Permit I
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00065
44 ' it 6 7 i , DE VELOPMENT SERVICES DA TE ISSUED: 6/18/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12130 SW KELLY LN PARCEL: 2S103CC -08800
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 035 JURISDICTION: TIG
REMARKS: Construction of new SF detached dwelling.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,570 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,730 sf GARAGE: 630 sf FRONT: 31 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 322,353.50
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,300 sf REAR: 20
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 W00DSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: • 401 - 600 amp: EAADDL BR CIR: SIGNAL /PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 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: $ 5,728.86
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 all other r applicable cal Code, State work k w Specialty Codes and
230 GALEWOOD ST 4230 GALEWOOD ST, STE 100
all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035 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: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Re": 5p LI 387J
3 7,.5,3,$ 3 may obtain copies of these rules or direct questions to
� S OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insr Rain drain Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Foundation Insp Footing /Foundation Dr: Electrical Rough In Gas Line Insp Appr /Sdwlk Insp
Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final
X
Issued By : Airt1..,,,t !f , Permittee Signature : Zing__ °-.---;'l" 1/ Zir__-
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
�O p i ' i, - k 5rr//��r?D. �
` Building Permit Application i t � ¢ • _ ; ; 1 � '}
City of Tigard Date received: � g --()3 Permit no.: /1t �/ )3 .�°' f ? 6
:_= Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Ti and O 3 1 (``
Phone: (503) 639 -4178 E C 1 V E Date issued: Bit) .1/ Receipt no.: v\
Fax: (503) 598 -1960 �� i ld Case file no.: Payment
FEB Y type: (-3
Land use approval: FB 1 9 2Q03 l &2 famm y Simple Complex:
= - � I I'E OF 01ERN1IT. .v' ;:'41'-'
li • , r , .' ._ • .,
❑ 1 & 2 family dwelling or accessory " a ' . mmercial/industrial ❑ Multi - family XNew construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
.,r ?'.' .;a ` JOB;SITE ; � � a } ,M ,-x F ,a ,
Job address: 1 I . w V ' < , j t. V Bldg. no.: Suite no.:
Lot: 93 I Block: 'Subdivision: , »4j (\`(L( k --- 1 Tax map /tax lot/account no.: a. /n? Ivr'Le)
Project name: a,cU D./6 SO '
Description and location of work on premises/special conditions:
0444,416V#111=; V OW Nl1Z � t- y t » � - t fol i'EC'fAL IN Foid`i TT1'ON; SE:ftlIECIO$T '
_ .. ,'.,,,,,.mom.. ,_,., �.s.. , c- g y w 1a , m, t ad s.:W: WA rig . 1 i
J - , A p �� � ���� u t ( lloodp lain 7 ,M' . '
Mailing address: ` erpa a !, R� " rt 1 & 2 family dwelling:
imigin - __ ■ ZIP: 7) . ii= Valuation of work $ i 322 3)
1
Phone:. T 1' � ,. No. of bedrooms/baths _2-j-_ c '�
gar
Owner's representative: , A' LM if _ Total number of floors _ /0 Phone Fax E-mail: New dwelling area (sq. ft.)
1j ' ; , .APPLICANT ; ' , - - Garage /carport area (sq. ft)
I 'N J! Parilltil �= Covered porch area (sq. ft.)
Mailing address: 4, ,�,� 1� a a. Deck area (sq. ft.)
City: "I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi - family:
t .:°.=.,.... Valuation of work $
t� r.� +`�,,,,, I`;� �t 4 ` , .,`r•= CONT.RAC'TOIt ,� °: .. �t �. _
Existing bldg. area (sq. ft.)
«� New bldg. area (sq. ft.) : ..
Address: W- 71111.
Number of stories
City: State: ZIP:
Phone: Fax: E -mail:
Type of construction
C'._,. 1 Occupancy group(s): Exist: A _: -
4t
'�'• ` c am° "�..
New:
City/metro he no.: Notice: All contractors and subcontractors are required to be
V.V z SA.: ARCIIIT CTIDESIGNER c - .-1 ° f „ k s licensed with the Oregon Construction Contractors Board under
Name: ( f � O i ' — r provisions of ORS 701 and may be required to be licensed in the
Address: y-ti1Q a �� jurisdiction where work is being performed. If the applicant is
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A •rovisions of 1 ws and o dinances governing this Ca Visa ❑ MasterCard
work will be compli wt.,, whether cifieriiiereA . Credit card number: / /
_ � ___ _ Expires
AUthoriZed Si a atu ' 4 } vim: F Name of cardholder as shown on credit card $
Print name: i . i.1 . : '�Z t (
1 - ,K Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6r)O. OM)
4 16 One- and Two - Family Dwelling
,
Associated permits:
Building Permit Application Checklist Reference no.: . -
City ofTigard City of Tigard g ❑ Electrical U Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING - ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
NT
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
• 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. �(
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. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location. ,�(\
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation. / X \
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
•
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (doo/COM)
M e c hanical Permit Application , _. : : . .. .. . ,
.. .. . . .
