Permit • CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00512
T iii) DEVELO P dS 3CES 639 171 DATE ISSUED: 11/13/03
ALA 1.1- 13125 SW Hall
SITE ADDRESS: 13620 SW 124TH AVE PARCEL: 2S103CC -07300
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 020 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,570 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,730 sf GARAGE: 671 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE: 327,234.50
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,300 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 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: BOIUCMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 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: 0TH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,748.02
DON MORISSETTE HOMES INC DON MORISSETTE HOMES INC This permit is Municipal to the regulations contained C o i the
Tigard other u
h r applicable cal Code, State work OR. Specialty Codes and
4230 SW GALEWOOD ST 100 4230 GALEWOOD ST, STE 100 all other applicable law All work will be done i
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97035 t
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: Oregon Utility Notification Center. Those rules are set
S forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
LI
Reg n: C 3 8737 5 5 may obtain copies of these rules or direct questions to
Lt 5 $ OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins( 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
_
Issued By : 1 //aeif,a+ -, 5 e l,�_.) Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
-, ,..v //- 7 - ° tut, ,,, - z ..,
44 . Building Permit Application
Datereceived: /6 1 b - Permit no.a 1 s • 7 /.
d
1'1 , City of Tigard Address: 13125 SW Hall Blvd, Project/appL no.! ") f� Expire date:
City of Tigard QgclIEWE
D
Phone: (503) 639 - 4171 ��jj r Date issued: By: Receipt no.:
Fax: (503) 598 -1960 UC 1 1 2009 Case file no.: Payment type:
Land use approval: C:iT J 1 &2 family: Simple Complex:
OI" TfG ARD
hl PL OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ,'New construction ❑ Demolition
❑
ZP
Addition/alteration/replacement 0 Tenant improvement ❑ Fire sprinkler /alarm ❑ Other
fi r ��
r'�'•i"y:'v ':..‘t.,....74,44;.., "` ��'`; �y,� {k <'�`�..t..�a= � . . ' Jollk'•Sl..,6�.. Ws?45vaNIrRi LONOW.tdtq R .'.,., ¢r, 1 ;.
Job address: ' T�
�(p� ( & B ldg . no.: Suite no.:
Lot: 1) address: ?? ,0,-)-0 (Subdivision: 1AAtil. S I Tax map /tax lot/account no.: `N.
Project name: %),,,0 V I r tS
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
-N (Floodplain, septic capacity, solar, etc.)
Mailing address: I trk w iffi w „ � rtes 1 & 2 family dwelling:
City: , , , Staten ZIP: 1 . 2). 2 Valuation of work $
Phone:. -- )-1C) Fax yj ) -7 , -mail: _ No. of bedrooms/baths
Owner's representative: , W041Ir j if G ,/j Total number of floors
P':one ,Fax: E-mail: New dwelling area (sq. ft.) } J ;UO
.. ',, � eiJ� _ , " ' v , Garage /ca -oort area (sq. ft.) O
�,) Name: C1n ` Y "- s Covered porch area (sq. ft.)
Mailing address: - ,,,J, a CC , Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $
r � Existing bldg. area (sq. ft.)
�� New bldg. area (sq. ft.)
Address: kr
City: State: ZIP: Number of stories
Phone: ( Fax: I E -mail: Type of construction
CCB no.: 3) 5 �j �j" Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 1 , provisions of ORS 701 and may be required to be licensed in the
Address: e �,6, .4,-.„,- C(, � CO :Y''� jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: ( Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A . rovisions of 1 ws and o dinances governing this El Visa Cl MasterCard
work will be complt wi ii, whether cified kierei{i r �tot. Credit card number: / /
1 'A �J Expires
Authorized si _ atu , f A C .. e: Name of cardholder as shown on credit card
Print name: X
.Ai +�
fit, 2 .1 2 Z. Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6.00/COM)
One- and Two - Family Dwelling
' ' Permit Application Checklist Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard `J g ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. X
8 Soils report. Must carry original applicable stamp and signature on file or with application. �(
9 Erosion control Cl plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed t/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" 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.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28 •
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (6i00/COM)
, • Mechanical Perm P
A Date received: Permit no.: ()5/ Il'l" City of Tigard >J y► _ ty g OCT :- ProjecUappl. no.: Expire date:
\
City of Tigard Address: 13125 SW Hall B1, Tigard, OR 97223
Date issued: By Receipt no.:
Phone: (503) 639 -4171 CITY OF
Fax: (503) 598 -1960 B ILDIN DIV
Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial Cl Multi - family 0 Tenant improvement
Iew construction Cl Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ' , i pal, SW 1, L-t ri 'Z Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: r , A 1M Block: Subdivision: M�t�� 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: 1 & 2 FAMILY DWELLING-PERMIT FE ' S "
Description and location of work on premises: AND CONMERICAIJINDUSTRIALEQUIPMENTSCHED ULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? Cl Yes Cl No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: e �,ej / _ HP Tons BTU/ I
Address:sja Fire/smoke dampers/duct smoke detectors
City: We. Lt r IIMEre ZIP: Iri1ffill Heat pump (site plan required)
Installlreplacefurnacelburner BTU /H
Phone:;,..... . Fax: E - mail:
Including ductwork/vent liner 0 Yes 0 No
CCB no.: '�r �(,i' ) Install/replace/relocate heaters– suspended,
City/metro lic. no.: N/A wall, or floor mounted
`� e7"-.1 /
Name (please print): 1 I 11114f0 t--ta-L-- Vent for appliance other than furnace Refrigeration:
CONTACT PERSON Absorption units BTU/H
/
Name: Alp ` NL Chillers HP
Address: Com.ressors HP —
V_ .► �!< E nv i ronmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
OWN F R Hoods, Type 11 II/res. kitchen/hazmat
hood fire suppression system
Name: } g n ,' D ,� Exhaust fan with single duct (bath fans)
16 li. Mailing address: M 1 1] Exhaust system apart from heating or AC
Fuel piping and d (up to 4 outlets)
City: 4i , State rill ZIPR .5 T ype: LPG NG Oil
Phone: , – 2 – _ Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert-type
Phone: Fax: E -mail: _ Woodstove/pelletstove
Other:
Applicant's signatu ".4 ',,� , .� Date: 1 I O her. —
Name (print): . ' f _
T
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained
Plan review (at _ % ) $
Credit card number: Ex
Expires w i t hin 180 da after it has been (
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 440-1617 (6y00/COM)
, Plumbing Permit Application
Dace received: Permit no.: 2.
S -rg , 005 -
' "sit, • t` City of Tigar SW W H � E I Sewer permit no.: Building permit no.:
�� l '' Address: 13125 Hal n 3
Ciry of Ti phone: (503) 639-4171 Projcct/appl. no.: Expire date:
Fax: (503) 598 -1960 OCT 2 1 700,3 Date issued: • By: I Receiptno.:
Land use approval: Case file no Payment type: I
• - ARD
Tai ► E OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commerciallindustrial ❑ Multi - family ❑ Tenant improvement
i New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other.
JOB SITEINFORMATION FEE SCHEDULE (for special information use checklist)
lob address: 1 C j W 190 i Description Qty Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot _40' Block: Subdivision: n`�t jn SFR (2) bath
Project name: SFR (3) bath
City /county: 1 ZIP: Each additional bat /kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Drywells/leach line/trench drain
Fat date of completion/inspection: Footing drain (no. lin. ft.)
I'LL' lRING CON "t RACTOR Manufactured home utilities
Business name: P `7 L • Manholes
Address: AFIZIMININIIIIIIIIIIIIIIMIIII i Rain drain Fax: E-mail: connector
h _�r� /, ZIP: Sanitary sewer (no. lin. ft.)
• one: r� - vim '� Storm sewer (no. lin. ft.)
hone: yG� Water service (no. lin. ft.)
CCB no.: [ I — 7 L.- I Plumb. bus. reg. no: — -
Fixture or item:
City/metro lac. no.: N/A �` , Absorption valve
Contractor's representative signature ll—' Back flow pre venter
Print name: ■ • Backwater valve
CONTACT PERSON Basins/lavatory
Clothes washer
0....1 ! Name: p\•• , .. ' Dishwasher
Address: • ima ,i / / 1c , ,V — Drinking fountain(s)
City: I State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
. OWNER Fixture/sewer cap
Floor drains/tloor sinks/hub
Name (print): �� '�^ Garbage disposal
Mailing address: - -e) L-1 Pg , aarral Hose bibb
City: L _ ) . State1160$:p713."� Ice maker
Phone: — !Fax: 4.7-71 E -mail: Interceptor /grease trap ,
Owner installation/residential maintenance only: The actual installation Pnmeris)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump _
ENGINEER Tubs/shower /shower pan
Urinal
Name: -
Water closet _
Address: Water heater ,
City. State: 1 ZIP: Other. 1
Phone: I Fax: 1E-mail: Total
Minimum fee $
' Na all jurisdictions accept credit cards, please call lunsdicuon for more Informauon's Notice: This permit application
Plan review (at _ %) S
0 Visa 0 MasterCard expires if a permit is not obtained State surcharge (8%) •••• S
C.edit card number. w ithin ISO days after it has been $
Expsres TOTAL ----
accepted as complete.
Name of cardholder as shown oa credit card
S
Cardholder signature Amount , 4.iO -46i6 (& JCOM)
44 Electrical Permit Application
Date received: Permit no.: ! / 9070 2 d d U
;v1. y" City of Tigard 1 PP P
Pro ect/a 1 no.: Expire date:
CiryofTiga d Addres 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 ECEI
Fax: (503) 598 -1960 R Case file no.: Payment type:
Land use approval: oCI 2 1 7(1 3
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory O tilt ;tfini Cl Multi - family O Tenant improvement
0 ( A'dtfi on/alteration/re
v New construction Nd��� i p
lacement O Other. D Partial
JOB SITE INFORMATION •
Job address: it ItA , MI Bldg. no.: Suite no.: Tax map /tax lot/account no.:
—
Lot: a r Block: Subdivision: MLA 11 ' ,
Project name: Description and location of work on premises:
Estimated date
of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE -.
Job no: a Fee Max
C'�� -1 L escription Qty. (ea) Total no. insp
Business name: New ewtesida ial- singkormulti- familyper
Address: 4 " - is • �` &h • E dwelling unit Includes attached garage.
City: L� . State: ° ZIP: Cf "2 3 Service included:
Phone:L447j - I Fax: E -mail:
1000 sq. ft. or less 4
, f � , G Eac additional 500 sq. ft or portion thereof
4
CCB no.: ) Elec. bus. lic. no: lv L energy,res 2
Limited m mercy dential 2
___..„
Each manufactured red home or modular dwelling
nature of supervrsinq electrician (required) Date 1 01A 67) - Service and/or feeder 2
Services or feeders — installation,
Sup. elect name (print): i License no
c9.- 5 alteration or relocation
200 amps or less 2
c`
201 amps to 400 amps 2
Name (print): , �`C) '��J�� 401 amps to 600 amps 2
Mailing address: l NMI '� 1i , )� �. f - 601 amps to 1000 amps 2
City: . Ir, �' ZIP: 9 Over 1000 amps or volts 2
Phone: , �i��I�j -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or tens 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 1 State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: I Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial 0 Health-care Each pump or irrigation circle 2 facility 2
O Service over 320 amps- rating of I &2 0 Hazardous location Each sign or outline lighting
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egressflighting plan ❑ Other Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (a[ %) $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / I within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (&O0.COM)
• f
I
1
►
S TREET
g LA"(PLE41 , Owner /Agent for Do.) 1"lo��ss�f� ri�5 . I, *tE ( PERM IT HOL E PRIN7�
■
■
■
■
Do hereby c ilif' thti the following location ■ �j � meets City of Tigard /Washington County ►
41 A land use and development standards for street tree installation. ■ ■
■ ■
■
ADDRESS: i 3( y 0.9 ' /tvt. ■
■
LOT: 2.0 SUBDIVISION: • 14MTS er..0 _ 4J4L ie ■
■ ■
DATE: S--/fr r o7
►
13 Y: ■
1
■
RECEIVED BY: C'1„,..r_.-_______. DA'Z'E: //- — ►
-
- - -- - - -- - - - --
A fYYYYTTYTYYYYTNITT YTTYYYYYYTT�T®Y TTTIFTTTYVVYTT"IfTVYOTOITYTY
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 � —0-057
INSPECTION DIVISION Business Line: (503) 639 -4171
P BUP
Received49 3 2 Date Requested 3/ )// YAM PM BUP
/
Location < 3 b 2D 7 2 4' Suite MEC
Contact Person Ph ( ) 02 U q - «f3 7 PLM
Contractor / 0 / 4/1 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 1}0‘Af b
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
LUMBING "- t-A2 �- P % - 0 03
Poi
ndelab
U N , 67 �v
Under Slab \ \\
Rough -In
Water Service 00.3 1`o
Sanitary Sewer D A Q�� OLi'
Rain Drains �` J
Catch Basin / Manh. e
Storm Drain
Shower Pan
4
PAS • • RT FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL £/
Service
Rough -In
UG /Slab
Low Voltage
i Fire Alarm
.
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�
�
SI I Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line ��
ADA
Approach /Sidewalk Dat Inspector G Ext
Other:
Final DO NOT REMOVE this inspection reco from the job site.
PASS PART FAIL
CITY OF TIGARD . 24 -Hour
BUILDING Inspection Line: (503) 639-4175 572
INSPECTION DIVISION Business Line: (503) 639 -4171 M S
P BUP
Receive �AO 1 2 Date Requested -/ " / PM BUP
Location I &7 2 v / 2 4 1 Suite MEC
Contact Person �� Ph ( � � 32P PLM
Contractor 4 Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear) — -�
Framing ,f 4 .,`� �L �ad i ii) 3-/e s Al
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Tina
PART FAIL
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
Gas Line
D amper s
•AS - RT FAIL
tLECTRICAL
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: LI Unable to inspect — no access
Fire Supply Line
ADA -- D ate 1 — // — 4 1--- ector E4 1--- Inspector � P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL