Permit /// 4/5 LA ;t7 a-: , , a-� e l
ITY OF IGARD Z96 MASTER PERMIT
PERMIT #:
A DEVELOPMENT SERVICES DATE ISSUED: 9/12/03 3 -00448
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10240 SW 69TH AVE PARCEL: 1S136AA-00301
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: New manufactured dwelling placed on individual lot. TIF, and parks credits apply for demolished
residence. Revised to include 384 sq ft of covered deck and 128 sq ft of covered porch.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SFM FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE: 12,499.20
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 • 400 amp: 1st WIO SVCIFDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 1,527.04
This permit is subject to the regulations contained in the
WEBER, LESTER C JR BLUELINE CONSTRUCTION INC Tigard Municipal Code, State of OR. Specialty Codes and
11530 SW MAJISTIC LN. #2 PO BOX 546 all other applicable laws. All work will be done in
KING CITY, OR 97224 OREGON CITY, OR 97045-0032 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 750 - 6646 Phone: 503 784 - 0812 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 78931 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Sewer Inspection MFG Home Electrical : GGO IJ 6 .
Foundation Insp MFG Home Set -Up Fin ,4:22A144,/k-10
MFG Home Footing Se Electrical Final
MFG Home Plumbing i C By e Elecctrical.;
Is : ■ j ii �, Permittee Signature : x
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. .
Plumbing Permit Application Receivedn, FOR OFFICE USE ONLY
Plumbing ,,„,.
. •
Date/By: -- ,03 16 Permit No.:11r7r-c9003 770 "ft( ;
City of Ti T Planning ppr al
Date/By: Sewer
igard
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 Land Use
Internet: www.ci.tigard.or.us '. % liViA(i?.
, .10
. t:71 11 Date/By:
_Am Contact Case No.:
s.: /81 See Page 2 for
24-hour Inspection Request: 503-639-4175 '''''-- Name/Method: i l(\ Supplemental Information.
7i • :...!;-:',.:.ii2 :.; ' ,..t f2Ept$QiiimagAtot.;ifiettiffitifotinitioji***01.00::.'.
0 New construction 0 Demolition Description 1 Qty. 1 Fee(ea.) 1 Total
ig Addition/alteration/replacement 0 Other tAl., :--- :: • 7,..S. Neli t - Oelliits
. :21D --.':,..;. ., .:-1 -... c.-.•. -: -.k .*=. t ‘ ..,:: ' ,%:. -: 4: • ;_ •
4 -,--' c
: 1-.5-.,011CititigS,14(Yft,:forigackutility-cOnnettion),h._::,
:g;-:''''`fr .. 2'.. '! 't$ ,:
SFR (1) bath 249.20
D 1 & 2-Family dwelling D Commercial/Industrial SFR (2) bath 350.00
['Accessory Building 0 Multi-Family SFR (3) bath 399.00
El Master Builder 121 Other: frIp Each additional bath/kitchen 45.00
Y0/3::SITTASWOR,SIA:TTOISt indlOehtION ''''..,.:-.., --. --. Fire sprinkler - sq. ft: Page 2
Job site address: 1 oz..4.0 51....- 1 Ade. i.:- =1. , ,...' . ' . :1:1S'-5. i.i-.: _'.,. :'''': gite4liatiiil". ' - ' ,.,7; ;s:-9,-:. :-.'. .,; :; ' '
Suite #: ' Bldg./Apt.#: Catch basin/area drain 16.60
Drywell/leach line/trench drain 16.60
Project Name:
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
■-1,.4.0e, elci -1-0 64÷§ . Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) </(22 Page 2
Subdivision: ' Lot #: Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: 1G1'36Fir4 Water service (no. linear ft..) Page 2
iL1itrovrtienit..:a",
.;... :. , ' :.;',L,:;:7:::ii 7' Absorption valve 16.60
A cb-otirkof) -r C.x ■ s - T - % rt.) kiPc-•r&V Backflow preventer ' Page 2
L .. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
' ;:-: 2 .44:1 - , TENAliit ''., i --. .,'.) Ejectors/sump 16.60
Name: /..5-1- R,Ge_ Expansion tank 16.60
Address: 06 ?,0 s m s L.,,.1 - 1*Z Fixture/sewer cap 16.60
Floor drain/floor sink/hub 16.60
City/State/Zip: 1j ,i.1 C vr-Le Oa, 4 1-12-‘k Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
If Atkaali ,. -:' :; ". .. ': - ; - !:0 CONTA.OTIEgSON -,' : ,X Ice maker 16.60
Name: BLUE.1 J#-.IS roms iyurt 0.1 imr Interceptor/grease trap 16.60
Address: fp 13 544 Medical gas - value: $ Page 2
Primer 16.60
City/State/Zip: ' eye. . C.,. et q41> c Roof drain (cominercial) 16.60
Phone: 5(;•• ?)3.1-01312_ 1 Fax: 60_5 4 1 17- - Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
j.4 .7: : 2 '., ONSTTAketOki -' : 7*'.::ie!-,-,:- Urinal 16.60
Business Name: OW /A)-i°_,. Water closet 16.60
Water heater 16.60
Address:
Other:
City/State/Zip: - _ Other:
Phone:- - -
Fax 'I -, -:-::,: , ,f'`. - ,4...:- .: ',-- 7}
....
Subtotal $
CCB Lic. #: •-• . Pot Date: th. Lic.-#: . Minimum Permit Fee $72.50 $
ure: ,L
Authorized
2/.0 N Residential Backflow Minimum Fee $36.25
Plan Review (25% of Pennit Fee) $
Signat cur
-st- - j State Surcharge (8% of Permit Fee) $ 5-8
(Please print name) TOTAL PERMIT FEE $ qr,30 .
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
- a.S.,.1:4 „P. - C -0\ rtlZ 0 *Fee methodology set by Tri-County Building Industry Service Board.
i
i:\Dsts\Permit Forms \P1mPemitApp.doc 01/03 \)),01 w)1,,,.... ..?, 0 g 4 fiZ1,1-6C
)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
2 . t` .Fee �ea , ; Tota� �J " Permit Fee
2 Sijuai-e�Foota e..
Footing drain - 1" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46 ,VahiatiOp: .; >P rnut- .Fee:' , . -;r
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
�, Bee ca T�tai ' additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $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
Inspection of existing:plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
• Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
5' Comments regarding fixture work:
want► 6y 4FtxlEur4wor�G,Perf6rmed g g
FF� re Type ° [ - e $epla r-
;: I' ?a' - d, „1New " c - Moved Ezlsting..° >SI1 .
Baptistry/Font
Bath -Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
3"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice MachiRefrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Electrical Permit Application FOR OFFICE USE ONLY
Received(. Electrica, y� 5r 3 - iPIP.'
Date/By: `7 /�6/� j ? A Permit N.; '
Y
City of Tigard Planning al Sign
`J DatelBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223
A DaY Permit No.:
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 / / Post- Review Land Use
�' � h Date/By: Case No.:
Internet: www.ci.tigard.or.us �) Contact Juris.:
24 -hour Inspection Request: 503 -639 -4175 Su See Page l for
P 4 Name/Method: '�1 �j Supplemental Information.
- E' :TYP OF D WOR - _ '-,. _:.:' PLAN VIEW (Male `che& all that apply) i .
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement ❑ Other:
commercial ❑ Hazardous
❑Service tal Service over 320 amps- rating of ❑ Building ng over over 10 10,000 square feet,
; CATEGORY OF CONSTRUCTION -' '. ' • 1 & 2 family dwellings four or more residential units in
—
all & 2- Family dwelling 1=1 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ F ders, 400 amps or more
❑ Accessory Building ❑Multi -Famil ❑ Occupant Load over 99 persons anufactured structures or RV park
❑ Master Builder e'6ther• kk(!i 4 6 ❑ Egress/lighting plan ❑ Other:
. ' •... .JOB SITE"INFORMATION- and- I,OCATT ' ` _ sets of plans with any of a .
the
/ D n �. Submit bore
The above are not applicable to temporary construction service.
Job site address: sX TO ^ , : FE * SCA M LE.: ,..._ ■
Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
Cross street/Directions to site: New residential- single or multi- family per
dwelling unit. Includes attached garage. --
/1. A � " , 99 -iv 6? Service Included:
� 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
. " DESCRIPTIOS :WORK ' • service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 1 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
` D PROPERTY QWNER , - • • ' 1 .. ❑ TENANT ,. . .
' 601 amps to 1000 amps 240.60 2
" Over 1000 amps or volts 454.65 2
Name: L -f e/L IA) Iii—c-4.... Reconnect only . • 66.85 _ 2
Address: Lo 2, q-o ....c.) ic Temporary services or feeders - installation,
City/ State/Zip: alteration, or relocation:
y p: t .� (QJLQ_ ! 72 Z3 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
:'0.- APPLIGM. T -.. • ' : ❑. CONTACT PERSON Branch circuits - new, alteration, or
Name: ---/LQA i 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: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: 1 Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
— Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
Description:
Address:
City/State/Zip: Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
•
CCB Lic. #: Lic. #: Other:
':- Electrlcal-Permif :Fees*' ' :
Supervising electrician Subtotal $ -rj
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ 6 , c/3
TOTAL PERMIT FEE $ $!o . 73
Authorized ! / Notice: This permit application expires if a permit is not obtained within
Signature: ` �y 1 �� � J Dat e: p p
� /�,,� l 9 /a 0,3 180 days after it has been accepted as complete.
/ *Fee methodology set.by Tri-County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 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
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
•
Check Type of Work Involved:
Audio and Stereo Systems
El Boiler Controls
• Clock Systems
El Data Telecommunication Installation
O Fire Alarm Installation
El HVAC
• Instrumentation
O Intercom and Paging Systems
0 Landscape Irrigation Control
Medical
▪ Nurse Calls
0 Outdoor Landscape Lighting
O Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
f) -Y -
Manufactured Dwelling OFFICE USE ONLY
Permit Application Date received: 1 A/9 Permit no.iniragy3,0 fyg
. A 4J- r City of Tigard Project/appl. no.: Expire date:
City of Tigard 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:
Internet address: www.ci.tigard.or.us
Health dept.: DEQ:
Land use approval: -
TYPE OF PERMIT
❑ Owner installed of Contractor installed ❑ Repair
0 New 0 Addition/alteration 0 Replacement: Same location ❑ Yes 0 No
JOB SITE INFORMATION
Job address: 1022 -t O S`J e. Space no.:
Manufactured dwelling park: h( 4. Address:
City: `n 6642, D (Xl-_ State: ZIP:
Tax map /tax lot no. /account no.: I S134, Ffe4 71 -QD3° 1 Lot I Block: Subdivision:
Base flood elevation: Elevation certificate:
Description of work on premises: 1 1 . 4 S IALL4 )1 s t - 4 4 A sV V / -c ry ., 12 e
OWNER IVIANUFACTURED HOME INFORI•IATION
Name: t.C.Srca.. Y.�r�3EZ
Address: I IS 3 O 5 `J 51 S T1 ,. 7 Concrete stringers /slab under home: 'Yes 0 No
City: 1! is h Ct State: O � j_ , ZIP:CZ'}2Z y ❑ Single 0 Doubb irriple
Phone: Fax: I E-mail: 00
Owner representative: Valuation $ Square feet
Phone: Fax: E -mail: (dwelling and set up only, does not include other permits)
SET UP /INSTALLATION CONTRACTOR ADDITIONAL PERMITS (ifrequired)
Name: B LUEL 4I e: COO sTiz_vc.`nO4.l 'N L . ❑ Mechanical Permitno.:
Address: Fe 1-0..,, S y i ,
City: O2_ CZr( C t t-,( I State: OL 1 ZIP: ej }O Lis lumbin ms T o o yermit no.:
Phone:563 q fit( OE] Fax. ya -O 152- E -mail: ¶Electrical l g 6°3 Permit no.:
CCB license no.: b4' i [ City/Metro license no.: S 115 0 Foundation Permit no.:
MDI license no.: rj 0 Garage Permit no.:
SKIRTING CONTRACTOR
❑ Carport Permit no.:
Name: p,,,,.E d4 i3 - -'150 -6 d (0 0 Cabana Permit no.:
Address: 1 1 S , Sc c) IV1ItSuS1L (nl. Z.
City: 1 u LA r . y I State: p e I ZIP: of --4.. ZZ g 0 Ramada Permit no.:
Contact person: Les it Z L I Phone: 0 Awning Permit no.:
CCB license no.: City/Metro license no.: ❑Alterations Permit no.:
Skirting license no.: MDULSI license no.:
0 Other Permit no.:
Name: 3L v..rE L S1 'z_77 A-! L
Address: Qp 3 y 6 Notice: Manufactured dwelling installers must have an Oregon
City:
Address:
n,1 6 State: CA_ °j 04 j MDI and Construction Contractors Board license under provi-
sions of ORS 701 and may be required to be licensed in the
Phone: -4.8 i/ -06 Z I Fax: - q' e z.-4 -mail: jurisdiction where work is being performed, or the appliant is
I hereby certify I have read and examined this application and know the same exempt from licensing for the following reason:
to be true and correct. All provisions...0 laws and ordinances governing this
type of work will be compiiedwitf whether specified herein or not. j 3. 11 f'(_ /J
�-
' 4 . � . ,2 t ►tl o, E.)
App n signature Date Set up fee $ S. O
y State surcharge $ ? d
`Notice: This permit application expires if a permit is not obtained within State fee $ 33.
180 days after it has been accepted as complete. TOTAL $ RA2,5 - 1
440 -4624 (8/00 /COM)
/le eye t -Zo o3 - ,36A 7 -
�/4 ,/03 e- .9� 7'9C
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 639 -4175
MST 3" � ��
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Re uested 1-2 AM PM BUP
Location . ! 0 g / Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner — (o /f ELC
Footing •
Foundation Access: ELC
Ftg Drain
`‘ G < < ELR
C Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation e 4.4
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
PAS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA SIT IL
_. CHANT
Post.& Beam
Rough -In
Gas Line
,caeke-Bempers
114W 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 0 Please call for reinspection RE. 0 Unable to inspect — no access
Fire Supply Line
ADA � - 2 Q - D
Approach/Sidewalk Date Inspector • Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD - 24 -Hour
•
BUILDING Inspection Line: (503) 639 -4175 MST 3'40
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested l"- �( AM PM BUP
Location l0 oZ 1 / 0 9 " Suite MEC
Contact Person � /� Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner —_ ELC
Footing �"
Foundation - ELC
Ftg Drain Access:---
Crawl Drain /C-- ELR
— G"'
Slab I spection Notes: i 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 ART FAIL
CPLUM -
am
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
" ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
4 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ( '
ADA Date / — Oy Inspector /0 Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD E
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ALL PRO ELECTRIC INC
5224 SW DOSCH ROAD
PORTLAND, OR 97201-1255
Electrical Signature_Form
Permit #: MST2003 -00448
Date Issued: 9/12/03
Parcel: 1 S136AA -00301
Site Address: 10240 SW 69TH AVE
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R-4.5
Remarks: New manufactured dwelling placed on individual lot. TIF, and parks credits apply
for demolished residence.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
WEBER, LESTER C JR ALL PRO ELECTRIC INC
11530 SW MAJISTIC LN. #2 5224 SW DOSCH ROAD
KING CITY, OR 97224 PORTLAND, OR 97201 -1255
Phone #: 503 - 750 -6646 Phone #: 503 - 246 -0361
Reg #: LiC 148108
ELE 26 -1099C
SUP 4630S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Sig" ture of Supe' ising Electrician
If you have any questions, please call 503.718.2433.