� Date received: Permit no.: aM 3 _coo ,
'YaY,l
^
�I- ,.•�_�� City of Tigard Project/appl. no.: Expire date:
0:y4/Tigard 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
-
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT . .
0 I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family O Tenant improvement
X New construction 0 Addition/alteration/replacement 0 Other-
: JOB` SITE INFORMATION ; - COMMERCIAL VALUATION "SCHEDULE
Job address: (,...-1 ) . L Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite nor? value of all mechanical materials, equipment, labor, overhead,
Tax ma_ /tax lot/account no.: profit_ Value $ .
Lot: (Block: [Subdivision:\AA ,) 75 -1 .4' j 'See checklist for important application information and
Project name: \N V jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: , ' 1 & 2FAMILY DWELLING PERMIT FIE SCHEDULE --
Description and location of work on premises: AND COiYIlVIERICAI;IINDUSTRLt EQIJIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? O Yes 0 No Alteration of existing HVAC system
- , . MECHANICAL' - C•ONTRACTOR"' Boiler /compressors
Business name :� �. State boiler permit no.:
_ HP Tons BTU/H
Address: rkarn Fire/smoke dampers/duct smoke detectors
City: V " LI r State• " ZIP: -1-man Heat pump (site plan required)
Phone: jG) - Fax: E -mail: Install/replacefurnace/burner BTU /H
Z y � Including ductwork /vent liner O Yes 0 No
CCB no.: , Jt J Install/replace/relocate heaters-suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): r f O PJkAr ( LELL Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON Absorption units BTU/H
Name: If I C0` - EL L- Chillers HP
Compressors
Address: ,SL- CIA 0 - - 1- . ' _ 1 T" Environmental HP
ntal exhaust and ventilation: , -
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
' - OWNER = Hoods, Type l/ lures. kitchen/hazmat
„
- hood fire suppression system
Name: �y M` �L Exhaust fan with single duct (bath fans)
Mailing address: • / air �i �e,1`l Exhaust system apart from heating or AC
��.� Fuel piping and distribut (up to 4 outlets)
I City: E���� ZIP t �� Type: LPG NG Oil
Phone:. E - mail: Fuel piping each additional over 4 outlets
ENGINEER ' • Process piping (schematicrequired) .
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: J Fax: E -mail: • Woodstove/pelletstove
f 7� - bl Other:
Applicant's signatu "> , _ , Date: �/�7 Other.
Name (print): ,(: - 9 .. '
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application
0 Visa 0 MasterCard Minimum fee $
expires if a permit is not obtained
Credit card number: / / Plan review (at _ ,o) $
Expires __- within I80 after it,hasbeen State surcharge (8 %) :::
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount • 440 -4617 (606/COM)
•
` Plumbing Permit Application '. : �'r. ' >- , •: ,
Date received: Permit no. • V _ , ,, /' i • , ►
,t_�q, City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 97223
City of Tigard Phone: (503) 639-4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
. .. TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
►- ew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other.
JOB SITE'INFORMATION ., _ • ; • FEE SCHEDULE (for special information use checklist)
Job address: i 2 v (6 Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot C5 I Block: Subdivision: VAN-. SFR (2) bath
Project name: 4A•'t. SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est date of completion/inspection: _ Drywells/leach line/trench drain
_ - - Footing drain (no. lin. ft.)
'- - , "., PLUMBING CONTRACTOR Manufactured home utilities
Business name: p L ' 11,-10 Manholes -
Address: ia_.• Rain drain connector ,
ZIP: Sanitary sewer (no. lin. ft.)
City: ��� � � a Storm sewer (no. lin. ft.)
Phone:(C? 1 -'jl-( . t Fax: E -mail:
CCB no.: t "2" "7 L Plumb. bus. reg. no: - Water service (no. lin. ft.) _ ,
Fixture or item:
City/metro lic. no.: N/A , — Absorption valve
, Contractor's representative signature r — Back flow preventer
Print name: • ' , • ' Da� Backwater valve
1 CONTACT PE f_ . , - , Basins/lavatory
Name: ` >
` t , � _ . ` N e Clothes washer
Dishwasher
Address: ' _ y- , a Q.-v_"ve_ • Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank ,
Fixture/sewer cap
� 7 - Floor drains/floor sinks/hub
Name (print): \ 1 3[ 1�L��C_ " 072 - 04-1 Garbage disposal
Mailing address: _ • • " • go tab • Hose bibb
City
_�� State ZIP:t 7C Ice maker
. Phone:. J qt
, - , r I Fax: •, Interceptor /grease trap �—
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump _ ,
Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other.
Phone: Fax: E -mail: Total
credit cards, lease call Jutisdicuon for more information. Minimum fee $
Not all jurisdictions accept p Notice: This permit application Plan review (at %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained State surcharge (8 %) .... $
Credit card number. Expires w ithin 130 days after it has been TOTAL $
- - --
- -- - - accepted -as- Complete:
Name of cardholder u shown on credit card -- - - - - - - -- - -- - - -- - -- - - - -- -
S
Cardholder signature Amount 440-3616 (6/00■COM)
. . , A . Ele Permit Application
Date received: Permit no.: AST_ _ 0, 000 -
_ ;Igt1 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
'TYPE OF PERMIT
0 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ Tenant improvement
V New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
All: y ' 4OB;' INFORMATION
Job address: C) ` . .� ` 131dg. no.: Suite no.: Tax map /tax lot/account no.:
'' ►��/�
Lot: A Block: Subdivision. �f - ig/7MA
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONIRA( , ; I FEE SCHEDULE ,
Job no: Fee Max
Business name: ,/ 1 Description Qty. (ea.) Total no. insp
� - New residential - single or multi- family per
Address: 411 i Tlitillal l giffilp _ �` /I ig dwelling unit Includes attached garage.
MI M' Iaarr::, ZIP: iP MIZA Service included:
Phone: j j Fax: E - mail: 1000 sq. ft. or less 4
r 4.• ' Each additional 500 sq. ft. or portion thereof = = = —
CCB no.: y - .� Elec bus lic no: p�/ � Lin energy, residential 2
C' Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling ■■ .
nature of supervising electrician (required) Date — / � Service and/or feeder 2
' ' Services or feeders - installation,
Sup. elect name (pant) 9 s 3 � License no: q pZ
mot. alteration or relocation:
i.KII* " nxi:615,1lt()PI (s[ ' ()VvN - " , ` . ,x e - 200 amps or less 2
' _ 201 amps to 400 amps ___ 2
Name P rint : • ) • . ��
` .� 401 am _
amps to 600 amps __ 2
Mailing address: a t�� � S . _
601 amps to 1000 amps _� 2
City: L • s ��-'` ZIP./ Over 1000 amps or volts ___ 2
.� Reconnect onl 1
Phone: , IWA Z '1�' y Owner installation: The installation is being made on property i own Temporary services or , orre feeders - 171111110 . •
which is not intended for sale, lease, rent, or exchange according to i' �stallation ,alterationorrelocation:
200 amps or less 2
ORS 447, 455. 479, 670, 701.
201 amps to 400 amps __ 2
Owner's signature: Date: 401 to 60o amps MIMI 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit: •___
- - � - pI;AN REVIEW (Please check all that apply) ' ' Misc. (Service or feeder not included): IIIII
O Service over 225 amps- commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 ❑ Hazardous location Each signor outline lighting MIME 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, all
O System over 600 volts nominal more residential units in one structure alteration, or extension
O Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan O Other: Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %)
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
- - - - - - - - - - — - - Expires - -Ex - - - - - - - - - -- - - -
P accepted as complete. TOTAL
Name of cardholder as shown on credit card
S •
Cardholder signature Amount 440 -4615 (6/00/COM)
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4 STREET TREE CERTIFICATION
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CITY OF TIGARD '24- Hour.
BUILDING Inspection Line-, (503) 639 -4175 MST 3 -- (Do
INSPECTION DIVISION Business Line: (503) 639 -4171 •
BUP
Received Date Requested — AM PM BUP
Location / 3 c K.4 Suite, MEC
Contact Person Ph ( ) ' ? ` 8 3 7 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
- Y Other: - - -
SS P. •T FAIL
'r" , BIN
Pos`• - -:rn_.
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O.-
4 10 PART FAIL
ANICAL. „_
Post & Beam
Rough -In
Gas Line
Smoke Dampers
FAIL It V_P*1"
ervice
Rough -In
UG /Slab •
Low Voltage
Fir
final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
- Fire - Supply - Line - - - -- - - - - -- - - - - - - -
- --
ADA
Approach/Sidewalk Date F/ I nspector ���- Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL