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Permit GD /? /o`f O-a -c.�.J `2( .f ✓c c1J4y Q Q CITY O F T IGARD MASTER PERMIT PERMIT #: MST2004 -00220 j, DEVELOPMENT SERVICES DATE ISSUED: 7/28/2004 - -R 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 'SITE ADDRESS: 09534 SW JUBILEE CT PARCEL: 2S111 BA -08000 SUBDIVISION: JUBILEE PLACE ZONING: R - 4.5 BLOCK: LOT: 008 JURISDICTION: TIG REMARKS: Enlarge utility room and add bonus room to rear of existing house. Other mechanical is duct work. 9 -3 -04: Added sump pump to permit.(1 /8/04, adding (1) additional branch circuit and limited energy BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 318 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 29 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 318 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: . SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 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 SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 4.00 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: X VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: DATA BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor TOTAL FEES: $ 953.39 RANDOLPH G +JAN JANET L OWNER This permit is subject to the regulations contained in the WARREN, RAND Tigard Munidpal Code, State of OR. Specialty Codes 9534 E 4 , JUBILEE ILEE CT and all other applicable laws. All work will be done in 97224 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 - 620 - 6412 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: 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 Footing Insp Post/Beam Mechanical Electrical Rough In Rain drain Insp Footing Insp Underfloor insulation Framing Insp Electrical Final Foundation lnsp Crawl Drain /Backwater Shear Wall Insp Mechanical Final Foundation lnsp PLM /Underfloor Exterior Sheathing Ins! Plumb Final Post/Beam Structural Mechanical Insp Insulation lnsp Final inspection d /� ` Permittee Signature : 6Svia---1. Issued y >♦ _ _ —� g ,, Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Applica O ''' ��� �� . F OFFICE USE' ONLY City of Tigard JUL ,d l 6 2 Received per Date /By: /]� t 7 / 3 t: 3 Permit No.: �Tpci / • 04 , 5 41 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r Phone: 503.639.4171 Fax: 503.598.1960 y �'�nat�f�''� "� mIA Date/B Other Permit: Inspection Line: 503.639.4175 OW( OF Tic-114- '! Date Ready/By: 10 See Attached Checklist for Internet: www.ci.tigard.or.us BUILDING Div rolki Notified/Method: . Supplemental Information .r .,��,. ..y <a ;3^ata ..Y?�S3k:f�.Y.. �iFS. �'k s t , *, 4 ,:�:n� = ` ; 11,4 " a.:` v 01 WORK` , a µ.+ t K '. r i ' F .REQUIRED'DATA:. i, FAl1'IILY'DWELLING .�,? +.._y_.'- '.aft- _. ,n�. t', �. a 1_g., Wit"'' „= w'a. ^rs � "*-v. tp mw °.�,' riw�.t,.�,'.rarGn... ✓I ., z,n I. �„a.....x. ,,.: _.. . . - - -r �m.k €:K _:. :� .- D 2 -„ -_, ❑ 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 .�• -.:s t•• : <. i2 , 17 , t, .��.:,� ,F , =s�.. *- c .�, >- n+:i:° - ;,;',7,6 ,1 work indicated on this application. '- �. "...'�' >.,:�'��' "� "'kkar''''i'�'.��.¢". ^€;;: '� � k � _ man. . >!S = ..t�4:av "1 ; ,w '�,ifa�'�: �� .` �!; ,�,, ; .N , • 0 .. i ^fliii. a: - . °i:ift! 'CEGORY TRUCTION ` . k,, fA ..I. r «.. .t Valuation: $ 21F ' �.0 RI- and 2- family dwelling ❑ Commercial /industrial 00 El of bedrooms: / ' _ � (A9 ' n - ❑ Accessory building Multi - family s°r� ❑ Master builder El Other: Number of bathrooms: ,;; .• +iira�A; ;v?'*.3 @ami's's`- s»;e;°a�'d» °> f,., :r ��:5' ,ffe ':�n'ac .,. , }•'�'a. ,', "rs« ' i , t 1 J0BulS1'PE TNFORMATIONSAND LOCATION" & t , Nti Total number o f floors: Job site address: , f , � -� ! e w t New dwelling area: 3 1 g square feet 9 9 t3 � g W v ; p, City/State /ZIP: Ti. R fQ1 0 A 2 2.4- Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: H [I .- I I Y e. Co ns t. L :ft /9-1 Deck area: square feet - C 3 c -e � 12 F ,_..F n � V 1 e � Ter tc ,, - L e.. f 1 Other structure area: square feet r it O/rq Q ]) � P r 1 1 R US VI Subdivision: J t P 1 Lot no.: V Permit fees* are based on the value of the work performed. �( I ` Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no .: # i Bit Q © n 9 equipment, materials, labor, overhead, and the profit for the . Ae ` �� i *t - DESCRIPTIONS O�F a : r r k ' work indicated on this application. av; a 6,C X 12' aci 4t. --c t-o ba ck a ara. -e avd Valuation: $ Existing building area: square feet U 1 l �lf Co owl. i p -- f .e. X ► 1)14.c h a i s e C.1rP4t1 y Ol (' e r- �i(fi t 1 I duo tM 0 qA0'. a ( t/I ct Ql n YIuS 00 , M New building rea. q re feet s ua a f ig 4 PROPERT h ( ERA + ; - _V 0 ' � I ® TKEN�`l� �, N _ Number of stories: Name: R . f W i ", / Jcinve $ Wad" yr O-" Type of construction: Address: . { T f j_ C o/ ,..1& e e PI Occupancy groups: City/State /ZIP: (5)3) O _ 44 Ti atr- / - 0 R ` 22 L.1- 7C, Existing: Phone: lZ : ( �) )3� 7 -7'147 47 New: ?=:,,,,,,, :.r.. .,,,. at n _ ", :Vaiii.- . .i.MV. I ,' 1 •`,;r :ff r..,e y a It 'PLICANT ' . ,K ®,CON,TACT PERSON •�� . 'I':�' ; ,4 ' ; , ,� fir`! # ° '..,.• �.,, -., ,!� €v �• r ,<:� ; �'€w,;t,:.;:', �° : , ;<:�.t,x,'t":ut��:.•.:..�;, , . ..� sEF., », ,,, `i�= - �a..;��e�s..�5sr�n a : _a.re?�..�...:��, ^��'":�, ,y�e. a�� , _ .. . _ , ,:.7,..24 � � NOTICE ' ,Business name: • All contractors and subcontractors are required to be ` ' / licensed with the Oregon Construction Contractors Board Contact name: R a �l a. r hr &,v1 under ORS 701 and maybe required to be licensed in the Address: / . 0_.....,_ jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: apply: Phone: ( ) 5-c?/v ..e , Fax: : ( ) E -mail: i'—g t.✓e r f e.✓t. 0 .1641) 1 Crow .r_ .: .. g - �. ,� ,.,. .�: ;ar.:ata? ; s s:'S; . : 'b',,,, ?,. i ; : e�.'a,,r 41;,,':;£-;°. :'J,; `:' ,�. ;. "k„w"^"� =(;ti3;; t a te' �. r � � I•`- ,�*�` \>�. � Y 7 - i ,, � r� �" "�" a- � s 3 li `4 a a ` .; r � - , i - COr NT R ACTOR 0. x;.a. `�.., , :.,,.. ')' of = N - w_,..I r =. , Business name: t , !V 6 v E ' , ,.., ,., ' BUI , FEES* Address: Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lie.: .. ' . 6- Date received: Authorized signature: // This permit application expires if a permit is not obtained „Arc l within 180 days after it has been accepted as complete. M 111 Print name: C S fc �� Date: 7///12 C1 * Fee methodology set by Tri County Building Industry / ( Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(I I /02 /COM/WEB) One- and Two - Family Dwelling Building Permit Application Checklist �' F ` ' OFFICE USE ONLY City Tigard Received Permit No.: y Date /By: 13125 SW Hall Blvd., Tigard, OR 97223 //t,e Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 $l�vi "i' ❑ Electrical ❑ Plumbing ❑ Mechanical 24- Hour Inspection Line: 503.639.4175 41.91r E ` 1 Internet: www.ci.tigard.or.us ❑ Other: - 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. ❑ ❑ ❑ 3 Verification of approved plat /lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ _ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. • 0 0 - 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ 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 if copyright violations exist. 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 -f1. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot 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 ❑ ❑ ❑ 0 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 .ro'ect under review. JURISDICTIONAL SPECIFICS 23 i ive (5) site p . s are required for Item 11 above. Site plans musfbe 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 s - - each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development.Fees "document.' ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 t Building Fixtures Plumbi Permit A p .1 c at io n �� FOR OFFICE LSE ONLY . .:.1 ` °" ' Recei City of Tigard J 2, 2U0, DPermit No.: 13125 SW Hall Blvd, Tigard, OR 97223 A Phone: 503.639.4171 Fax: 503.598.1960 A Date/By: Other Permit No.: AF3 �rotia € €Ni � � ,, -67 24- Hour Inspection Line: 503.639.4175 vv �F ��' I runs: I See Pa e 2 for C��Y T lG �( ��„� Date ReadyBy: g Internet: ww.Ci.tigard.or.us R � 199LC»�G D� Notified/Method: Supplemental Information ,',.: '. = v, "' ,gi ? :, .',, . . ?.:s,. g'h' ', , :� '`� > r €3 " '`x',',#a' : a,;,;a, �- `w . . ._. `.'.'^ v �.�`' "' .�,=.c ,�».: '+.,{ r ... . .p ter t; ^:,, ". " _ ; »- 'E r . "� T YEE O W ® RK- , , r" s ...:1 .; 5 .. , ,, _F'EE,,;.S . s`" : ;'.� •J� �€ � "� " ^mss.^ �` �`r' � x- , ,'+" �z�i ,'..F > ? ".�''" :>::�<a�a. - %, ". faNa�S:i:� =;=Mr. . �, . >e„- �h -� -e, € For special information use checklist. ❑ New construction ❑ Demolition Description I Qty. Ea. 1 Total [ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) r. >f I i CATEG®R 01 CO = � U: 411 I`I r. , x " ` n "° = SFR (1) bath 249.20 W1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/lcitchen 45:00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 L a �. . , deli ireai FO TIQN D I O ATION � i* .4V . .; i, ei ,, a,r ..w: ,.k.w S ut Job site address: `i F3 Li, SW j (4 /k '', 1, 0 f. , e, l Catch basin .or area drain 16.60 City /State /ZIP: 'T jr _.pi _ 0 7i. Z 4 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1 Project name: Footing drain (no. linear ft.'. ) Page 2 Manufactured home utilities 110.00 Cro .V 1. �w � ������ ss street/directions to job site: ° C, e �^/) j , f / gy m Manholes 16.60 V Y r c,1017u1 I d" � 4 v 0 7f-Cif 2) p t f ,, � V 0 VI Rain drain connector 16.60 ✓ P G co-- J Q vl � I/1 ft Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no l j ' _ P'00 Absorptoionivam �, 0 � � � � , r � ; , � � , Absorptn valve 16.60 �� i s € b SCRIPTI01V 0)H� W®RK . - . .a 4 * � . ...r> II G _ - , , . . 4_4 - ,, �.. � ,- ..,t, Backflow preventer Page 2 la J Backwater valve 16.60 �0./ U ��/� -' �- r� _.._ �y - � / 1n f yQS t 1 , Z t h � c l Clothes washer 16.60 W [/ Dishwasher 16.60 :sir . >- .s �:z�:;. ;- .:::�.� ,.�';, �:,: � ..;»..: �¢,�,,_.� �_� -f mir I PROPEivi D OWNER �. `i . . ,, € TENANT t .'i Drinking fountain 16.60 ,., ,�,,mem ,, .w'. Aii.. 4. fl... ,,.. _ ,a ,,,Ic. sA Ejectors /sump 16.60 Name: R 777775 f 1 (T Expansion tank '16.60 G . ({ Address: 4 , s Vv ! la b , 1, l Fixture /sewer cap 16.60 City/State /ZIP: l 17 15 Q rot Q it 9 7, 2 Floor drain/floor sink/hub 16.60 Phone: (t zd..- h t Z -C- �)rC� - 0 V 7 - 774'7 Garbage disposal 16.60 a t" I , = Hose bib 16.60 "if P ICANT -'re ❑ C01' TA rizz>'ERSON� iM1 VItic 4 �„ 4 . 1r . t .,, :a. ;, ,, ,;! a�u ,., .ate, ,..;� x � Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: R Q( tAlevr r'e- Medical gas (value: $ ) Page 2 Address: , Primer 16.60 City/State /ZIP: a Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16,60 E -mail: Urinal 16.60 1 V.; � i � ' GONTRAC I'OR , V' . 1, L " ` 16.60 i 4 �a .f: , ,: x_ _,_ :eli . 1,7, A W ater closet Business name: DUO x') �%/ Water heater 16.60 . Address: � Other: A... 'l•- °,-- City/State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: ' � ✓ TOTAL PERMIT FEE Print name: (�} Date: 2. D 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. 1:\Building\Permits\PLMF- PermitApp doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S><te iTtrlities .H. ..k az .., Qt otmear . rT° Sq Iare Footage , ...:. Pere it Fee:, Footing drain - 1s 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 �� a ; ;.i ° s $ =- • Storm 84 Rain Drain - 1st 100' 55.00 ` Crmlt Fee: , $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Q a { additional $100.00 or fraction thereof, to and F1XtUre .. ; .> r <.. ._ �)�Fot 4: including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . rrt1 su Quantt €y Iiy (Ptxture� WQrkPerformed, Ftxtur g a r 1 :1 4 Re pl a c e t � Comments regarding fixture work: Baptistry /Font Bath . - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru • Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3" - 4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Bradley Quantity Total Commercial Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review ' Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: . i:\Building\Permits\PLM- PermitApp.doc 3/03 . . . . . .. ElectricalTermit Applicatiop vr..\\VE,0 FOR OFFICE USE ONLY City of Tigard cleus.' Received i Date/By: 7,9g 0 Permit No.: ii , ---; „ illy „ 1 ,0 400240 nn Alihk 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 . 4- 4 b 2 Date/By: Other Permit: Inspection Line: 503.639.4175 NO. nil' Date Ready/By: Juris 0 See Page 2 for Internet: www.ci.tigard.or.us .--../ nc-r■Gw.um Notified/Method: Supplemental Information wi,v*A.pm,:pr.;ifx:mtoviw,: 5.35,:,_,,,,moze,,-10,,,,,t,gin ,i,t,trN,'71 c ,,,,,,,.,„„.„--,,, ..,-- ,.., ..-- ., . . . 0 New construction U AdditiorValieration/replacement Please check all that apply: OService over 225 amps, comm'l EHazardous location 1:3 Demolition 0 Other: EJService over 320 amps - rating OBuildng over 10,000 sq. ft., - ---.., , ,ai taviometost:raiimitirdtgoAriatakgripwv of 1- and 2-family dwellings 4 or more new residential , o4..' VAL '',,,a.7 `,..e•i,, ' 2 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0 System over 600 volts nominal units in one structure EBuilding over three stories OFeeders, 400 amps or more IN Multi 0 Master builder 0 Other: nOccupant load over 99 persons OManufactured structures or NiaLaIlltill***N4:411#101ANOWEKKI071011 ClEgress/lighting plan RV park 0 t , EHealth-care facility pOther. Job no.: Job site address: C 1014 S lAj, t i _1 i el- P I Submit 2 sets of plans with any of the above. City/State/ZIP: TT' ard 0 R q‘ 72, Z Li The above are not applicable to temporary construction service. , . . . j , 10 mot:TvzIETA4 0011C ,T; --',:':- '7" - -- • ' Suite/bldg./apt. no.: Project name: Description Qty. Fee. Total ** Cross street/directions to job sit ( , e w T- 0 --,,,_ e y c _ o ,10/ New residential single- or multi-family dwelling unit. , Includes attached garage. , Ttrita t 9: 3 .1" A i IKA 5 4A Qv% V iel.4%- Terrqc ejC0-- _ 0 y) 1,000 sq. ft. or less 145.15 4 Subdivision: J 413.7r re. p I ac/e, Lot no.: IF Ea. add'l 500 sq. ft. or portion 33.40 I Limited energy, residential 75 2 Tax map/parcel no.: 23 RA - 0 00 0 Limited energy, non-residential 75.00 2 „,.,_ I e , ' -574, ,, ., =,- 4 ,, 7 .4t, - , - E ach d l ar Mil,;41;3i „ 4, :A t ' :1-1,,,43 ac manufactured or mo u n r 0 n (I C i Services or feeders installation, alteration, and/or relocation dwelling, service and/or feeder 90.90 2 ISAIe-Gtkp. o ,., LVA Si) er /L)ryer- , q d d a cr ex i +104 of ....,* 200 amps or less 80.30 2 c- I cc- bid" - for t 5 V t G ti iv1-5.101 ift"" -- 4;:i ;*;ik'avelttY ,' ,mies.14:5,..;:irtfAuf,0"5.1,:.:mol, 201 ampamps to 600 400 amps 106.85 • 2 s to amps 160.60 2 Name: i' 0 1 7 , vt4d,T Q4 601 amps to 1,000 amps 240.60 2 454.65 2 Address: $-- tt. s w Jul) •..4 1 .[.ee V 1 Over 1,000 amps or volts _ Reconnect only 66.85 2 City/State/ZIP: ' Iv - alf 0 (J .-77---)-.1-i Temporary services or feeders installation, alteration, and/or J relocation Phone: ( .5 6' 0 _ 6 fZ Ceti ) Fo3 7 'Erg -7 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or .. change, according to ORS 447, 449, 670, and 701. I e ili ' Date: 7/ 2 Fy 9 401 amps to 600 amps 133.75 2 t Owner signature: 4,..,.. AI ' Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with Fri?. "iTa.a4 W ' service or feeder fee, each - 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: p q vi ay Ltic fr-e,v1 without service or feeder fee, 46.85 2 each branch circuit Address: - 3 ...) --- Each add'i branch circuit 6.65 2 City/State/ZIP: ¶ 7 CC." .& Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 , 2 E - Signal circuit(s) or limited- iVrifiliela MI: energy panel alteration' or extension. Describe: Page 2 2 Business name: Each additional inspection over allowable in any of the above Address: Per inspection 62.50 City/State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax ( ) Industrial plant per our 73.75 Milliataat CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal • Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: TOTAL PERMIT FEE Authorized signature: , / - 7)/ ir ,....-.--- - . This permit application expires if a permit is not obtained within 180 .- 1...-- days after it has been accepted as complete - t Print name: R,,,t tA 4 4 --- 1 -- e14 Date: 7/2q- /014 : . Fee methodology set by Tri-County Building Industry Service Board \ / * Number of inspections per permit allowed. \ i: \Budding \Pennits \ ELC-PermitApp doc 12/03 440 Electrical Permit Application - City of Tigard Page 2 Supplemental Information • LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* [] Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical (1 Nurse Calls Outdoor Landscape Lighting* ❑ Protective Signaling Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\Budding\Permits\ELC- PermitApp.doc 04/03 Mechanical Permit Application �.p FOR OFFICE USE ONLY � � City of Tigard � Date/By: / : 64 Permit No. V;, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503 e2 A 7/„ /p / /� / Other Permit: `` � a 0 ��h� I + Dat Inspection Line: 503.639.4175 ul •f ` Date Ready/By: Saris: 0 See Page 2 for Internet: www.ci.tigard.or.us ` - g � 1G W.' Notified/Method: Supplemental Information (- '( O� c�1 \lls\O‘ ;.,;?:;" s; eta :.. . ----'''''''''%* 'i -xa :� ,; -x.z �,,c: -�,x ; i; a ?:;z .: s„ - �a,, re -. ,.. �... .411 ... `" T ?YPl A Q +r . € C „,,,IF1 . - I S E NC . H ECI{I IS --wR - u „�' _kk:as g, as a '?:.��� ��+�:� �.r. � -;"EPa *, r,� . .�a.% 'r .a. "�.cT c� -�.,_ �, . ei ...� <., _.. r.�� -r. r. ❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. t ham ,,� a ,P, s . r te a �:�k a * r.; � a - a _ Value: $ r .� .,;,,, °34,4 ORY OFCOW RUCTIQ1sFa 1 f .' `rifi�, °° N_ , .,I s , . . E 12 IDEN'�IA , EQUPMENTS /<SYSTEIVIS¢EE `MI.1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total r'" � �' Y tea,,. ..�' -."� � r �� ,,. �" =�=:5 � '��x'7`": _/ ' bB SITE INFOAtt1VIATIOI!F - AND, LOCA 1IO = , y ,�, t .;„ „ Heating/cooling L t (� / 7 Air conditioning or heat pump Job site address: 3 i.4, d w ,j „As 1 I8 „e p • (requires site plan showing placement) 14.00 City /State /ZIP: .9,, d C`� j 0( ',7 2-2-4 Furnace 100,000 BTU (ducts /vents) 14.00 Fumace 100,000+ BTU (ducts /vents ) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: 01 Duct work 14.00 Pe_..1.4. T � �rG f �� / C �6 1 Hydronic hot water system 14.00 "" J L e.-E- 1 t7 t1 13 rte( `? cl iIrN" d'✓1 V -e.tn' T' r1'tiC e Residential boiler (radiator or f - ) L }gyp h 14.00 ... . F O ✓1 cJ :4 E 1 � F� 1 I Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 \ � q Q� Flue /vent for any of above 10.00 Subdivision: JWh ke . 1 1 Lot no.: V Other: 10.00 Tax map /parcel no.: 25 13 tT - d rOO © Other fuel appliances ,. i . . , .. ;!. *:$w:- < Water heater 10.00 mot° . w � ; sue , llESCRIPTTON OF tXT - ` , . t` 10 00 :.�_° ;:i112/,...;,,,,..,:: sr a �_ .v e, � ,n �#:., �..,. ,a.,�.,'_r.�.. 99 Gas fireplace U/ i 't` 1 1 .4, eA,✓ G�,dt .t� v 1 fJ vt r4 O v a F et/� du vilvew`f Flue vent for water heater or gas ,} fireplace 10.00 " II / 'ty M`d r e' C--'e -3 (61// to Cet �k a vt Log lighter (gas) 10.00 t( 1 I t Yhda(9 elm U.v1O"C ca of h. (J'Bt'4 � Wood /pellet stove 10.00 �lt-�,f b ! ' p r.,/ b 0 no ro n >M Wood fireplace /insert 10 i`F` PRQPi W1 RT tOR't �' Chimney/liner /flue /vent 10.00 .., . �,�, _ .k.Z. , a,�,. .. +..,,..* .. $ >_.. rr _ ".5. Other: , 10 00 . Name: f0 4 „ d a �- f , e ,, A , Environmental exhaust and ventilation 51.47 /� Range hood /other kitchen Address: R 4 J I `e• e V l equipment 10.00 City/State /ZIP: r ' S ,,,ra OR rJ Z 14 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( 5-p3) b Io - c"l ,J I i Fax: ( ) toilet compartments, utility rooms) d 6.80 ,d,',V - ; :. €E x-,v_ -a s s;.k.:: , 2: .te_. l ° .;: r4 ±:;f r s-st<,pa ;:, =, , 5.". x APPL + � ',�CONfA CT - ^ EERSON} Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: R a.-A. dy Wqd're,." $5.40 for first four; $1.00 for each additional Address: Furnace, etc y 'rtA✓rl/ e Gas heat pump City/State /ZIP: Wall /suspended /unit heater itrPhone: ( i:)3) 62 6 1,+ 2 Veer. -r( (4 "7Ff_7g '� Water heater / u Fireplace E -ma' 11: 1rq, vt rlt J V✓61IT .e,✓11 . _ p j t�, � ©'M Range _ f' , ` � ii? , � ; �i GONT e olt -. ".. it _.. ` : � 1 : : Barbecue Business name: �� � � V Clothes dryer (gas) Other: Address: _„ t, . ,. ,_ .r;,: =ita lie • S *ti,, . ,� •_. ,ME PER MIT= FEES City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) • Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) TOTAL PERMIT FEE 4. Authorized signatur `, �: n This permit application expires if a permit is not obtained within 180 V vV t days after it has been accepted as complete. Print name: g amy' W Date: 7/4%/0 * Fee methodology set byTri- County Building Industry Service Board i:\ Building \Permits \MEC- PermitAppp.doc 12/03 440- 4617T(I1 /02 /COM/VIB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: qa' T's P f k 'a o „alvaluaf><pon_.p •t . a w .Perm><t $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • i:\Building\Permits\MEC- PermitApp.doc 12/03 2 tJul.26. 2004, :21APt1 CLEAN1 WATER SERVICES 503 6914439 1 No.2422 P. 1/1 `` t r a 5 I. r of) E .L_, 0 � .1 ¶9 i ��QQ 11 JUL 2 1 2004 1•) File Number a ��1 acarwate Services q 10® m • Our camlt,rtent is clear. • L .e • , ° or ening Site Assessment � �\ p C° Jurisdiction - y >5 Date 20 ( G\ /. \ \AG Map & Tax Lot „�.,y 1 (UM— b 0 v d Owner r ..y a, q .1� ei' '6V\ \ "� Site Address rj 7 3 _ ' W ,J,,A i 1 P.R tom_ _ - __ i ' ' 1 7 2,2 y Contact . '. ,,al _Q ,_ G l /4-tr - •P. vi ,,, Proposed Activity I2 24( ' el c r,l r -p ,, -�- Address . fig 1n�.___J,� 1 e e O` �41:c a r,aii, hoes ar .- . 1 orb 97 _ � ,_e Phone 6 r . . . i OMe) OffiCfai use oly below this Are Y N NA Y N NA ry , i-••-, Sensitive Area Composite Map p7 Stormwater Infrastructure reaps Vim! I --I Map # .__2,5fea.41 13J QS # tLi79' f•' ❑ V IA Locally adopted studies or maps I� L1 n other LJ Specify _ u Specify Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04-9: ❑ Sensitive areas potentially exist on site or within 200' of the site. T7•IE 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. 11 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. TTIIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: • Reviewed By: ,; • Date: _ ______ $! Returned to Applicant Mail Fax -V Counter Post -it" Fax Note 7671 Dat . 0 Pam p' Date_3Zag B From Co C.05 Phone a Phone p Faxrrc� - d•, - • A4r Fax l! .J 7 � 7 � CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE WESTERN CASCADE ELECTRIC INC PO BOX 23124 TIGARD, OR 97218 Electrical Signature Form Permit #: MST2004 -00220 Date Issued: 7128/2004 Parcel; 25111 BA-08000 Site Address: 09534 SW JUBILEE CT Subdivision: JUBILEE PLACE Block: Lot: 008 Jurisdiction: TIG Zoning: R -4.5 Remarks: Enlarge utility room and add bonus room to rear of existing house. Other mechanical is duct work. 9 -3 -04: Added sump pump to permit. 10/8104, adding (1) additional branch circuit and limited energy for stereo wiring, Your company has been indicated as the electrical contractor for the permit indicated above. In 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: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: WARREN, RANDOLPH G + JANET L WESTERN CASCADE ELECTRIC INC 9534 SW JUBILEE CT PO BOX 23124 TIGARD, OR 97224 TIGARD, OR 97218 Phone #: 503 - 620 -6412 Phone 1t: 503 -521 -0000 Reg #: ELI; 34 -6160 ST 46245 IC 153416 AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature ffeifrervising Electrician If you have any questions, please call 503.718.2433. L -i - e- 50 � o �.' 3- Permit #: H - OD ?-9-0 Address: `15 5 Au) J'L k Issued by: Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1541 ,al. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. #. I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. 4 OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Constructio Responsibilities on the reverse side of this form. 7 (Signatu • -. permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) r � Infor i iation Notice to Property Owners About Construction "k'essponsibiilities Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378 -3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must . obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs ifone of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 - 7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1 -800 -829 -1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work ofrough- in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140. Salem, OR 97309 -5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. . prop- own.pm4 1/94 CITY OF TIGARD 24 -Hour ��yy L BUILDING Inspection Line: (503) 639 -4175 MST o� <7 `Dd2-61 INSPECTION DIVISION Business Line: (503) 639 -4171 / BUP Received Date Requested _ AM PM BUP Location � �- .. ' Suite MEC Contact Person h (&14) 7:9- 7 9 6 17 PLM Contractor Ph ( ) 0 -6 v/;,. SWR (UILD 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 Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: ina !, — AS PART FAIL PLUMBING: .' °0 r � � Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole • Storm Drain Shower Pan Other: Final PA S S � S . PART FAIL Post & Beam Rough -In Gas Line Smoke Dampers • PART FAIL CTRIC L � . Service Rough -ln UG /Slab Low Voltage Fire inal� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS PART FAIL S1T'E ❑ Please call for reinspection RE: A Unable to inspect — no access Fire Supply Line ` ADA Approach /Sidewalk Date. f2- ` /5 Inspector Ext Other: Final DO NOT REMOVE this Inspection reco fr m the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour L! BUILDING Inspection Line: (503) 639 -4175 MST 2 7 — d 0 ZZ0 INSPECTION DIVISION ' Business Line: (503) 639 -4171 BUP Received Date Requested AM PM BUP Location 1111 ■ �._ . _ Suite MEC , Contact Person Ph (&14) _74qr _Z9 -7 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 -:,'•° 4 Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: 4 40110 1111 1 e /„.; 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 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 g � ADA / !�� • Approach/Sidewalk Date f � �" � I nspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site PASS PART FAIL