Permit 2. CITY OF TIGAR® MASTER PERMIT
PERMIT #: MST2004 -00013
141 DEVELOPMENT SERVICES DATE ISSUED: 3/3/04
'�' ��---� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11491 SW 90TH AVE PARCEL: 1 S135DB -HP002
SUBDIVISION: HOFFMAN PART /MLP2003 -00015 ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
REMARKS: New SF
BUILDING
REISSUE: MAS 1144 STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 20 FIRST: 1,852 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 757 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 10
VALUE: 191, 843.90
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 1,852 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: 1 GAS OUTLETS: 3
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FOR: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 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: $ 7,708.76
This permit is subject to the regulations contained in the
HOFFMAN, MICHAEL J LEWIS & CLARK HOMES Tigard Municipal Code, State of OR. Specialty Codes and
1223 NW 24TH #5 16058 S. FRONT all other applicable laws. All work will be done in
PORTLAND, OR 97210 OREGON CITY, OR 97045 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: Phone: 503 722 - 1182 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg #: LIC 77409 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
•
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Fireplace Insp Water Line lnsp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Line lnsp Water Service lnsp Building Final
P Beam Structural\ Mechanical I sp Shear Wall Insp Insulation lnsp Appr /Sdwlk Insp
1 \ R ( n
Is ued By 1 _ `� J, . �1/t' - ' Permittee Signature : y / -y�
t-e-
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
J- ■, Zvi .6V4./J 1V: -u r3.1 aUJ::) til,itfU CITY OF TIGARD
CUoo_ •
s - ' L' . LA-) QjDO 7_®D®2
R$t1 i Pert ? :if. vj , = - 1. , 'ti�7i i ® FOR OFFICE USE ONLY
1 .
� TIGAAp
City t)f Tigard D . e �� J Ycrmit No .��' > ® ® ' ' °tst� / 1
• ' 1312,5 SV,/ Hall Blvd -, Tigard, 0 " U 2004 Plan Review /
Phone: 503.639.4171 Fax: SlI 1 4 *.r/o nrylr „' l lr'C Doze B : IV — 3 - tr t °tam - Terrain al L Par v 3 ' d eio /s
"' mix Et See Attached Checklist for
Irlspectiun Line: 503- 639,4175 .p�/ � Vii- "1 i� Dateiicndysy;
Internet: www.ei.tigard.or_usG 1 O Notified/Method: SupplomentalInformation
BUILDING +DIVISION Y :IL•li °'l,l L..,,,:,,
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:
i r Q Dernoltuon I .: ''
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Now constructi Permit fees* are based on the value of the work performed.
_ Indicate the value (rounded to the-nearest dollar) of all
0 Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the•profit for the
'}r <; 'I;''e ". ,.1„ j., 4.r S -,5 i� ar - ,.' •o:. ; ':p: ;J';�;d y''`' ii ; �u i h 'work indicated on this application,
;11f 1• 7
0, µ .ld l �k 691 ;4 4 4 44 15 ' 1 7 � ' , '1• , t ! l l� .' 1!. i ,,:', li
il': r I.�F.,::.�lj:�l `11h.�Prh � ,fi 1 I p I :,�L�:. :. r CI:I ? .,;ir +,:.J...41. Valuation: $
1- and 2- family dwelling 0 Commercial/industrial
QAccessory building ❑ Multi-family Number of bedrooms: 3
❑ Master builder 0 Other: Number of bathrooms: j
' . : 3 it 4'° °:) p ,1., / C ,Il i e w • {i ,.� ,,,; 1 ��; •,•u.,;� ',;i;q - ,: °1r I jil, ;, : j "p h ' 9. 1
' v Total number of floors:
�; I:cNlPI1 {vrµ�41' w {^I ", , * � w Mk4_ .!J "� � I i � F I �II :r:1 1 !ii rc I'Ii'
Job site address: 1 14 q I . % 4 New dwelling area: 115;2 square feet
City /State/ZIP: _ " KD (rj 2,2.: _ Garage/carport area: ?r r square feet
Suitelbldgiap.no.: Project name:14-OFFiSAN ekR.T1 Covered porch area: Co square, feet
Cross street/directions to job site: ( 13£g.a. Deck area: square feet
Other structure arca: square feet
- t t' A 11I: ^ t•; Tl YY (] 1 IIA I h'L'1 ° "i' +� II "' +
Subdivision: Lot no -: Permit fees' are based on the value of the work performed.
Indicate : i Di m I C(tj . .41`yn. r ... r'f KL7s ,
� _ � J 1-.. f,' : ° .:in,•. "' ii':'rK ° :.• .. ::114'1 1 i l.i: is .r I'.•.''...
Tax map/parcel no.: i ! I -a i7 g I �,�}( ,E)_ Z" equipment labor, overhead, and the profit f r the
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�i�e sl.., ,- . es.i. 'iH �If ; I., ('•:,'�. K ; .L, �,,. ;i;,,l"mi ;r,! work indicated application.
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Valuation: S
- Existing building area: , square feet
• Ncw building area ' square feet
•
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^..•':�.:ii...i' �" - �?' i '�. 1= '�17.'l#jj.r.4� j,M1i �; i,�' J3" :: i„'� :n,,, Number J'W'" ' • .IPFjh1,i,,r,!�:;.,:Ira a:i G1! i; ∎ ;iaila r: . i r 'I'. f ' i r `'I l Prk ,T) ■ N umb of stories:
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Name; . M F *EL +OF 'J Type of construction: .
Adder: 11,7_, .' N w 2_41t, 5 Occupancy groups:
City/State/VP: 'PO ( p 0(2. ¶1 2.-1 O g:
Phone: ( t! $ 1 o - "100 Fax: ( ) Sr 2'7 - 45'0 •
New
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Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required' to be licensed in the
Adaress" jurisdiction in which work is being performed. If the • City/State/ZIP: - applicant is exempt from licensing, the following reasons
apply:
_ _
Phone: ( ) Pax:: ( ) •
p -
E -mail:
•
r {(4 'k;.F '''!�''7,: 1P '9',I( .1::`i•tL, "il�i•�i! "iSle'e i , ; , '„i „u, •�iV4� I, ` °ii'i lli!',' jai' r”: ` ^.'a7, " i�r'rr:'
�- d�ilyu4"M, l4°ad�Cnf �� c:�`!ll�ll �.Iti�ll�f jtl�l��'t�4".r .�� � !)P� , ��c}$✓, �iy iiy6' .1St'41 <:'�t::.!';IH'.9xi'9ir': ct.•t ?XY:c:,::i:ISi
Business nanze 9yi 2 — t'4 f.'! :le: ' ` Fi :I. tamara
-
Address: /G E2 6---- .)
Please refer to fee schedule.
City/State/ZIP; �� / 4.
/.. 2-� r2� ( / 7," r�5 Fees due upon application
Phone: ( ) T / / Fax: ( ) .�f �,,, tC—
Amount received
CCB lic_: 7.7470 7
Date received:
Authorized signature: This permit application expires Ka permit is not obtained
within 180 days after it has been accepted as complete.
Print name: � . ` ( Date: 1 < , - - 0:1
_ • Fee methodology set by T1i County Bulling industry
Service Board.
i:tauiidirQlPetmiuis ' am,itnppdec 17J11 4O-4 13x11 Vo2
•
Mecb Permit A 1 . ; ! ,�� k D FOR OFFICE USE ONLY
n. Received / �y
City Of Tigard i Date/By: Pemiit Nt Y16T�� ,• /`/
13125 SW Hall Blvd., Tigard, OR'97Z Plan Review
Phone: 503.639.4171 Fax: 503.598.196p�A, ►) u Mit //Hoil/o �i t I I r l\ Date/By: Other Permit
Inspection Line: 503.639.4175 J l`1 Fa °• Date Ready/By: Suris: ® See Pa e 2 for
Page
www.ci.tigard.or.us T1GABS Notified/Method: Supplemental Information
G'TY gaDVISICA,
�,: r- � > " <�i�' <,:�; 'a�WORK;";�;;. : f.. COMMERCIAL . YF EE: " ,SCHEDLiI. E .:,U SE CH
.
r
® New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
tee: =<.; <x:. , " _te '':,, ,... "'' ",,;:- .;. :> R ''''' ;: �_ ,; ,,�:�, :
,' ::.._,� . s . Value: $
" `s" -,::t' q CA'1 EGORY' OF';.`COP7STtEtiJ.Gfi N
, -� `• '4,z�,. - �:. > kfi ,+� >R. , ..,>: E,¢;`v=,. �a: ;x ^ =".�t'�.w'ta ".A= .. "- ,...�_ ,,..._.:��_., a_ .
, ^, " _ r- .. . . „ _ _ - _ -
REI SDETALE
NIQU IPMENT•/ SYSTEMS FEES*
t4 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
` " ' *v. ez, JOB IT. :f. „ IO ..� 4.. ' , 1 ; - 1 `."" H ea ri n coolin
" � �. �>-. �. �+, �:;> S a; u_ ��•ta �:a�+x 4..=3:�".��,,,.2m.�,.'r. ��- �,,u^•..�:',.. a- _._,�.. ,.. ,... � P,/ g
Q Air conditioning or heat pump
Job site address:
44; Li) 9ore (requires site plan showing placement) 14.00
City/State /ZIP: ^ri 6,sr1b q ►' 2 , 2 , Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:gdPFM AJ VAIZITtICIV Gas heat pump 14.00
Cross street/directions to job site: 0 BEEN % Eta Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: 1,4 ( 3 5 D g PA giEL y Other fuel appliances
r �., .. ^,t; :.;;39`9 W #;> i �3�t',: y tratE, e'��'s . f j j l ^i ^w <,': . 5 ,P 1 ; ;, ri' f.;.i•; "a =. L„.g;. f t
; ���,:_���� a ?:L l :: � ,� a '�;�t: r - �, ••,�t;,;;,�,;x." :�x`;' <'�,. Water heater 10.00
. 6V i * _rieaate" 14 ,a. l IDES RRIPTI,'N„QOF WOR " , e2,0m. "a.,
ix'M^'.:rt,e• xse2s�..=,.:�a:"^�'�.: i.,...�...,�_�ux��°,>x' ra�aax .r�£:,:r�'�za:Fb.•,v aa:.�w.. zz:•= ::s�'r:?;',be:� �...,< Y*, 3�� .'+ ::iN
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
;w . ' k'd:ztif :�.,$:: :�:.�,, ; y ; . - ;. -: ::d , „ n >; ,:;;:o4; ,n ; tt, Chimney /liner /flue /vent 10.00
4 :
„PR00 BERTY IO WNER ° -'" `r 1 ` :. �;.= s: ,alt %;TENANT G. w ` " s.
., t� ,z:�,a.dcR.«, _�� zra.;��;5x, ,z�rwx. x,.,{r d �,w'?� �:�i a , `itzs :.�..,?Ss`i$..a, ,�- . " nt .a . '.. a,Ezl.. (]then: 10.00 •
Name: ivt HoFr Environmental exhaust and ventilation
Range hood /other kitchen
Address: 12 V'5 NW ,'t1 1 5 equipment 10.00
City/State/ZIP: r ripriv) ()Q- el 7 2.-10 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (50) g (Q . 3 3 Fax: ( ) 1 17 - 45b i • toilet compartments, utility rooms) 6.80
�� yg , ;, W ....c�z�'zt.t,:.�aec-,_xt, cif::a•^a. �• - :' - ,K�,.� ,„Ar '�; w;ax. �'�;.
r bs ys � 2,PFIfIeUff zs <;�W 't vp ❑ir OO '�, RS ON ,' Attic /crawlspace fans 10.00
ail. . r141'.$a.• * .:6 . , ra✓:,,,g,l, .. t. t«L`a>'1. -4t», .c "ke,:x.l'NI, l s�-.cu .„.. ., . a. z'. .. .:, & ate -t,, o :.,,,
Other: 1 0.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP.: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
S s' ' xa ::'* i r,'k:5 "e+y.: ,:�;f�ssw�y,: „ ^t:.°:R� f't 9 °; `s :� `:. 'h ;:.V: s r ; ^a, aFT:., .;€' �: j:
^:= tij r °I':i ;�':'� � ?: M?'. s �.,, , .., Y `^.,`e. ,.., s . r h ,�� . �, � � "� �'`3.
,. 7:s;�ts ft 11 h' #•: i V. <a:,.'' ; CON, TO „1 e . ,...�; : ..fix': , a:. ' a "* Barbecue
iA"� k'�.,;.....s4�,; z �. ",•,�;x,�,;,- �., : I nc :^„,da , "� „ iro-, c , ; ,,, d..�
: q.
