Permit 6/ � 4' � .
CITY O TIGAR D ozro MASTER PERMIT
PERMIT #: MST2004 -00114
� 1� , DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004
: - � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12240 SW ANN CT PARCEL: 2S103BB -13100
SUBDIVISION: LAKE TERRACE NO. 2 ZONING: R - 4.5
BLOCK: LOT: 024 JURISDICTION: TIG
REMARKS: SF addition & remodel Other mechanical units include (2)gas fireplaces and duct work.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 24 FIRST: 390 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: V
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 237 sf GARAGE: sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 200,000.00
OCCUPANCY GRP: R3 BDRM: 0 BATH: 2 TOTAL: 627 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 3
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2
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:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVQFDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 9.00 SIGNAL/PANEL: IN PLANT:
MANU HWSVC /FDR: 601 - 1000 amp: 601 +amps -1000v MINOR LABEL:
1000+ amp /volt :
PLAN REVIE W S ECTION
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: $ 2,525.99
This permit is subject to the regulations contained in the
KURTIS SIXEL SLS CUSTOM HOMES INC Tigard Municipal Code, State of OR. Specialty Codes
3472 NW 115TH PO BOX 1093 and all other applicable laws. All work will be done in
PORTLAND, OR 97229 TUALATIN, OR 97062 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.
Phone: 503 - 528 - 1100 Phone: 691 - 9878 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: L1C 91577 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 Underfloor insulation Electrical Rough In Gas Fireplace Plumb Final
Footing Insp Footing /Foundation Dn Framing Insp Insulation lnsp Building Final
Footing Insp PLM /Underfloor Shear Wall Insp Rain drain lnsp
Foundation Insp Mechanical Insp Exterior Sheathing Ins l Electrical Final
Foundation Insp Plumb Top Out Gas Line lnsp Mechanical Final '
Is ed By : ■ . / / _ i4L: Permittee Signature : ;
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b in:- s day
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00114
t� DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004
: ,y;
�— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12240 SW ANN CT PARCEL: 2S103BB -13100
SUBDIVISION: LAKE TERRACE NO. 2 ZONING: R -4.5
BLOCK: LOT: 024 JURISDICTION: TIG
REMARKS: SF addition & remodel Other mechanical units include (2)gas fireplaces and duct work.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 24 FIRST: 390 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 237 sf GARAGE: sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD sf RIGHT: 5
VALUE: 200
OCCUPANCY GRP: R3 BDRM: 0 BATH: 2 TOTAL: 627 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 3
MAX INP: btu FLOOR FURNANCES: VENTS: - WOODSTOVES: GAS OUTLETS: 2
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 FOR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/OSVCiFOR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 any 401 - 600 amp: EA ADDL ER CIR: 9.00 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: $ 2,525.99
This permit is subject to the regulations contained in the
KURTIS SIX EL • FIX IT NOW
KURTIS IS EL FIX IT Tigard Munidpal Code, State of OR. Specialty Codes
3472 115TH
97229 16210 NWJOSCELYN JO SC C 97006 ST and all other applicable laws. All work will be done in
PORTLAND, OR
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.
Phone: 503 - 528 - 1100 Phone: 503 - 819 - 6355 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 155801 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 PLM /Underfloor Shear Wall Insp Rain drain Insp
• Footing Insp Mechanical Insp Exterior Sheathing Inst Electrical Final
Foundation Insp Plumb Top Out Gas Line Insp Mechanical Final
Underfloor insulation Electrical Rough In Gas Fireplace Plumb Final - •
Footin / . Dr; Framing Insp Insulation Insp Building Final
Iss ed B I � � %' � /i
By _ .__... ,i/�..... Permittee Signature : r
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne t business day
Jun -09 -04 02 :5P Rayborn's Plumbi I 15036 912328 P.01
r�.� cr��u ,c 1 : »ri i r KUf 7 JLJ GUJ ! UP 1 HU1 Inc.
5 036927983
P 2
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE RECEIVED
RAYBORN'S PLUMBING INC JUN 1 u 2004
PO BOX 69
TUALATIN, OR 97062 CITY OF TIGARD
BUILDING DIVISION
Plumbing Signature Form
Permit #: MST2004 -00114
Date Issued: 5/1112004
Parcel: 2S 103113B-13100
Site Address: 12240 SW ANN CT
Subdivision: LAKE TERRACE NO. 2
Block: Lot: 024
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF addition & remodel Other mechanical units include (2)gas fireplaces and duct
work.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
KURTIS SIXEL RAYBORN'S PLUMBING INC
3472 NW 115TH PO BOX 69
PORTLAND, OR 97229 TUALATIN, OR 97062
Phone #: 503-528-1100 Phone #: 503 -692 -4139
Reg #: LIC 87852
PLM 34 -166PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Si. 'ture of Authorized Plumber
If you have any questions, please call 503.718.2433.
i 1 , t / 5 0 5 — . 5 g
Jun 09 04 04:35p GAW Electric Inc. 5032176236 p.1
6- 99~2000. 12:57PM FROM SLS CUSTOM HOMES 5036927983 P.3
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE RECEIVED
GAW ELECTRIC INC JUN 1 U 2004
P.O. BOX 3414 CITY OF TIGARD
TUALATIN, OR 97062 BUILDING DIVISION
Electrical Signature Form
Permit #: MST2004-00114
Date Issued: 5111/2004
Parcel: 2S103B6 -13100
Site Address: 12240 SW ANN CT
Subdivision: LAKE TERRACE NO.2
Block: Lot: 024
Jurisdiction: TIG
Zoning: R4.5
Remarks: SF addition & remodel Other mechanical units include (2)gas fireplaces and duct
work.
Your company has boon Indicated as the electrical contractor for the permit indicated above. I n 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: Buiding Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
KURTIS SIXEL GAW ELECTRIC INC
3472 NW 115TH P.Q. BOX 3414
PORTLAND, OR 97229 TUALATIN, OR 97062 w
Phone #: 503 - 1100 Phone tt Gcf ?. 3 e/ a
Rog #: LIC 150495
ELi✓ 34 -5860
SUP 3939$
, 1 , !:_--
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x # do t — -
Signature of Supervising rician
If you have any questions, please call 503/18.2433.
4x 503- 598 -/9
•
.FROM YORK Communi Development PHONE NO. : Feb. 11 2004 01:14PM P1
t z ll 77771
File Number 140
Cl ean W ate Services FEB 1 1 2004 l
Our commitment is clear. ensitive Area Pre - reening Site Assessment
By_ ---
Jurisdiction Tt • Date a c_ - 5 Zoo
Map & Tax Lot 039D 1310o Owner • ...'
Site Address = ?r -
SIR! orA ►. OIL G `all iM • •
■ � sE�� • • 'r Contact -
Proposed Activity Amt ri R � Address > >~ 4:381Z e
Phone C 0 3 67 9 gct3Q
Official use only below this line
Y N NA Y N NA
I Sensitive Area Composite Map I im Stormwater Infrastructure maps
Map # ZJ l tcI �A QS # 14317
ro Locally adopted studies or maps Other
Specify _
Specify --- - - - - --
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. O c/ -
14 Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST 'PERFORM A SITE.CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas
exist on the site or within 200 feet on adjacent properties, a Natural Resources
Assessment Report may also be required.
1 I Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered on your
property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS
REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A
STORMWATER CONNECTION PERMIT.
El The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
•
Reviewed By: �� Date: 6`0
� G
Returned to Applicant
Mail AI Fax Counter
Date - /l6 y Bye ✓"
155 N First Avenue. Suite 270 • Hillsboro, Oregon 97124
Phone: (503) 848 -8621 • Fax (503) 846-3525 • NWW.ct nn, s rfStaigev ti
Permit #:04 - 000755 - 00 - PE
CleanWater Services
Onr commitment is Hear. 2550 SW Hillsboro Highway nspection Request Line: 503- 681 -4444
y 4 hour notice required for all inspections
Hillsboro, OR 97123
Ph: (503) 681 -3600
Project Name: EC ONLY
Project Address: 12240 SW ANN CT Issued By: Miriam Wilson
Type: Erosion Control Issued: Mar 22, 2004
Single Family Expires: Sep 18, 2004
Project Description:
Owner Applicant Contractor
SIXEL, KURTIS M & KRISTINE R DAVID YORK NONE
3472 NW 115TH AVE 215 NE 56
PORTLAND 97229 PORTLAND, OR 97213
Fee Description Amount
Erosion Control Inspection Fee 64.00
Erosion Control Plan Check Fee 41.60
Sub Total 105.60
TOTAL 105.60
I HEREBY CERTIFY T. • T. .1.0v ORMATION IS CORRECT.
SIGNATURE: ,IL Date: M2".0 Z1°- t of
DAVI Pt. ORK
6/3/2004
Case Activity Listing 10:15:25AM
_ E M A Case #: MST2004 -00114
•
CDMPUTER SYSTEMS, ,NC.
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4" r r�.w
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Assi
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r, ,
Hold for 6/3/2004 None DONE JMT 0 o n .er call from Chris /General
I
JMT contractor, they and all the subs are
off the job. Owner has put the project
on hold and is looking for other
contractors
•
•
Page 4 of 4 CaseActivity..rpt
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:, (503) 639 -4175 ' MST a0V–/I/9'
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received t/ Date Requested / / — / AM PM BUP
Location /2 7-09 5‘e-e 4-1-4 44 ei-e,(4.76 QQ ���� Suite MEC
Contact Person / y t .,ter Ph (_L) 57a3 '/ 5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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
G
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
ower'P
they:
F 010 PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRIC AL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal 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
Approach /Sidewalk Date /1112.) _o'4 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 a ( I - 66 fir✓ (-(
INSPECTION DIVISION Business Line: (503) 639 -4171
o BUP
Received Date Re ested ` � AM PM BUP
Location / ;-?` Jl Cam Suite MEC
Contact Person Ph ( )/ 9 — ga PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation _ ELC
Access: pja Drain ELR
Crawl Drain
Slab Inspection Notes.: ' ; �,; SIT
Post & Beam :;� ? a *.;, 4 _ ��_
Shear Anchors ® - � /
f/! = '
Ext Sheath/Shear •� � d- "���-
r
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling i
Roof i
Other: �;i
Final
PASS PART FAIL _ 'LM
PLUMBING
Post & Beam
Under Slab
Rough -In ;:�f.
Water Service Air
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
•wer P.
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
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 I '
Approach/Sidewalk Date P at Inspector Ext
Other:
Final DO NOT REMO ' - this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour •
/`
BUILDING Inspection Line: (503) 639 -4175 MST �oe 7 -6v
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received / t Date Re uested � AM PM BUP
Location / �i 146 ? Suite MEC
Contact Person Ph ( ) �iJ� 413 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under .aED Slab
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin -
PART FAIL
HANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal 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: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk D a t e v 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 a0 & /(
INSPECTION DIVISION Business Line: (503) 639 -4171
CO BUP
Received Date Requested C AM PM BUP
. 0 Location • / � 0 (2/Yl� Suite �y MEC
Contact Person Ph ( ) �� - l 3 1 PLM
Contractor 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
Insulation
Drywall Nailing (77
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final �
PASS PART FAIL f
PLUMBING .
Pos eam
nder Slab
Roug -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot
n
PASS PART IL
EC ANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS 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 reins ection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date c 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 C — Ov /!cf
INSPECTI0 1 DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re nested_ /�- — �— AM BUP
Location / 2 Z 6 Suite MEC
Contact Person Ph ( ) / 9— ?0135
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Acc ss�� G? �„ „ „ �, -0, N U '4- n -9 t ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam (4) Shear Anchors i =�X /t_ [�,
Ext Sheath/Shear ` d?A/(-1
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �� Ali ✓G - , 41/
Other:
//i _ /
Final
PASS PART FAIL
PLUMBING 7,0e,
Post &Beam - ' ( - ' ✓� ' i / "
Under Slab _
Rough -In ` ,41. . i46/ ��/ t,.!
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
P S t . P5 FAIL
ECH CAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS 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: n Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / J Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL