Permit •
6
I• CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00044
44, DEVELOPMENT SERVICES DATE ISSUED: 4/9/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15865 SW AVON PL PARCEL: 2S112CC -19100
SUBDIVISION: DURHAM OAKS ZONING: R -12
BLOCK: LOT: 027 JURISDICTION: TIG
REMARKS: SF detached residence.
BUILDING
REISSUE: BVH1305 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 502 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 803 sf GARAGE: 220 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 10
VALUE: 126,525.60
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,305 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 2 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: 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 FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 2 201 - 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: $ 7,025.77
BUENA VISTA HOMES BUENA VISTA HOMES This permit is subject to the regulations contained in the
Tigard other r applicable e Code, State work k w Specialty Codes and
6932 SW MACADAM #C 6932 SW MACADAM HOMES
all other applicable laws. All work will be done in
PORTLAND, OR 97219 PORTLAND, OR 97219 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: 503 443 - 6033 Phone: 503 443 - 6033 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 152235 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 Ins[ Rain drain lnsp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp 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 lnsp Appr /Sdwlk Insp
�j
Issued By : / ' . Permittee Signature A /.° 11, / i� g(e(1,0„...,
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next usiness day
/3
Building Permit Application FOR C�FF CF t ... ONL
y ,
E.
= 7-* Received Building ,��// S;
Date/B -3 -o Z b Permit No.:/ l ' rr s°
_ O re,
City of Tigard Er ' D Planning Approval Other
13125 SW Hall Blvd. Date/By: Permit No.:.�a)R- ,)ee,/ -000V
Plan Review Other N
Tigard, Oregon 97223 JA I t Date/By: Permit No.:
Phone: 503- 639 -4171 Fax 503 - 598 -1960 ' "' ''" ` t'i ` 4: 1 ' . 1' '� Post - : Lan
1eW d Use
w
Inte ww.ci.tigard.or.us 4. ...-'I Contact lane.:
24 -hour Inspection Request: 503 -639 TY Su See Page 2 for
P q � O Nam e/Method: �y� Su. demental Information
LDING DIVISION
..TYPE • OF WORK , -. � �
R
.g:1 New construction 111 Demolition D Demolition 1 & 2 FAMILY . NG,. -. ,
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees° are based on the total value of the work performed. Indicate n 1
E 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 ❑ Other: Valuation S
. JOB SITE INFORMATION and LOCATION No. of bedrooms:] No. of baths:' • Cj r
• Job site address: 1 `�G S P> ��� Total number of floors
5
New dwelling area (sq. ft.) 1��
Suite #: Bldg. /A t. #: Garage /carport area (sq. ft.) - 2,a4 .5F rrl
Project Name: & U& K5 Covered porch area (sq. ft.) 2 SF-
Cross street/Directions to job site: Deck area (sq. ft.)
��� OA �1�'C1 V� Dim G1 rV1d Other structure area (sq. ft. /n
1
REQUIRED DATAc : .: xs
Subdivision: Ow( Oo KS I Lot #: 2_.- COi4i1y1ERCIAL =USE CHECKLIST, >: _
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,
• e , 1 n � ^ i-I 011 �I ) ^ if overhead and profit for the work indicated on this application.
� IA 10i1 1. (- . : ° ` a j / , t Valuation S
- - — • Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories _
(} PROPERTY OWNER j 0 TENANT • Type of construction
Name: 'e-.1AfX)(1 \J l\G,- -(,, VDm 5 Occupancy group(s): Existing:
Address: 1 QG(727J So M, Ca aA.ri() . New:
Cit /St.te /Zi.: IPb 0. IA i / lei
Phone: ( Z, NOTICE: All contractors and subcontractors are required to be
Cj_ ✓ L� t/ lQ � f Fa x (` � 1I Z � licensed with the Oregon Construction Contractors Board under
[� APPLICA 2 CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: EA/CAA EA/CAA jurisdiction where work is being performed. If the applicant is exempt
Contact Name: \ 1\ V\ \I PAS from licensing, the following reason applies:
Address: c.O3 Y \ P . ( at rive,
Cit /State /Zip:
Phone: M I Fax:
E -mail: 1(1(i j`Y1 YYl IV V` I 1,, BW DINGPERMIT FEES* . ,
' I p � C -P I s refer ta�fee.scheduIe: • CONTRACTOR - . .. �.. .. _ . .... _. . .
Business Name: r PRIG& V 15A #,S
Fees due upon application S
Address: GJ ..k al G L ..I g --L.
Cit /State /Zi.: CA M a . / �L! Eri Amount received S _
Phone: .. r. 1 . P JIM I,i �.3 Date received:
CCB Lic. #: I R?_ _
Authorized
Signature: �/f Date: / Notice: This permit application expires if a permit is not obtained within
/ , V.. , 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \BldgPcrmitApp doe 01/03
•
01/20/2004 16:22 5032537693 SUN GLOW INC PAGE 02 FOR OFF1C1.: t'SE ONLY
r 'Mechanical Permit Application Received Mechanical
Datdl3y. Permit No.: li i? T o --000 y'L 6
City of Tigard RECE1 ED Planning Approval Building
patdl9y: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 07223 AN N 3 rd 1(1 Date/By; permit No
Phone: 503- 639 -4171. Fax 503- 598 -1 . L Ptut- Review Land Use
...,. Dax/B : Csae Nn.:
Internet: www.ei.tigard.or.us �. =J i contact furls.: See Page 2 for
24 -b,our Inspection Request: 503-639-41 am e" Name/Method: Sup plemental Information.
BUILDING DIVISION
OF WORK :. .CO H ∎N' FILE*,, SCHEDULE 2 :138E. .S"1<": '., R {s
1/0 New construction • Demolition Machanica) permit fees' are based on the total value of the work
Addition /alteration/re' lacement • Other: perihrmed- Indicate the value (rounded to the nearest dollar) of all
_CAT ECO1 [ a - :CONSTRUCTION, 4 '; ; -
mechanical materials, equipment, Tabor, overhead and profit.
V S See Page 2 far Fee Schedule
III 1 & Z -Famll dwellizt_ 1110 CommttciaUIndust:rial �; 15Y3�NfFEE��,E
lil ulti -Famil • 413 . , t • EA A ccesso I3llildin ,� lei Descri .: on a Total
IN Master Builder • Other, HcatnP/coorwg
3OBSTTE INFORMATION.aiid•LOCATION Furnace - add-on air conditioning"• 14 -00
Job site address: 1 - , r D Gas beat pump 14,00
Suite #: B1JA.et. #: Ductwork 14.00
Pro'eCt Name: : . / i �/,Iii / .. 14.00 �s Residential boiler
Cross street/Directions to job site: (tbr radiator or h • • the a . =rtt 14.00
D vxli- ,(// l . �1 Vd tinw (fuel, , non electric)
l\ { / 1 (� in Unit bemoan
in duct, , no est rte 14.60
Flue/vent for an of above 10.00
II Lot #: 'r units 12.15
Subdivision! L�
Other f'ueI Ap • fis.oces
Tax trap /parcel #: water healer - 10.00
ESCRI>E''FTON OF WO • ' ' Gas fireplace 10,00
4 / 2 1E4_ .14 Ann= Flue vent (water hottel 11 • lace) 10,00
��r Lo: 11.: .et (gas) 10.00
7 /w✓i�i�'�1 /IIRa �� Wood/Pellet stove 10.00
• INIFKM1111/NNiJA Wood fire-lace/insert 10.00
Chi rnnny/linerifluelvent 10.00
I TEN . , •:, . Other: 10.00
a �ETt,ORRR'L'Sf'O�'V1'C'li`.R: "' � :.: • �. , , � Etsvironmental Exhaust & Yeatilgtioa
Name: . '.� / ��li►`�ir'•/'+.��i [�� R n ge. hood /other kitchen equipment 10.00
Address: von - m 1 A. I am " Clothes dryer exhaust 10.00
rl a aretWO SM Single duct exhaust
Phone;�i'�,�si MATMG IPISI ; (bathrooms, toilet earrtparrntettts,
ill ,AIP'PL1C • 'ST _ I i ,COPiTACTPERSON utiti rooms 6.80
Name: u /./ a� ��.) �.` D . Attic/crawl • . e fans 10.00
Cs /7�l Orhet - . 10.00
Address: , <`A .' £ D A Fuel Fining
Ci IS . te/Zi e : ••(' ..40 for firs! • $ .00 each additio. al
'
Ption �'i�'' [ . Fax furnace etc,
:
E -mail: m( , . -gin r 1.S i .l' I wall heater
•" COI+FFRi1;G`FOR . . , Water heater
Busirkess Name: < • ,LY) (iJ ._Z u.-‘ Fire -lace � ".
Address: L . � �
V ' - :. r ►. NENE
Ci /State/Zi • : i . 0 A. c Z b Clothes • :as NM .4
Phone 5)3 - z53-- Fax: IPA. -153=1 Other:
Total: � UM W'S=
CCB Lie, 4: . p f3 Mecbaaiaal r .' G ewe
Authorized 4��++�'��'0 I J ZOI 1 09 subtotal: S
Signature:
Slgrtna ture: Date: ` I V Minimum Permit Fee S72.50 S0 S
(}
f ,_ f „ � 6n lob Plan Review Fee (25% of Permit Fee) $
` ( tptassa t name) State Surch - 8% of Permit Fee) S
TOTAL PERMIT FEE S
"Fee atetbodoloQy set by County Butiding Industry Service Board.
Notice: Z This permit application capital er permit 1s not obtained within "Site plea required for exterior A/C salts
I50 days after it has bees aaaepted as complete.
i:\ Dsts\ l'ertnit FomulbtecPermltApp.doc 01/03
01/20/2004 16:03 FAX 5036284633 THE MULLEN COMPANY 8002 /002
Ri �atbin Permit A lice ' FOR 01:1 1C1_ USE ONLY
E® RLce Plumbing ,�
14 G Date�Br Permit No.�j�oD' Y`
City O Tigard Planning Approval sewer
pataly.: Permit No.:
13125 SW Ha11 Blvd- 1 JAN '3 Ak Plan Review Other
Tigard, Oregon 97223 Datefey: • Permit No.:
Phone; 503-639-4171 Fax: 503.598.1960 Post - Review Land Use
karat: www ci.rigard.or.us CITY 0 '-,- f
.1 ..iiI', Dat!/sy: Cue No.:
Contact Jail.: CS Sce Page 2 for
24-hour Inspection Request: 503- 639 -4MILD ---.. � ■ame/Method: ` suppleeuntal ta(ormation.
TYPE OF. WORK._' ,-' . ' ' • . _ I • FEE *:SCHEDULE r'speiraina[oim ctiedillit)''
1N New construction Demolition Description ( Qty I Bcc(a.) I Tuai
•• ..
� -, 2 f ffi
Addition /alteration/re lacement Other; ' r ' �t �: � ��_
.. �? ` p •. �.. ll�� � 1 � �` , F,14r:�? �'�
1 & 2-Family :�f''+A GO' S OP N .9 a� OON 1 ttasl00'IE 4 � tE7 pa�l! _ 1f�{i 2i ,.,..:tt
FU d wellin Commercial/Industrial, . SFR 1 bat 2 49.20
Y g SFk (2) bath 350.00
Accessory Building Multi - Family SFR (3) bath 399.00
Master Builder (:2ther: Each additional bath/kitchen — 45,00
'JOR SITE TNFORI TIONaotd -LOCATION Fire sprinkler - -. Page 2
Job site address: ) "8 65 b, v I .' -.c >:F;-.: a .,.:.....:• • 'Site 'Militia. - '-.,;
Suite #: Bldg. /A t. #: Catch basin /area drain I 16.60 _
Project Name: D wir � A r A-1.< Drywel /leach line/trench drain 16.60
Footinlrain (no, linear ft) Pa,4e 2
C ross street/Directions t0 jeb Site: Manufactured home utilities 110,00
iJ ari U V r / t a Ra 4- 0 I VD1 vl/ /� 1- Manholes 16.6(1
Rain drain connector 16.60
. Sanitary sewer (no. linear ft.) Page 2 •
Subdivision: DINA WIMPY DIN S Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map/parcel #: • DESCRIPTION OF • • FtxtureorItem
I Absorption valve 16.60
/,IIr'i/ . Backflow preventer Page 2
1111 4 11 J -fill � Il lOI ainnI Oyi Backwater valve 16.60
Clothes washer _ 16.60 _
Dishwasher 16.60
Y.? PROPERTY'O�R ' ; UMW! • , , : Eject
Drinking urne 16.60
fountain 16.60
:� ., - - � , .. � -. .. � Bjetrtofa;/s
Name: %A 4 'A / (, , 1 l ill • iti I t 5 Expansion tank 16.60
Address: I /N1 1 Z 11 / /. li �� i� ai Fixture/sewer rap 16.60
t �ri>[/ a� � � „ r / Floordrain/floor sink/hub 16_60
��� �pG ����ne� Gaarbsge dispoeal 16.60
Phone 4 - LQO, �► fiiii.7�L'Fw� Hose bib 16.60
101 IT , :, COu ..., . . )£ItSON Ice maker 16.60
Name: y,, L.I� MIMU Intercepterl grease tap I 6.6Q
Address: C ' 14 1 / . DA Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60 _
p' Roof drain (commercial) 16.60
Phone:. ♦ 910 0 P Fax: a 4 7 Slnlc/ 16.60
vra 'V d V t OLD '. • 0 Tub /shower /shower pan 16.60 ,
OL�FI'RRF'CE?R Urinal 16.60
Bus ine Name: 7 /11 (. y,/ Wate Closet 16 -b0 —
Water heater _ 16.60
Address: _ / r. ' . . .E _ •_, % Other:
INMEEPILIMIMPAMIE Oth _ - • �...
Pion- F. /, ftri F. . Se PA �, • .. •e. s.Ftamh eemItRe`i0 .
CCB Lie. #: " ` lamb. 1...c.#: subtotal s
- z Q � � Minimum Pt rmit Foe $72,50 S
Au orized /)1I 6:: - _ L _ Residential Backflaw Miniraue Fes
r► 25
Signature; s-- Date:/ `t 536. Plan Review (7.5% of Permit Fee) . S
Pf p State sache a (8% of Permit Fee) S
/ (Pie print name) TOTAL PERMIT FEE _ 5
Notice: This permit applioatlon capirost if a permit is not obtained within ' All new coJS.meretai buildings require 2 sets of pleas with isometric or
1$0 days atter it has been eseoptad u complete. riser diagreio for plan renew.
*Fee methodology set by Tri- Couety Burldleg Industry Service board.
i s \Dsts \Permit FoamsTImPe mitApp -doe 01/03
01/20/2004 16:08 5036425815 ROSS ELECTRIC INC PAGE 01
•
,y
'El ectrical Permit ',".1'; y; , D Reccivea
Electrical /gyp �p 0 An
���: Pertttit No.: fJ '7�
City of Tigard 11 .� c3 !, ' Planning Approval Sign
] 3125 SW Hall Blvd.
J J V Date/Ely: Othe it No.:
Tigard, Oregon 97223 Plan Review Other
Date/BY: Permit No.:
)°hone: 503- 639 -4171 Fax: 503 -5981 OF Tl ' ARD Past - Review Land Use
Internet; www.ci.tigard.or.us BUILDING ` ° ` 11 Dontac
_ Case No.:
24 -hour Inspection Request: 503-639-4175 - Contact Name/Method: Su !uric.: I Su See Page 2 for
pplemental Information.
•
:.•TYPE OF WOKI ,.:. R W.. ' bilis'e likka7Ft
New co ■ Servicc ove 225 amps- ■ Health �
Demoliti mare facility
Addition /alteration/r lacement p E1; commercial ❑ Hazardous rotation
❑ Service over 320 amps - rating of ❑ Building over 10,000
CATPCORRY'OP CQPISTRU4 `�QH... '' 1 & 2 family dwellings g square u nit feet,
& 2- Family dwelling y four or more residential unto in
a1
g ❑ Commereial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories El Fecdcrs, 400 amps or more
[I Accessory .Buildin Multi- Family
Master Builder ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Other: ❑ Egress/lighting plan ❑ Other
:. a a ppE IIQFORMATION'9tb ittO 'AT.ION ..:: -;' - Submit — sets of plans with any of the above.
Job Site address: 5 6S vQ The above are not a livable to tem ra construction service. • Suite #: I Bld ./A t. #: REED SErt,]�....:.r...i
Pro act Name: KS � Deacrlption Number of inspections per permit allowed
Qty Fee (el.) Total
Cross street/Directions to job site: New resldeatJ. elogle or melt6(am11y per
�U/ A A /YI Rd � l I V V Ok • Servi e I Dolt Includes attached garage.
Service {ncloded_
1000 sq. n or less 145.15 4
Each additional 500. - ft. or Mon thereof 33.40 I
Subdivision: �]� mires,; Lot #: Limited energy, rosidential 7.00 a
Tax map /parcel #:
Each manufactured
Limited 512. home or modular dwelling
• • . DEscitu TION OP WORK' • ... .. •.. • service and/or feeder 90.90 2
�' ! i erviees or feeders - InstallANoo,
4. 1 AA 1 �vETA al or rel ocn tiea;
Fl eMr V
'1 `g; 201 200 a am.s or less mps m 400 art, 50.30 2
106.85 2
401 a to 601 a s 16 0.60 2
'' s tS •P.ROP ERTY OAR . - • DI '£E C ' . - : '... ,.. 601 amps ro 1000 amps 240.60 2
Name: rI�EIr i� /+ J I, over 1000 amen or volts 454,65 2
Reconnect onl 66.85 2
Address: P� / . u � i Ia • c Temporary ervices or feeders - installation,
CI IS . te/ i 11: I NA I / 1 / alteration, or relocation:
20f am s ar le ss
Phone , ► ,s li�i�' 51) M� � �� j0- -'�'ta 400 amp ,- + 2 I MI " I ' . CONTACT.PERSON: . 401 to 600 am . _ 133.75 2
Name: P�� u. e� Branch circuits - new, alteration, nr - -�
extension per panel:
Ad dress : • A. Fee for branch circuits with purchase of
City /State/ service or feeder fce,each branch circuit 6.65 2
�: B. Fcc for branch circuit; without purchase of
Phone: �Q L I �D 21_ I Fax: I Z,1 i I service or feeder fee, first branch circuit 46.85 2
E -mail: 'V ` 7 '-!• `7 Each additional branch circuit 6.65 2 '
/I ls') at P5 ras . G OTYI . Misc.(.Service nr Feeder not included);
::4 . . !•.COITRACFOR. Each pump or irrigation circle 53.40 2 • Job No: �" Each sign or ntnlinc Hering 53.40 2
Signal circuit(s) or a limited energy panel.
Business Name: 1 cSS 1 alteration, or extension 2
/
Description:
Page 2
Address: Q 37o 54,E Citai -' .- ,, y
CI /State /ZI • : iii S 60► -•a 0 ► f71 a3 Each additional inspection over the allowable in any of the above:
Phone:.5b3 Z 2800 Fax: P — "�` cdoo" per hour (min. l hol — 62.50
_i ($� Investigation fee:
CCB Lic. #: 1$"7891 other: — -
Supervising electrician - EIeMrEcal:Pelt ti b ;; i; :7
.. ature re. uired• /
subtotal $
Si si
Print Name: (It OS S Plan Review (25% of Permit Fee) S
State Surcharge (8% of Permit Pee) 5
Authorized TOTAL PERMIT FEE $
Authorized
e; Notice: This permit application expires If* permit is not obtained within
Date: 180 days after it hes been accepted as complete.
*Fee methodology set by pi-Comity Building Industry Service Board.
•
(Please print name)
i:\bats \Permit Forms \ElcPerrnitApp,doc 01/03
STREET TREE C i .
1 ..
,A,
r
¢ `
I, Al v $ , �,� caner /.gent for 1LA€1 e . V r 5 f
(PLEASE PRINT) (PERMIT HOLDER)
Do her b 14-::-.4-t 1 'Al, on
e ,ice f t . e location
-44 Af meets Ci o�LT�ig /Wa i g ton County
�« -.'= q+, ,5"YJr;�wa.v .a3�a z+ u-., .. „„.,+,rrr «a�n.aagesa;esa;+,'x
land use and development standards for street tree installation. Ps-
ADDRESS: I S$ 6 5 � V✓ Avon 7 I o.
44 oa.
LOT: o� n 1 SUBDIVISION: 17 h A ,.q oa k S Ot-
BY: DATE: 1 / l' /CI
1 110 A °L 110 0>
RECEIVED BY: I t DATE: 0.
A
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 63,0100 (f . 000 9'
INSPECTION DIVISION Business Line: (503) 639 -4171 0 �
� `� BUP
Received Date Requested `� / 60 PM BUP
Location / T ° 6 Suite MEC
Contact Person --- 2/jir , ‘ 4--C, Ph ( ) 2/6 I6 62 PLM
Contractor Ph ( ) SWR
LDI Tenant/Owner ELC
Foo ing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear ,
Int Sheath/Shear
Framing /14 l' CU°" .f-vi , Ast4 e C2 Z
Insulation � , 1 --- kr al o/c
Drywall Nailing /
Fi rewal I
Fire Sprinkler
Fire Alarm
X/ri-- j
Susp'd Ceiling
Roof \ '
Other: ( A '0/ I t ,Z 4 P cl IZ. l
PART F;113
�.
CUING AV
Beam � r
Under Slab / V 0 l
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS RT FAIL
AL
`ost & Beam
Rough -In
Gas Line
Sm a Dampers
ina
PASO PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final j 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 a j t it i� f q(7
ADA " ( V �
Approach/Sidewalk Date t 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 �� yV
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
f 5&5 Location I V O A( Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam fh
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation _�pQ n ` ( n � ,t tt /
Drywall Nailing T �I �� VV I� v ! UDI _ ►�[ 1 v
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
F' - Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS PART FAIL
SI E 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire ADASupply Line 1 -0 I (C14
Approach /Sidewalk Date I nspector ( ' ( Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line. 639 -4175 MST , c% c 7
INSPECTION DIVISION Business Li 639 -4171
BUP
Received Date Requested — AM PM BUP
Location / S R� s Suite f7 MEC
Contact Person Ph ( ) 7/ 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam pos
Shear Anchors
Ext Sheath/Shear f� / �S S
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS tki RT FAIL
Pig.
-earn
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P
Other: 1
PART FAIL
ANICAL
=Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk /-2,//65 roach /Sidewalk Date
PP Inspector �' v Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL