmumpermit fee 536.25) 27.55and includin $25000.00
Rain Drain,single family dwellin 65.25 S25,001.00 to 550,000.00 5379 5' or the first 525,000.00 and SI.45 for
Inspection of existing plumbing or eac dditional 5100.00 or fraction thereof,to
specially requested inspections-per ur 72.50 includin $50 000.00_
550,001 00 and up 12.00 for the first 550,000.00 and S I.20 for
Sub ,1al: each additional S100.00 a fraction thereof.
Fixture Work:
Are you capping,moving or replacing e3.1. ng fixtures? If
"yes",please indicate work performed by fi ure. Failure to
accurately report fixtures could result in finer sewer fees*.
I mann b i .'omments regarding fixture work:
I su. NeM ,
Ba.tit /Font
Hath -Tub/Shower —�
-Jacuzzi/Whirlpool
Car Wash Wash -Each Stall
-Drive Thru
Cua.idor/Water Aspirator
Dishwasher -'ommercial
-Domestic
Drinkin• Fountain
E e Wash
Floor Drain/sink -2" -
3"
1"
Car Wuh Drain 'Note: If the ure work under this permit results in an
Garbage -Domestic
Disposal commercial increase of sewer , a,a sewer permit will be Issued and
-Industrial fees assessed for the sew create must be paid before the
Ice Mach./Refrig.Drains - plumbing permit ran bv issued.
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall _
Sink -Rat/lavatory
-Bradley
-'nrrmterrial
-Service
Swinmtinj Pool Filter ` -
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures.
i\D)ata\Permit Forms\PlmPermitAppPg2 doe 01/01
Mechanical Permit .Application1 I11t I►1 1 It 1 1 `,1 11\1 1
Received Mechanical
D.witly: Permit No.:
Planning Approval Building
City of Tigard Date/By Permit No: ____
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 DswBY:_ Permit No.: __ _
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
i Date/By. Cue No.:
�,,
Internet: www.ci.tigard.or.us •� ®Contact Jung: See wage 2 fir
24-hour Inspection Request: 503-639-4175 • 1 Name/Method: _ , Supplemental Information.
_ TYPE OF WORK COMMERCIAL FEE`SCHEDULE 0 �i�'f
ew construction Demolition Mechanical permit fees•arc based on the total value of the work
Addition/alteration/replacement Other: perfoi ed Indicate the value(rounded to the nearest dollar)of all
—Asomechanical materials,equipment,labor,overhead an I. ofit.
CATEGORY OF CONSTRUCTION
113 & 2-Family dwelling ('ommercial/Industrial Vrlue: S____ _________ ____ See Page 2 for Fee Schedule
• Accessory Building ta■ Multi-Family __ _~ RESIDEN'I'(AL EtrIPMENTB
ITo
lescription Fee(ea.) Thal
• Master Builder Other: _-- iiI
MINIM 4,l t , Meld LOCATION Furnace-add-on air conditioning'• 14.00
Job site address: - 72. /1/�.,6,1- .4� Gas heat pump 14.00
Suite#: Bldg./Apt.#: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters(fuel,not electric)
(in wall,in-duct,su ed etc.) 14.00
Flue/vent(for any of ve) 10.00
Subdivisio f fig.)' ,Vj ' Lot#:6 ,,Repair units _ 12.15
Other lre) Imes
Tax map/parcel#: Water heater 10.00
--— ——DESCRIPTION OF WOW Ou fireplace 10.00
Flue vent water heater/. ti lace 10.00
Log lighter WV 10.00 ,
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
1l• EChimney/liner/flue/vent 10.00
____ at 1 fl LL `Other:
10.00
Name: O SlX .27Asia lA/f' t Esban &v -.._
Range hood/other kitchen equipment
10.00
Address: /'�� �) / Clothes dryer exhaust 10.00
-
City/State/Zip: 1Z�1 Single duct exhaust
Phone: -c:-,6- _.,.5` Fax: (bathrooms,toilet comp.rtments,
__ utility rooms) 6.80
Name: Attic/crawl)ace fans _ 10.00
Address: _-- --- Other: 10.00
City/State/Zip; ••tss.N for first 4,51.00 each a
Furnace etc ••
Phone: Fax: �Gas heat heat pump •• _
E-mail: Wall/suspended/unit heater ••
` •1 Water heater ••
._.. .t kw-tee .
Business Name: / Fireplace ••
Address: /7,. ,7 v Range
Cit /State/ZiBBQ ••
Y P�1 1�iJ _ �' 7Z G clothes dryer Ws) � ••
Phone: -3 /7 , Fax: Other: ___._ .. --
CCB Lic. #: / Teal` ,
Authorized / /, Date",,______ -- l Su. ';..:'_$`
Signature: IV - _* __ Minimum Permit Fee 572.50 i
Plan Review Fee(25%of?emelt Feet, $
(Please print name) _State Surcharge(8%of Permit Feet_S
TOTAL PERMIT PEE $
Notice: This permit appliatM.expires If a permit is not obtained within "Tee oatbi uigy sal by TTI-ea.ty BMWs.Industry Unice Board.
ISO days after It has bees accepted as complete. "the pMo required for titular AR'snits.
i Osts\Permit Forms\MecPermnitApp doe 01/03
Mechanical_Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
51.00 to$5,000.00 Minimum fee$72 50
$5,001.00 to$10,000.00 $72 50 for the first 55,000 00 and SI 52
for each additional 5100 00 or fraction
thereof,to and mcludm$510,0(X).00.
$10,001.00 to$25,000.00 ' $145.50 for the first$10,000 00 and
$1.54 for each additional$100.00 or
fraction thereof,to and including
$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and
SI.20 for each additional SI 00.00 or
t fraction thereof. `—
Assumed Valuations Per ' ;,lance:
Value Total
fkscnption: it (E:a) Amount_
Furnace to 100,000 BTU,including 955
ducts&vent
Furnace>100,000 BTU including ducts 1,170
&vent
Floor furnace including vent 955
Suspended heater,wall heater or floor 955
mounted heater
Vent not included in appliance permit 5
Repair unit
<3 hp;absorb.unit, 95
to 100k BTU
3-15 hp;absorb.unit, 1,700
101 k to 500k BTU
15-30 hp;absorb.unit,501k to I mil 2,310
BTU
30-50 hp,absorb unit, 3,
I-1.73 mil.BTU
>5011p;absorb.unit, ,723
>1.73 mil.BTU
Air handling unit to 10,000 cfln -_ 636 _
Air handling unit>10,000 cfln 1170
Non-portable evaporate cooler 636
Vent fan connected to a single duct 446
Vent system not included in appliance 636
hermit
Hood served by mechanical eaha 636
Domestic incinerator 1,170
al or industrial inti for - 4,590
Other unit,including wood yes. 656
inserts,etc.
(las piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL S
VALUATION:
i\Pets\Pemtit Forms\MecPermitAppPg2 dor 01/(11
oi II / 4 H .44011.-41-190. - II6
- oliale-P/5/)/e6 PPZIES%
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---____________--- 464;4/. ...............„..,.........;/- /47 V)
✓L . - NkJ .9--nC
S3 /— a5—os—
CITY()F TIGARD- SITEPLAN REVIEW
BUILDING PERMIT NO.: -
PLANNING DIVISION:
Required Seth ks: TX Approved 0 Not Apurmed
Side: Street Side: I�
Frunl. A'`) Garage: .� Rear: /5—
Clearance:
5Clearance: al Approved 0 Not Approved
Maximum Building Height- ..J. feel
CWS Service Provider Letter Required: ❑ Yes al No
❑ Received/� Date: OA/
ENGINCERINC M PAR WENT:
Actual Slops: 't.3 % arAppro ed 0 Not Approved
Site Plan: GApprweil Not Approved
By: /f #1• 1/ Doc: ,0
Nuts.
Oct 30 2003 11 t 31 AM OeoPaciric Engineering, 1 503-5'SH-W/US p. 1
00 fill
unar rano IDr.
Real-World Osotachnlcai Solutions
Investigation•Design•Construction Support
October 30, 2003 RECEIVED
Project No. 02-8072
Vista Northwest NOV 3 ?(w4
P.O. Box 91459
Portland, OR 97291 CITY OF TIGARC
(Fax 503-64C-2714) BUILDING Div' h•
Subject: GEOTECHNICAL ENGINEER'S FOUNDATION EXCAVA PION REVIEW
GREENBUUU0 POWs LOTS 2,6,7,8, AND 9
CITY OF'DURO,OREGON
GeoPnclfic Engineer, Jim Imbrie, has visited the above-referenced lot on October 24"and 301'. The
purpose of our visit was primarily to review the foundation excavation subgracle. The native
subgrade soils consist of medium stiff silt that is prone to softening In wet weather. We
recommended overexcevatlon beneath footings and placement of 4 to 6 Inches of oompacted
crushed rock to prevent softening In wet weather. The thin layer of gravel need not be tested for
compaction,but should be visbty comped.
The current subgrade is oansidered adequate for spread foundation support. Based on our
observations, the foundation subgrade and excavation setbacks should be acceptable for support of
the proposed single-family home to a maximum allowable bearing pressure of 1,500 psi. No patio,
sidewalk or deck footing subgrades we observed. The minimum steel reinforcement should be
Incorporated(two no. 4 bars In the footing and one in the stem wall.) If foundation oreckkp is desired
to be Inhibited.
Our work scope for this phase of geotechnical review pertains to foundation bearing conditions
only and is limited to the conditions existing an-.1 exposed at the time of our sits visits. If you have
any further questions, please call.
Sincerely,
GEOPACIRC ENOINEERslO,INC.
40.0 17 2. 0
7;4745 .' 46 0 -71
r 4
James D. Imbrte, P.E. OREGON
Principal Engineer ;2: 13 01 e75
o.
7312 SW Darlene Read Th(!tl)M4441
Portland.Oregon (7224 Pas( 8l11417115
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CERTIFICATIONT ET TREE
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A I, l — l�i z_5,- 1..5. 7 agent for 1/i ss-h- ,</i., ►
A (PLEASE PRINT) / N (PERMIT HOLDER)
/ \ p ►
A \ e``�e
A ��G . 10 ►
A Do hereb . 11 . , .f l ,wing location ���r,�`oM ►
A meets . Of ' • on . ounty G u ►
A
I land use and development standards for street tree installation. ►
A
A
11
A ADDRESS: 7,7-e ,,. ./ifZ 'a 1' /_ ►
A
A ►
1 LOT: 6 SUBDIVISION: ►
BY: DATE: �s���
1
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1 RECE . .Y: _:!;. .,it Lk d-ti 4 DATE: ►
A/TVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV•VVVVVVV•VVVVVV\
CITY OF TIGARD 24-Hour
BUILDING I! lip Inspection Line: (503)63 175
MST
— �-
•INSPECTION DIVISION Business Line: (503)6 171
BUP ---
Received DaterRequested 8 . J 6 PM — BUP
Location /P.) N 4 Cf-Z A Suite MEC
Contact Person __ —. Ph ) PIM --Contractor .. - ( -) SWR - -
BUILDING Tenant/Owner _ ELC _
Footing ELC
FoundationAccess:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear -
Int Sheath/Shear USA :-DC,s j t FJA1_
Framing
USA L_IC (moi r
Insulation C-r-mr1rrT c r
Drywall Nailing
Firewall
---- -------- ----------
5U(.-/4 mi-c"1,_ 7
ler--
Fire Sprinkler
Fire Alarm R Por r u 5•lZ.04/ cc S l P�1CGf/ L-�C' ' Q61
Susp'd C fling
Root
Negigj) e-IPPA —
c .•
PART FAIL
PLUMBING --
Post&Beam hirr- ,[ Iic Ate/ /41i'� - 'TZL� 1Fo/e
1 Under Slab —• �., id
RougWater Se . L, RODOP� (-4A SS t F pt ��•i\i
Water Service i►����
Sanitary Sewer - r/. + L r
Rain Drains -
Catch Basin/Manhole
7.. 00 _ •• 1 A.-_r1,.'` _-
Storm Drain c/
Shower Pan .. ____1412.104-71: � S •/� ' 0 V
Other:
Final __
PASS PART FAIL
MECHANICAL 41111
------
Post& Beam ariff• ��
Rough-In
,as Line
• : Dampers
•
~, PART FAIL ------
TRICAL
------------
Service
Rough-In .4 _
UG/Slab
Low Voltage — -
Fire Alarm
Final Ell Reinspection fee of$ required Wore nest inspection. Pay at City Hall, 13125 SW Hall Blvd.
PARS PART FAIL
S [1] Pieties call for reinspection RE:__ r acmes
Unable to inspect-no acse
Fire Supply Line 0/
ADA -
Approach/Sidewalk
ate 8 .19 - (2Iws'oeto. _. tin-.—_
Other.
Final DO NOT REMOVE this I..p•otlon eco . f thw lob .it..
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING • Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP _—
Received ___ ___ _____ _. __ Date R:•uested_L74 AM __ PM _ BUP
I ocation _ T-_ 1_ A S . I Suite MEC
Contact Person .- __ Ph( _) O — PLM
Contractor Ph( ) SWR
BUILDING 1 Tenant/Owner _—___-- ELC __—
Footing -1I
Foundation Access: ELC
Ftg Drain Y�r ELR
Crawl Drain l� 7 V
Slab Inspection Notes: SIT
Post&Beam Mgr
Shear Anchors - --
Extt Sheath/Shear
int Sheath/Shear
Framing _
-------- --
Insulation Qrak/'
Drywall Nailing Q -- — _----
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
-_Shower Pan
Other.
Final
PASS PART FAIL -
JMECHANICAL
Post& Beam ----- --- -- -- -- ----- -
Rough-In _
Gas Line
Smoke Dampers -..
Final
PASS PART FAIL
HELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fi = •larm
efrlip
r i Reinspection fee of$ required before next inspection Pay at City Halt, 13125 SW Hell Blvd.
P � PART _FAIL
1 I I Please call for reinspection RE: D Unable to inspect-- no•oe m
Fire Supply Line
ADA '9!— --odv
,�)
Approach/Sidewalk pate--- -- Impostor -- L-6 ---EXt.
Other:
Final DO NOT REMOVE this Insp.atlon record from th•fob sits.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING 41111 Inspection Line: .9-4175 , MST d 423-°o 43-13
INSPECTION DIVISION Business Lino: i • .39-4171
_ BUP
Received Date Requested_ _ /0 AM._ PM _ BUP
Location __ ! 7 a 0 i'• a,� La-Z_ _Suite— MEC
Contact Person l/� X Ph ( _) /.3 0 3 q PLM ---- -
Contractor _ Ph ( _ ) _ SWR _
BUILDING Tenant/Owner - ELC
Footing - J
Foundation ELC
Ftg Drain
Access: a ZQ O`f ' 45 0-' (42 Y ELR -.----_-----
Crawl Drain N
Slab Inspection Notes: SIT __-
Post A Beam
Shear Anchors ---- -
Ext Sheath/Shear
Int Sheath/Shear
^ ,� _
t .
._.Framing -,
Drywall Nailing �__ �c1cJr ..- _
Firewall
— .V A<mnl
_ k jk L-1Fire Sprinkler
Fire Alarm SC4-;12"•A
•ILDC1
-L
(�Susp'd Ceiling
Roof fk
Other -
Final ._
PASS RT FAIL
tCUMBI _- - - -- — — —
Post&Beam
Under Slab -
Rough-In
Water Service - -- -
Sanitary Sewer
Rain Drains ----- -
CStormatch Basin/Manhole
r in / -
Shower a
Other
PART FAIL
HANICAL
Post A Beam
Rough-In
Gas Line
Smoke Dampers -- --- ---
Final
PASS PART FAIL - _-__- - ---- - -- —
ELECTRICAL
--
Service - ------. - ---- -
Rough-In
110/Slab
Low Voltage --- - —
Fire Alarm
Final CJ Reinspection fee of$ - required before next inspection. Pay at City Het, 13125 SW Hall Blvd
PASS PART FAIL
SITE L 1 Please call for reinspection RE'_ __ C7 Unable to inspect--no access
Fore Supply Line
ADA /// /�(O/4 ,/1
7
Approach/Sidewalk atm or Id -----
Other
final DO NOT REMOVE this inspection resod from the job site.
PASS PART FAIL