.."S'S: �. ni' -" c.._ rdpi'.. "��4;'a .. ...:� 1p'
_ ': +.:u:.-.�.t.. `k xA S'+e".. ,, .�'w*s3"� »d^�.. - i .. .�:�� ^.° v �:.. c..
Business name:" Clothes dryer (gas)
n a �� L�'t �l 4 "�' Other
Address: 2 .5`1 2-7 �7I l 22 i ! z," , yF " ,;G}' CHANICAI'PRIVI
EIT-EEES *;
City/State /ZIP: C - _.��t, ?/ C t. t �' �� `� D i.� <:� Subtotal
Phone: ( ) f Fax: ( ) C Minimum permit fee ($72.50)
f c': 5 0 2.7, ( 1 ) Plan review (25% of permit fee)
CCB lie.: J - 7 1 � ( State sur char g e ( 8 /o of permit fee)
'V
i''l�te 3 f 13 ! 3 °
TOTAL PERMIT FEE
Authorized signature: .1 This permit application expires if a permit is not obtained within 180
/ 1 w. ' days after it has been accepted as complete.
/ _ * Fee methodology set by Tri -Count Building Industry Service Board
Print name: Date: , / .0 G gY Y Y g tTY
d /
i:\Building\Permits \MEC- PemutApp doc 12/03 440 -4617T (I 1/02 /COM/WEB)
Building Fixtures ECEIVED
Pl Permit Applica On FOR OFFICE USE ONLY
City of Tigard JAN U See Page 2 21' Received Permit Nc • i r r0®/ ^.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re :
C IT Y O F TI c" II Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 " S ani ��y ipwL € "� +' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 s, J r-� 1� Juri5:
p BUILDING �,; y' W Date Ready/By: 0 for
Internet: www.ci.tigard.or.us Notified/Method: I Supplemental Information
2 ye;
D
`'OFD- ' FE S E GH ULE
'�` a, � . �kTYPE WORI{ ` E_.
4
'] New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
5
x CATEGORY �OF �C a�NSTRIfGTIO1V «�;;�: SFR bath
„��..," , {,r �?`.> .; � O .. 1 () b 249.20
c?'.t�'1"fi"di.,...'�sz�rr,..'. ,.,.,�.. �'s "...'ai;"��,�a:e,., , »,..a<_. ,x ^..ti, uq., «+r �r.�r.�:PC ,+;:«_ .. _- _e�.., -- . :_. �„ _ _,
Cj 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
.; "' s - £ee k: : . W t,; .: _:,:¢ :•, ,;_ ,:� :,_ , ..r:.
v Fire sprinkler ( sq. ft.) Page 2
; , 3 -;a ",,, .,.; :aJ,OB S II:E .IN ON . A1ilD' "GOC°A TON i '- 'V,';
...,...:.��*�.ds iota` �M,>. �Xa. �^ r^ �: ru #�iv... ,,M. ara� :�.. ^; ,,.�:eE.t'�v;..'E"�� - >.:.r - '�;.:.. _ . . :t i.,.1 Site utilities
Job site address: 1 I 49 , W 00 Catch basin or area drain 16.60
City /State/ZIP: -ri ( 12,..c> 1 '7 22. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: f Project name: 14 E'FMdN Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: t"vR ENaciZ6 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: 1 • ∎ 1 3 q i 5 p, ZCEL. 2 Ab sorpt or item
Y,��;::J -; s:ta;���'?� �3�t�� ,;; F:�ax ;�� �;
� �,.!�: „_ _, <au, - Absorption valve 16.60
_..,, . 4' :, , 1.. -. ` ••I . . DESGITIPTI®N OF WQRK. ' ,.. >"a ;k " ; ;
.,,. :'��,�::.�m•l'� °���.�;.: psi± k. kw* 3���; �... ���:, r:,n-.. �.. �, ��: �F- �_ �n.:.�,;��MS��.�:�,,.. Backflowpreventer Page 2
. Backwater valve 16.60
Clothes washer 16.60
Dishwasher ' 16.60
i #<.,.:.t. 14,, . ; a.„ x. a r . , , s, ,.. .,: _, ;�:: :zw . .,: ,: ,;. � Drinking fountain 16.60
•
,ea. ' _ + 1x.siza` tom_ a Ejectors /sump 16.60
Name: MI G� AEL, 1-4OFF 1
Expansion tank 16.60
Address: ` Z, 2-5 N(,1) ?A s Fixture /sewer cap 16.60
City/State/ZIP: a, - jANj 1 72 , I Floor drain /floor sink/hub 16.60 '
Phone: Hose bib 16.60
zi , 45b Garbage disposal 16.60
(, q fll -S Y z,.. , 3 (Q . 3390 Fax: ( ) , P���:,1 , ::c : ;.,.; ,F.44. 4 , ^;s �,,, -: ; � ::,,r, n�mgli _i „„ �
It
A. ' ? :; s 1 r. AERLI( ANtT - is a A a ^ „,£;'6 ee ., zi i1 ` _, :CONTACT'' °SEERS. Y k l i Al t1
ctta, u � ,� a.��.G .�:�.��,,:; �s ,,.. Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) . Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( ) •
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
::, ;.a ";xi: = } ^' +.u:� `, s : ;z"a ;;s ;rt`x;n°•'F_•r.#it- ek'k itit'`.�`: '- ' ; M ',; z
���' r s' a3+ ,i�aiq� "•'��:a,:.,xi� ; "s. .,,'�,r�, r"�'� �`,:z�".s. =sue=' *`ti'^'F"
:Y , , ��.,EONTRA;CTOR :T :1 j` ;_ :' •
?�'Ks;�`.s' = °r�':7;*:=N<_, �� ">�,r'�.s.�::�:.,,�= a. �,;��G a , ,..��,��: .,t�,�,: ��: = �t= � = :� ..�• :•N. _. Water closet 16.60
Business name: T. J 5 Pl (Arm b i ,, y Water heater 16.60 -
Address: CI s g $ - i ND It /rn (iJa `i Other:
Subtotal
City /State /ZIP: ay4-- IAN 4 U I^E o h 9'7 (o Minimum permit fee: $72.50
Phone: ( ) s G( -14`706 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: 3 i < Q 9 Plumbing Lic. no.: p �(, - ..40 Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee)
Mt
5'7 7 °a TOTAL PERMIT FEE
Print name: ...-- ' 4, Date: I a-- 3 i 0-3 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Bui lding\Pennits\PLMF- PermitApp.d c 12/03 440- 4616T(10/02/COM/WEB)
CITY OF TI`1CARD 24 -Hour
BUILDING Inspection Line; (503) 639 -4175 MST �� 4" " ool 3
INSPECTION DIVISION Business Line:. (503) 639 -4171
BUP
Received Date Requested 7 ' • AM PM BUP •
Location /) 9 / 9� 7L Suite MEC
Contact Person Ph ( ) 3-34 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
1nt Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
4114..f--t? - ASS PART FAIL
P UMBTNG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
' APART 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: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7- Zg— 24– Inspector r 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 MST2OO�f -013
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received / Date Requested ' AM PM BUP
Location G f g/ ' 5 ?` Suite MEC
Contact Person —r h ( ) g/D -3360 PLM
Contractor _ Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -40
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
na,
■j PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
FAIL
ECTR ICAL
Se -
Rough -In
UG /Slab
Low Voltage
- Alarm
'n:..
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA & -- 3 -r O
Approach /Sidewalk Date J Inspector �+ — Q `vim ' Ext
Other:
Final DO NOT REMOVE this Inspection r ord from the job site.
PASS PART FAIL
i
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TREE C ..
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0.
i ..
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4. , 0-
I, 11 MCA k -L P F/71 JAJ , Owner /Agent f cl 4 l - / i j/ c,,,,
(PLEASE PRINT) (rRMIriLDER)
°x ,, -,,
+
Do herebyc z t y t -a:4h -6 fol location
meets ,g4pc f: T and /Was ri` on Count
_. Y� h,,; .gi ..... -:n ;. Y
l and use and development standards for street tree installation.
• ADDRESS: //49! 5 W 00'7- Ot-
• LOT: 00 Z SUBDIVISION: gel F F /V M,v PA1 kT M L P 2c -c00/ 5 ::
• BY: -. j DATE: Z ,7--
0.
• RECEIVED BY: "�� DATE: 7-4 -
A