Permit y iI
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00312
� DEVELOPMENT SERVICES
R�L�1� DATE ISSUED: 10/8/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15660 SW ALDERBROOK DR PARCEL: 2S111 DC -03700
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 382 JURISDICTION: TIG
REMARKS: Remodel kitchen & bathroom. Other fixture is hose bib
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT:
VALUE: 500.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES: 1
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: WOODSTOVES: GAS OUTLETS:
A
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 500 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: $ 338.06
This permit is subject to the regulations contained in the
PHILIPS, CLIFFORD M NEIL KELLY CO Tigard Municipal Code, State of OR. Specialty Codes
DOROTHY M 804 N ALBERTA ST and all other applicable laws. All work will be done in
15660 SW ALDERBROOK DR PORTLAND, OR 97217 accordance with approved plans. This permit will expire
TIGARD, OR 97224 if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
Phone: Phone: 503 335 - 9245 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg u: LIC 001663 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
Plumb Top Out Final inspection
Electrical Rough In
Framing Insp
Electrical Final
Plumb Final
Issued By : '1/Lt ' Permittee Signature . ! k�,
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Oct 05 04 08:52a p.2
Electrical Permit AppliCSt10[1 FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
naterly_ • -
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - - _..... . __ - _.. , _._ -.
Phone: 503. 639,4171 Fax: 503.598.1960 44 o1* i \ Other Per1tut:
�'; _.
Inspection Line: 503.639.4175 `s Patc��...,
bate heady /13y: Jars: H See Page Z ror
Internet www.ci.tigard.or.us Notified/Method: Supptemen[allnrorma(iUn
e ' r,, - M1 + °,i.,t, ii � .,h t r, �,y.r lt{. 7 , k 1 Ti. ..1,,.,. i. . , ., �ggy1< ,1t Q,�S't ,, 7t `r c . e :E 2r��'.`'.i S �:.: ' i i ;:: fit ir'. y' ,` 7 " �..., y. q....,. ,....... •
, x t , v k .f : t ti i a k .ZT f iii: d,Ii , , - $ �an s ", f l 1 .1 .l 8 ti1 4 �. x, n fi� '' H "' •' x
li==r .:.Z Lw� 0:;:t'k k3 E' : :14 <r-1 e'i .,.dt.gikt:!t' c l� 4VAi- , ..43.V: . w ` 4 .e - a A. fit ?1. a,. ,.,«.of , , ;, •
❑ New construction l Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'1 ❑hazardous location
❑ r Dcrnohtion ❑ Other:
Q Service over 320 amps - rating ❑Suildng over 10,000 sq. ft.,
Ae it t i ;I �s h ^ ( . 1 , ;� �.i' �R "; i Vr i `i"1'^ r a A j { uMY ,a+ i `i: '�11 ky1 r
r - " ""°° � )1 ! l 'i f "' ,1 � P Ute.i *A r rax < A la4,1st , v.44% w i ' 0.0. , 4 . , 24, :, ., of I- and 2-family dwellings 4 or more new residential
. ��, n„ i,.! ";..k"h,,.l�Jt..,r...'..,..)�l h,a . ,,9r.�.x�A�,k_7. Y;E �fl[ ,
pe
it 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory budding ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
■ Multi -family ❑ Master builder ❑ Other ❑Manufactured structures or
s"'L:�roa rr c` 1 b t, c and ti s , / fry( / sr' %3 r m �^�s e i�e'rx� a F5" t a , f ❑Occupant load over 99 persons
td lo,'p%',� t ! a d. p
, w ; 1�t H ', ,t;l , � 1 9 9 J 6 , t ��1 t1 ,] ,# P "y: l ex'1 �( ,,
La , . kr.. S'..` aril' i. ?�A �l � nr` �. 1 1�rlt , �n� ,, ,.�.:.x�7:��'�.3-.h��r� � '�,r. ���...X.�: aa�," �ir' 1:, ��p. J, r�.„ �, tiw!», 3Y +.�f� ❑Ept'css/lightiltgplan RV park
❑Health -care facility ❑Other:
Job rio - : Job site address: ` t t ,_,c .\,,,.) `k, - ,c: - A.. . Submit,,?, sets of plans with any of the above.
City/State/at': '7 Q(;), ck'1 y IP- The above are not applicable to temporary construction Service.
1t ii},'y'iiii.uJjrrF�P ;'iFtihA� ,,ificitiA.,t s�s� @il�irnA � .t
Suitc/bldg.lapt. no.: project name: , ��t 1 �7S Description Qq vet- row "
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
"^" Includes attached garage.
_ 1.000 sq. ft, or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no
�� y ti + -- � i s ,+, �., .srr vn,,.:y, , � r i , Limited energy, non - residential 75.00 2
N %% . , l' . v� l q fl i i$ TIHt d .. L . is ,A �LE1'S 3 1t 'r' " �lZ�,,'k?
m * 1 ,.. N� rm'•..., .. x., qt r :LOA 4...., hitu t, �t 0. tit {.1,, , V .: ).to Ea manu facture d or mo
ellin s and/or feeder 90.90 __ ., . 2 -
41 Services dw or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
t' r i , s" ms`s y�� Y + i s lei � " ' t , k 'i A �' p 4 rips
a' obit., �V „ 8 ''Nvgi :,, .dials' :I ✓rig a, i.. 1 5tt�ir ,11, t rt l �r ¢ "• x ' i 201 amps f0 0 a[ 1 5
401 amps to 600 amps 160.60 2
Name: Q t s \\ kp 601 amps to 1,000 amps 240.60 2
Address: r' • ` Over 1,000 amps or volts 454.65 2
", ". • 6.• ` _ .rf�;:i■ r- Reconnect only 66.85 _
City /StaIdZIP: \ ii c -- QQ 3 i Temporary services or feeders installation, alteration, and/or
rela ration
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner lnstallatfion: This installation is being made on property that 1 own which is riot 201 •
nlps to 4 00 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension. per panel -
;fit i < r tt qg� . a j n 41 �.t.x r µ , i kas . a a;;. }� a t,r�y i a , cr t,l!!:spi A. Fee for branch circuits with -
A"( F.M'' n4 yl.. .. ' v to �. ,`.,, ro t i a �'t7 1� {,� ,2'tie "8
.+��,�'i'[-a�3�,,.k� `^S,,wPw,�,`� "�;,:..,d.,� , 41?'���.�:�t, d�� ,R,hr �i�nr,.�.fC.,ryrle=;��.�l�v+�: service or feeder foe, each
Business name: branch circuit 6.65 2
Contact name, - 13. Fcc for branch circuits
without service or feeder fee, 1 46. {$ 2
Address' each branch circuit yC,,b
Each add branch circuit 5 6.65 - 33 , 2
City /State/ZiP: Miscellaneous (service or feeder nut included)
Pump or irrigation circle 53.40 2
Phone: ( ) 17ax: ' ( )
T Sign or outline lighting 53,40 2
E-mail: Signal circuit(s) or limited -
+'l A« .1 l �r' a a i r y , x h a R i t�,
. ',m ° r x 5 ' t ' c lr, stir,,' �l" fir alteration, or
1,.4i.� a ` i w^ (,tillGs+y+,t rJ"sy�f� 1r'tc`$ *dtt' energy panel, a extension. Describe: Page 2 2
- [ Business name: 1.1 E,,_ r_,
Address: ��� Each additional inspection over allowable in any of the above
- -- .. Per inspection 62.50
Ci ty / State/ZIP c Q �. c3 1 Investigation per hour (i hr min) - 62.50
Phone: ( ) h alt: ( ) Industrial plant per hour �y 73.75
,5 ..- y'" 4 -V: ^ A� -) 1 P�TOK.'. r M ry�r@ �� :11. d."5,01t)r 19 - 7 !" . S .
CCB Lig.: N B. 14 Electrical Lie.: _-r - Suprv. Lic,: \ `215 Subtotal �j t
Suprv. Electrician signature, required: / � ` 1 0.1\° 1 Plan review (25% of permit fee) �
Print name. -- ' D. e: - State surcharge (8% of permit fee) L-% I
\----' D. �o - - TOTAL P>ERIXIT FEE
Authorized signature' n aure:
b" ' iklivilik0---
Tate permit a expire% if • permit is not obtained within 1 AO
days after It has been accepted a% complete
Print mole: 0 m `l 4, • Fee methodology set by'fri- County Building Industry Serv,ce E surd
` 1 '" Number of inspections per permit allowed.
is U[ u l'cndLAPp.doc 12101 44D..46t sr( 12JO2 /COM/WIItt
10/05/2004 10:31 5036916771 MODERN PLUMBING PAGE 02
95/15/2003 13:56 FAX 5035981960 CITY OF TIGARD x004
Building Fixtures FOR, (11'r1C1 L 51.ONLY
Plu��%n Peet PPlumbing W •
City of igard 7 c\ t', t>. A natnn , Sewn'
'ermitNo.:
13135 SW Hall Blvd, 0 C Ptah Review Other ' e
! at No.:
Tigard, Oregon 97223 e C) it ° bste Paae• B o 1 Perm use Land
Phone: 503.439-4171 d.o , l59$ � , ..� .::., , 1 ,.' - � pia , Case No.:
Internet _�� 1.1 -, � Contact runs.: Sec page 2 for
24 -bomr InspectitlhRequest 503- 6394173 i` am:Mhiethod: S , leetental information.
"' ".2‘M �;: :dfI 1ir METE' , 1 ELE7 i 4 ! mai . 'on Qty. Pe co.) Total
A h0 ii�l r l �e Cr1ffit Oche • ' I ' I�' '' „ I I I' , .p , ' b p Tw
'-� Addition/alteration/ teration I• r ' l ' 6 r, I : , i •.i, �,:.7
w' 4b •
? "" �" ' a::: p.;: _? �'t. x:i t !:1 a QNg i . a " " `RiP;i
SFR 1 bath r ' 249.20
," 1 LO111 'oial/Inclusuial 356.06
■ Acceaso Building IN Multi -arnil SPR bath r 399.00
Each additional baths/lsitohefl 45.00
Ili M[satcr Builder MI lei ON:, !!!! li ;I F ci ' g _� J�
"'';'-1,1) t r' O d'I1:,,,h' f - "I1 a ..L.: 1111 ��7'�'nqp'y - � 7 � '
L�'...1 r''w : i ' °:' ^ . it (,:"76:1:5M17 :� ' � °'` is I� t'IQl 1 .e� I .. Ci j7 � � .,.�t.����'��•'� '.0fuf�F;i'�II� J��I '
Job site address: 15 �c ('t7 S Gk\ �{ E- .'1'11.0 _ ►1t Catch basin/area d 14'60
Stsibt; Sld /P► . : r 4 eli/leach '" 1 -.•' dram 16.60
'east Name: $ Footin_. drain no. linear it Mill Pa 2
t;;rooe sta'ma+JDirectione to job rite: Manufactured borne utilities MIMI 110.00
Manholes MI 16.60
Rain drain connector 16.60
. Sani : sewer no. linear ft. =
Storm sewer no. linen ft
S ax ion Blau: et Water tervlce no. linear i
T �
Tax Ina #,: :.I. . � "�Vf]:I�,':�, d ,;tiff �,Yt. Z:
. N. . +'' }IN�Fid
.,p�t.�4 • ; ,,i1, "in
Vi 1 Vi e 1 ,' dJ i^0,'rl„ ' II 1' • '' ' ' Abs.' . 'on valve 16.60
-. 06,e\ Bacldlaw •revaner NM F::.e2 11111=11 .
_ 16.60
Clothes washer 16.60 MOM
Dishwasher 16.60
.I ,. -• • I fountain = 16.60 .
s ;74 u. ;s. , ,�i- yi n. =,'''v„ , PRiF" 7771- r'I ; r.. i �r IN Vectors/. 16.00
'��''.'I.Yl�7 �:. ,SUVw n 1111-
Name: EX . anion tank 16.60 - i
,,. 16.60 � i
City/S Floor drain/finor sink/hub -- 16.60
City /stat0/ 12 - Garb; _ - •■ . 'owl 11.11 16.60
� l fl one bib NMI Iv
Phone: ax: r 16.60
Name: o _ I 2
Address: Prime 16.60 -
City /S1ate/Z • : Roof drain cottamercial I6.60
Phone: Fax: sinklbasia/1: NM 16.64 =NM
'fuWsbower /shower ,. an MN 16.60 MIN
E-mail: ;' .,' t ' iiYar :Ini • Urinal 16. WAI A 6�iy' 7�1� ' ` i 1 ' . �, Warmcl
closet ■ 0 U111
Business Name: 0 . 1 u r ` • Water hearer 0111111
Address: 1 12.0 c :), i to , 05'r ' cx 1 ,33RI Other:
Ci StstWZi .: lAa.l a' r, iL- c1-2,00.Z._. T-7 Other: .; . : rxt`rr y .7 {� 1 ililMI srety,, 4,111.:. :
Phane:5L�3 r� • ( l (,o ,
,t"ax :565 C I ' / ....��.:i:i_<�r� r ^ S'ubte1 131FERIMMIll
CCB Lie. #: ; 'JO to ' ', l Mioin urmPcnntt Fen $7250
AuthvriZed ltraidential aseldlow Minironm'Fee $36.23
Signature• r � / Da te: l `�/54 P R % of 1' t Fee
C � 0- (o
(Please punt flame) 2 orphans with Isometric -
NatiaC Tido permit appseation n:s it a it is pot obtained within All new for hell require or
1110 days otter ik has been accepted *Fee tmetbodoio$y ea by Trc>COUntY Building Industry Service $Oar
i :I\permit FamzkrbnPerrrdt A.pp.doc 01/03
a•
Building Permit Application FOR OFFICE USE ONLY
City of Tigard Received b "-- Permit No .
13125 SW Hall Blvd., Tigard, Plan R a rd, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /440 �M� i I�� Other Permit:
� � - Date /By:
Inspection Line: 503.639.4175 5 1a 1 Date Ready /By: Juris: lii See Attached Checklist for
Internet: www.ci.tigard.or.us Notified /Method: Supplemental Information
ikY :R`» "a7'. �'4'Y i= "S,xRF� 2:� "'' «Y;, a,,,p•_ yP: eSTl53pT' °. h•�
'•� ".y:"� .,;,,LP.`: >i `:;.�,p•, y tz�';x, ; ^'„�.�'x: �°N,b -r `= :-rs' ;�.,4 °`„i�� > ";t... 'C".��i dam'. ?.« °a'>
-` -s; `.: �;.TXPE':Ul? '4?VORK_ » =' RE ' E I -
.,�'.` .,s �. ��` �� [IIIi D- ,DATA. «ANT!''' =]~ . ILX:=p: �I1V
° Jv= Y3'C:�F«�>, ... 1_.`�'A .Saa:i�, �.,v�>"a�.`4a�`>'::;�s$��. -. -.: �`.� °ek, s.2"2;. „arm > >.. s v`�e iw >: *3`x,0, <.3.- y� }�_� "s`<_�v<:a i {/If
- ... .. .. a"- -" �` o-` �_` �M1l$"tiw'Y,,.<..';,£'d- ;A'.fl,,�` «'Pa:�v'-�°+m�•i��`".neY '.�6•
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
_ ..,,;,'.- - y`' __z, ,: <.' x= a i.
% .' 14 <
x t ' CAT,+ ,. ; CO,,, UC
-° w.h: � "�'�n�..�..��,- �:Y €'- w�`�.ri• ..,. :,cv ° "c:e:'rch «xs >:.. .�" .�'xa3 . a`a'.� .,Itea >: �.:°<*.:;� "- `:- Y�;?t > - - ...a:�' «3�i
1` 1- and 2- family dwelling ❑ Commercial /industrial "> work indicated on this application.
... Valuation: $ 5�0
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
S � S ` °s'�ea � ^s :4' v.•g," .., .. ^' .:.� » .�:.V�`-` � :.:,:,;` >i :�a: ¢ rr •: � = r '""�s.x
SF �'i 1._ Z, 7A13'., FU .M `,A Q ATION , >rq` ° :;; ;:z 1 r Total number of floors:
_r&�: ..-- �".a, -t m> ...,: _�� , k�. .,.<. « ^a' �. ���- � <>. >;�?��.�.: *:..;;� -.; , ;.- ".�aa«u , _ s.":::
Job site address: I SGG 0 SW 1 bre8Ro0K OR. New dwelling area: square feet
City/State /ZIP: Tr.4,411p s OR. 0 1'7 .""). Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: PNZLS Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIR,ED',DAT'Ai CO RCL S i
«��x�.:s�_�,` ����xa��:����'" ��� -
Subdivision: Lot no.:
W (q°I? Pe rmit fees* are based on the value of the work performed.
Tax map/parcel no.: �5 I (O �, 0370 Indicate the value (rounded to the nearest dollar) of all
;.. A s` @„ I ,, _ 4 ` $ yam __-> ^ \,,, ` , , , ” , t wil it equipment, materials, labor, overhead, and the profit for the
[ ,. 7 , _, , � _? :, a g o D I SE RI - IQ N 'O , _ t timer, work indicated on this application.
<ax-- .,a> ..'.a� >?cz. � -ga ��ta��tt'���s� ��. _:.- rr.��_ .. "�rx� .4�.ma�au aA Sav�u�� -fir-
• ., <R pN _Or or)e wz•+>aw --64-=- Ain1L0011'1 Valuation: $
Existing building area: square feet
New building area: square feet
sx u I R' , '" , l ' < 1 `: Number of stories:
�; . � PIZ TAY (? , �' � . � °: >::: � � .. �,�� YT x
�.:�-s'�....�:'a.:.�« : >;:.a�:.?�.saa�. >::w,s s ?3ry � "^���' \ .. •'� >�� �. >�,��;;a���".i � �azc�' > . ..,
Name: C } Don r, f p `, Type of construction:
IIS
Address: C0 SIN A2.i ;Leg(� Oa Occupancy groups:
City/State /ZIP: TT 6,Ax o r big 4 \72 '14 Existing:
Phone: ( ) Fax: ( )
New:
?•. �M r . : �;. .- ��,,..... „;.^�,`�oa } °> 'S' ;� k Ei "^ <
. x� a� ^; �"'::w`"'���5,�, .w
��'a �; �:' �� $Y�I . ' � '_�.�. �:. � ®�GCTtS. .PERS ® r �. ��:': s �� F` .� ,� .
...v, ,�e;�,��';;a.:- �z��r. x �;r.. ..�.. ���;,� - -. • ca °3sa: >:a��'.��,sY< :>.A'�;� . a`�� � a�` k`Q” o g� >�
Business name: p ,
,v �L 14E ���1 ^ � � All contractors and subcontractors are required to be
Contact name: Q Enere i�oapF licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: ( ZO4 N. lueezrp ' jurisdiction in which work is being performed. If the
City/State /ZIP: 1 earLis a4b 012 6 \1'1 )'") applicant is exempt from licensing, the following reasons
apply:
Phone: f o3 ) 335 01'145 Fax: : (5 ) IN 7 - - 157 4
E -mail:
W k �: ;. . GO =['RA `,l'OR .`>:. ti f i �: x:::a: °: �;:.
Business name: � /� ... / , - ,. ,5, . ,. >.::.: :»M. ;
me: N l.zc Lt �l G.�7�' ,lal+ ,�� �'' =. �E :�i .. : t;. 41 ; �,�
A _ �' y , 7a .zn ,, UII: WAW PE I a✓s 4 M , ,
Address: Q4 N. A L�aI Tis Si: Please i
City/State /ZIP: POrtTuwO 1 / 1 17 Please refer to fee schedule.
Phone: 601) 13 5- 9 Z V S Fax: (spa) Z11 '7.3S-7y Fees due upon application
CCB lic.: t CC 3 Amount received
Date received:
Authorized signature: ��� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �jCar;err cQi` Z &/ Date: /0/5/0 8 / * Fee methodology set by Tri-County Building Industry
( Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(II /02 /COM/WEB)
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (5003) 639 -4175 MST 00 - 603 �—
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received ) Date Requested I f / AM v . PM BUP
Location l 5706.0 Suite MEC
Contact Person Ph ( ) "/D — 9a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
C , 2 ELR
Crawl Drain U Y�
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:
:• S PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough-In
-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
C SS PART FAIL
LTR9AL
Service
Rough -In
UG /Slab
Low Voltage /11/4) 1 LA
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
A_ PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA / t,
Approach /Sidewalk Date L - // Inspector d Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL