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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00165 -4V1 DEVELOPMENT SERVICES DATE ISSUED: 7/14/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15095 SW 93RD AVE PARCEL: 2S111 DB -KE011 SUBDIVISION: KESSLER ESTATES ZONING: R -4.5 BLOCK: LOT: 011 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: BVH3212 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,402 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,810 sf GARAGE: 440 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRO: sf RIGHT: 15 VALUE: 308,476.80 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,212 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 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: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 W00DSTOVES: GAS OUTLETS: 5 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 FDR: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HWSVC/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: $ 8,221.53 This permit is subject to the regulations contained in the BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES 6932 SW MACADAM AVE STE CE 6932 SW MACADAM SUITE C Tigard Municipal Code, State of All work kwil Specialty o ne i Codes PORTLAND, OR 97219 PORTLAND, OR 97219 and all ra cer applicable ed laws. Al. This permit done in accordance with approved plans. This permi t will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 152235 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You 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 Gas Line Insp Water Line Insp Plumb Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Issued By : Permittee Signature : ■■ / , W Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the nex) business d CITY _OF TIGARD 24 -Hour BUILDING Inspection Li (503) 639 -4175 MST , '7aUq : a INSPECTION DIVISION W Business Li (503) 639 - 4171 BUP • Received Date Requested /D---/ AM PM BUP Location .,— ArT Suite MEC Contact Person 'h ( ) ` PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Fog Drain Access: -e � i °@, ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear / z ' - d (-/ Framing Y ' v �` (J Insulation Drywall Nailing —�— Firewall (2aM Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: di PART FAIL i4SE BING 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 r Ass"cD Gas Line (Z j�0 e Dampers 6, ar 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 t2 ( 3 ""( Approach/Sidewalk Date I nspector Ext Other: Final DO NOT REMOVE this inspection recor • AI the job site. PASS PART FAIL Building Permit Application FOR OFFICE t'sE; ONLY R � o Building Pe Permit it No.: /o atBy � �� rmit K Date/By: D � City of Tigard EC OVE® Planning Approval Other Y Permit No.: Y / 13125 SW Hall Blvd. JUN Plan Review Other 54)9 Tigard, Oregon 97223 JUN 1 1004 Date/By: d1A' ' 7-2- off Permit No.: Phone: 503- 639 -4171 Fax 503 - 598 -1960 / , yy ,3'I�;� \ Post- Review Land Use Internet: www.ci.tigard.or.us l Date/By: Case No. g CITY OF TIGAR ''" 4 __ Contact Ju ' .. 0 See Page 2 for 24 -hour Inspection Request: liC At6 Name/Method: / f- Supplemental Information . TYPE OF WORK - - • : - .: , • © New construction • . . .:. ' REQUIRED DATA:: - : - °_ .: •.,.:..:.;':-...._. • . . - ❑ Demolition �� �l & 2 FAMILY DWELLING- . : :: 2 ' ' ❑ Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees' are based on the total value of the work performed. Indicate © I & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Othe Valuation S . • JOB SITE INFORMATION anrllr �rrnnr No. of bedrooms : � Z 3 No. or aths: ' Job site address: / 50 9 - c.0 Q3 /4-`) Total number of oors New dwelling area (sq. ft.) r� Suite #: 1 Bldg. /Apt.;<F: Garage /carport area (sq. ft.)..........4/ Project Name: Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) - Other structure area (sq. ft.) :. , ..: REQUIRED DATA:: .. - - .COMMERCIAL IAL =USE CHECKLIST . .. - -, :Subdivision: I "� Lt, Lot #: .... . _.. . Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, NEW CONSTRUCTION — SINGLE FAMILY RES , overhead and profit for the work indicated on this application. DEATACHED RESIDENCE Valuation S Existing building area (sq. ft.) - - New building area (sq. ft.) Number of stories ® PROPERTY OWNER .. { .❑ TENANT :•: •: • -. Type of construction Name: Buena Vista Custom Homes Occupancy group(s): Existing: Address: 6932 SW Macadam Ave. Ste C New: City /State /Zip: Portland, OR 97219 Phone: 503-443-6033 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under A PPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: El iabeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: • . . E - mail: _ BUILDING PERMI F EES* = - - • -.:.. - . . ',; Please refer , o e scheduler : . CONTRACTOR • - .. . . .. ... .... - .... ... - Business Name: Buena VIsta Custom Homes Fees due upon application S Address: 6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 97219 Amount received S Phone: 503 - 443 -6033 Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized //1� _ Signature: (A. OP Date: Notice: 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. (Please print name) i:\Dsts\Pcrmit Forms \BldgPermitApp.doc 01/03 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY -) BUENNA VISTA lit 002/003 Plumbing Pe�rmi 1:2,4:1.k- 0 'e4 .r I Daunt.: / � /V� • . ; . ‘_� E i y ,r Dane . it Planning Approval Sewer City of Tigard Jul Date/13v: Permit No.: 13125 SW Hall Blvd_ 1 2004 Plant Review ether Tigard, Oregon 97223 DatelBv: Permit No.: Phone: 503- 639 -4171 Fax; 50.PW1g4f6751GAR Post.Review Land Use "_ ' 1 Date/13 Case No.: Internet www.ci.tigard,or.us BUILDING DIVIS'. ��I 24 -hour Inspection Request: 503.639.4175 '.: Contact lutist See Page 2 for P q Name/Method: Su • • lasneonl tnLDrmatioo. .- -' -TYPE OB-V ORI t P$$* .7C I1�,>&' ac es fsl SIIfOFinatioVi a ri •x' I New construction E Demolition Descsiptlon Peo(ea.) Total • Addition/alteration/replacement Other, - _ "` , 7 �• ., ` "�' ;"•.' ": �v �•.n�y� � ' � ;•� ;, �5�' �� yo•6 . �� :7�+faat�*�°e1Rugs'•;�, ?,.,:• ; �.. .�t -,, • "t' •,CATEGO1•,�YaDF. $. 1:1. D 171 •'•L - • . '.:•: -- ,a lit rlrai teui _ pniincctroor_r ; :y: RI 1 & 2 -Famil dwellin • ® ComrnerciaUIndustrial •-••. Y SF (1) bath 249.20 • SFR (2) bath 350.00 ■ Accesso Buildin_ ■ Mu1ti -F anvil SFR (3) bath 399.00 IN Master Builder M Other: Each additional bath/kitchen 45.00 JOB STEE INP.QRMA:TIUit iiitute•fx OPt ' ' Fire sp • $q. ft.: Pa e 2 Job site address: `5 `a ' 93 r�i€ ... ..,.. ; - =, :, • -. - . Stte.l;rtilitles• k%:.,.4..,; ' �‘�:: .. _. _ • . Suite*: Bld :. /A • t. #: Catch basin/arca drain 1 6.60 Pro'ect Name: . Drywall/leach line/trench drain 16.60 Footiadrsin (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 • Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Pa: e 2 Subdivision: Lot #: al Storm sewer (no. linear ft.) Pa- e 2 Water service (no, linear ft.) page 2 Tax map /parcel #: (DESCRIPTION OF WORK • • Fixture or Item N „CONSTRUCTION - SINGLE FAMILY aackflo valve ....._H___16.60. a e Basdcflow prevcntcr Pa$ 2 ' FAMILY DETACHED RESIDENCE Backwater valve •■ 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPEBTY'UWNER :` El TENANT Drinking irop fountain 16.60 .. - .,.. • :. Ei�orsJeump 16.60 Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6 932 SW M,acadam Ave _ St,._ c Fixture/sewer cap 16.60 Floor drain/ floor sink /hub _ 16,60 City /State/Zip: Portland OR 97219 Garbage disposal 16.60 Phone: 503 - 443 -6033 Fax: 5030443-2443 Hose bib • - 16.60 »=: APPLICANT • - . • ' •CONTACT'PERSON ' . ' ice maker 16.60 ' Name: R3 Mullen interceptor// ease nap . 16.60 Address: Medical Ras • value: $ Page 2 Primer 16.60 (;t /State/zi•: Roof (comnterclalL_ 16.60 Phone: Sink/basin/lavatory 16.60 . Tub /shower /showerpan 16.60 CON.IRACTOR Urtral 16.60 Business Nam:: ED Mullen P 1urnb 1. nq water closet 16.60 Water heater 16.60 , Address: 2447 0 SW Rainbow Lane Other: - Ci /State /Zi • : , ' _ .. . • ; Other - Phone: 503 - 628 -1 63 . Fax: s • - . Q_ •' ":P1awDlaP+acmJt:'ta.. CCB Lic. #: Plumb. Lic. #: - • 0 Subtotal s . 7 6 8 9 M Permit Fcc S7250 S Authorized Residential Backflow Minimum Fee $36.25 Signature: 2 . A y � a c i L Plan Review L55re of Permit Foe) • S Ray ul en State Surcharge (S% of Permit Fee) S (Please print name) TOTAL PERMIT FEE S Notlem Tbis permit application expires Ira permit is not obtained within ' AU now coatnierclal bullellti s requIre 2 sets of plans with isometric or 180 days after ii his beee tempted u complete. riser dlagram (br plan review. •Fee methodology set by Tri -County Building Industry Servico Board. i:ADsrs \Permit Porn \l'lmPermlt spp.doe 01/03 03/04/2004 16:28 5032537693 SUN GLOW INC PAGE 02 ..__ 1.. . Mechanical Permit Awlication FOR (VF .11(.4: 1I: t1i1. •SN. Received Mechanical %JAI-0 ,,,11, • Data/13.1.L - Permit No,: / t /IOTA' wfW City of Tigstrd E a Planning Approvai Bultding Permit Na. : 13125 SW Hall Blvd.RCEN De : ; Plan Review iiill111111111111111 Tigard, Oregon 97223 Dater13 . Phone: 503-639-4171 tai 503:69060 ,. . . Potit-RevieW Land Use DatetS Lallernet: www,ci.tigard.Or.US ,.4: Conttet Juris.: C't See Page 2 for 24-hour Inspection Requatt --". --"" Name/Method: Svplemetind Intbrmaidon. • BUILDING DIVISION • , . **.. • '. ''•.. :i'' ;:-':. Tym OF WORK :',..,:i'+' .; .,./':l.e•it,c01412ksZterigr...FEE‘.SCIEEDUTZVI/ThlticaNCICIM.SP:' t-- f New construction jJ Demolition Mechanical permit fees* are based on the total value of the work 111 Addition/alteration/replacement _LIOther: performed. Indicate the value (rounded to the nearest dollar) of all * • . - : . OF: a AT.`1':•::=•••''tf!,::::.•:.: mechanical materials, equipment, labor, overhead and profit. L 1 & 2-franil dwellin: a commercial/industrial v.h.t: S See Page 2 for Fee Schedule RI Accesso Builditil MIAMEMEMINIIIIII ,.-: RESIDEVIOAUE01.11PMENTinSIEM5EM:SCEMDULE Ileac?. don ° Fe ell. Totai I_ Master Builder Other: firatier(cimitg „nil,. SITE INFORMA T. car terrniu . - .,. • : ; . . f urnace - add-ort air conditionin . 14.13 Job site address: /50 • 9 3-f-g A L)------ Gas heat • ,- IMO 14.00 Suite #: aid t JA.t#: Duct work MM. 14.00 MM. Pro'ect Narne: , Fl dronic hot water s tern 14.00 .11111111 Residential boiler Cross street/Directions to job site: for radiator or h • rook system 14.00 ' Unit heaters (fuel, not electric) (in wall, in-duct suspended. ctc.) 14.00 Flue/vent for an of above 10.00 1111111 SUbdivision: Lot #: MI R •air units 12.15 Other Fuel Aprlattees Tax - 4. arccl #: Water heath 10.00 . . • , ' - , . DES or r ( t A t i * F W O R K ... ' ...i • - . - - G a i t replace _ 10.00 NEW CONSTRU TION -SI GL" F' I‘' Flue vent (water heatertsras tireplace) 10.00 DETACHED RESIDENCE Lo• - li. ter :- 10.00 Wood/1 ellet stove 10.00 Wood . , • lar.einsert 10.00 MEM Chirraleyilincr/Flue/vent _ 10.00 11111 KV ' .' ' OPERTV.O' N 7 -; ...1:-.. i NI TENANT:it'44'f!'t:.- :'...27i '.7:' Other: 10.00 . Ezvirotkolentall tx.htust SG Veadladoa Narne: 13 _ z 1.. V i s - .. . .11 - 41 . I{ ''' Range hood/other kitchen equipment 10.00 Address; 6 7 SW Maca:- I, • v-_ s - c clottics dryer exitaust 10.00 Ci /State/Zi.: Portland OR 9721 Single duct exhaust Phone , _ „ _ . , Fax: 1 _ , . _ , , (bathrooms, toilet compartments, ISIM:irglaiMIMIMMINNI 'COM - PERSON .' •.' uriliry moms) . 6.80 Maw David Golobay Artie/crawl space fans , I 10.00 — Other: 10.00 Address: 11.11111111M111111111111=1111037-7M11111.11 - Ci /State/Zi.: **(SSA for first 4, 31-011 nth additional) Furnac, etc. Phone: Fax: 11111b1111 - Gas heat %Air E-mail: Wall/sui • ended/unit heater MOOMMONIMI Business Narne: . , G , w ,.. Address:2428 SE 105th Ci /State/Zi.:Portland, OR 97216 BrErniNTINIIIISEillill Phote; 503-253-7789 Fax:503-25 - Ci, "...3 Other: .• CCB Lic. #: 45131 _ M . Total: _ eehaaleal Permit Fees* AuthOriZed . Subtotal: S Signature: - --1. C=it . Datcla2goli Minimum Permit Fee S72.50 S David Golob y flan Review Fee 5% of Permit Fee) 5 — (PleaSe print name) State Sum ar • e : a o • arrut • ee S TOTA.L PE • PIE S Notice This permit application expires If a permit is not obtained within • F methodology set try Trt-County Building Industry Servle*Soard. 180 dare after it iors been accepted is complete. Site ptan required for exterior A/C units. i APstaTermit Farms 1 MesPerrnitApp.doe 01/03 • • 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 RE ...r Ei -i . Electrical Permit App1ica Received Electrical Cate By: Permit No, :I 17 --- a ) l6 5 City of Tigard CITY OF TIGAR D Planning Approval Sign 13125 SW Hall Blvd. Plan Review Other Tigard Oregon 97223 Date/By Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post•Revicw Land Use Internet: www•ci.tigard.or,us " '. `;.';' Datc/By: Case No,: 24 -hour Inspection Request: 503 - 639 -4175 ..- Namef Juris.: I Su See page 2 for - NamelMethod: Supplemental Information. ig ..'`` ' •..TYPE;OF WORK .. .. •-• .. •' ' .. , P W:(Please•t eiftit7latiat:ii0111 );' ....... New construction Demolition ❑ Service over 225 amps- ❑ Health-care facility [I Addition /alteration/replacement Other: commercial ❑Hazardous location ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feat, ' ` CA1ECrORYOF'CONS ,•.RIICTI l'. 1 & 2 family dwellings four or more residential units in & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 Volts nominal one structure ❑ Building o ver t hree stories Accesso Buildin 1=1 Multi- Family g ❑ Manufactured ure amps u to or es ore ❑ Occupant load over 99 persons El Manufactured swctures or RV park ❑ Master Builder Other: ❑ Egress/lighting plan ❑ Other: JOIESITF. iwr` ^- ' ".. - .._- " ^^ `" ^u • • Submit seta of plans with any of the above. J n d , . Ay — The above are not applicable to temporary construction service. Job site address: /5095 Suite #: — 'r.SGHEIZ;E : k :. Number of inspections per permit allowed Project Name: Description P Qty Fee (ea.) Total Cross street/Directions to job Sitc: New resldeatlal- shcglc or mmnl- earthy per dwelling mitt Includes attached garage. Service Included: 1000 sq. 0. or less 145.15 4 Each additional 500 sq. ft or portion thereof 33.40 Subdivision: AIMA «'E!� 1 / r Canned cner rc5idantial t ��•�3Z Lot #• �'' Lim ited energy, non residential �s.00 2 al 75,00 2 Tax map /parcel #: Each manufactured home or modular dwelling DE t' ON OF WQ1t�K t service and/or feeder �`� Servlees or feeders - instaflatioo 90 2 r r✓V C0)1 s -,- S /%l � '] / C f�/ l ly alteration or relocadon: ' ,D.z — � (-he C � / r I)'J - •∎ d e,i � 200 amp or less 80,30 2 201 amps to 400 amps 106:85 2 � 401 amps to 600 amps - 160.60 2 �- 'LROPER'k'Y OWNER :; '1FEN 601 amps to 1000 amps 240.60 2 Name: 1 en a- \J/ S G S f� Over 1000 amps or volts 454.65 2 Reconnect only 66.85 2 Address: (p 7 )'g,. 5 lf/ /ac.hc/o, Aye L ` Temporary services or feeders - installation. Ci State /Zl. ; we 0 -7 a alteration, or relocation: 200 amps or less 66,85 1 Phon • 1 143 - (,‘0•3 Fax 901 ' f4 ;lilt/ 3 201 amz, to 400 amp 100,30' 2 401 to 600 amps .. C ' . • . Q'. a NT C'r'.PEI ON' : 133,75 2 Name: VQ, $S - Branch c i r c u i t s , new, alteration, or extension per panel: Address: A. Fee for branch circuity with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of Phone: service or feeder fee, first branch circuit 46.85 2 I Fes Each additional brunch circuit 6.65 2 E -mail: Misc.(Scrvice or feeder not included); ,...:' . ' CONTRtliC;C'E}R ' . .. Each pump or irigation circle 53.4(1_ 2 Job No: Each sin or outline lighting 53.40 2 Signal circuit(s) or a limited energy panel, Business Name: O r✓ �C alteration, or extension Page 2 2 Address: Q S 70 S ow to #. oc,3 Description: City /State /Zip: [`i �� s - 1-•p z OR /17193 P additional ins Each over the allowable In an of the above: Phone :5 (v iz 2.800 Fax :6V3 er s o on hour min. 1 ha s 62.50 Z �J � investigation fee: CCB Lic. #: 15 789! .Lic. #: 3(. Other _ Supervising electric�� `:: 3;feetrlt�l PElrm1 Subtotal c';:..° , :,;I... X siztiature required' Subtotal 3 Plan Review (25% of Permit Fee) S Print Name:.S . ROSS Lic. # : Z State Surcharge (% of Permit Fee) S Authori zed TOTAL PERMIT FEE S Notice: This permit application expires Ira 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. (Please print name) - l:\Dsts \Permit Fnrrns'.ElcPcrmitApp.doc 01/03 CITY OF TIGARD 24 -Hour f BUILDING ``� Inspection Lin (503) 639 -4175 MST �� - � ' 5 / INSPECTION DIVISION Business Lin (503) 639 -4171 BUP Received Date Requested / it AM PM ' BUP Location 'Sy - � Suite MEC Contact Person / � ) �l0 ! u PLM Contractor h ( ) 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 '' � 1 ����,,, // Int Sheath/Shear V�. ���/ n /∎4 Framing Insulation 5 T -- Drywall Nailing ('— l Firewall ._� �u L-- G L Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: I° Lc, e ,i>< V a 1-. 5 i\l _aim - re' PASS PART FAIL PLUMBING — Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains - Catch Basin / Manhole Storm Drain Shower Sewe k _ 0 . , r Other: - — Final 1./ lei t 6 14o PASS PART FAIL f MECHANICAL. �� J �t>! r ■ G A Ro & Beam 1 P� o �/ � ; 1 Rough In -�- �� . Gas Line Smoke Dampers i P SS PART FAIL RIC AL 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 El Please call for reinspection RE: / E. Unable to inspect — no access Fire Supply Line ADA j g Approach /Sidewalk Date J� `� Inspector ' Ext Other: r� Final DO NOT REMOVE this inspection record om the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING t . Inspection Line: (503) 639 -4175 MST oltOei INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / — AM PM BUP Location J� � ✓)_ uite MEC Contact Person C i ' -_ Ph ( ) 6 Y? - 2-too 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 Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final - PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage /Vb , ELik Fire Alarm • , S ° A RT FAIL Reinspection fee of $ required before next inspection. Pay at City. Hall, 13125 SW Hall Blvd. SITE El Please call for reins'ection RE: Unable to inspect — no access Fire Supply Line J ADA Approach /Sidewalk Date / Inspector 1 Ext Other: Final DO NOT REMOVE this inspection record from the j . s site. PASS PART FAIL • N AAAAAAAAAAAAAAAAAAAA®®®® AAAAAA®® AAAAAAAAAAAA®®®AtikAAAAAA AA It- 44 tt 44 ST:k. :-' s . -... -. ET TREE CERTIFICATION 0. A OP is 44 I, ZI Let r 2' , O for j L-1 `L, P/J4_ (PLEASE PRINV (PERMIT HOLDER) I l %, A . ., DIP s' r 44 10. .erg , 41rr,r,>.. Y 4 Do hereb Y'.. y < '. ., g location 41 meets T r i i Y; ' " op ,ounty PA' ® - land use and development standards for street tree installation. P OP 1 ADDRESS: e yr p. 0. ® I 1 LOT: (6 ? SUBDIVISION a / . ® 111 ® BY: / DATE: /2/0 ® RECEIVED BY: DATE: 5 ` VV YVYYV YY VYYY YYY YTAY' YVY YVYV VYYY®®®VVVYVYVVVVVVVVVYVVVVVVVV