Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00008
�i� DEVELOPMENT SERVICES DATE ISSUED: 2/3/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13717 SW LEAH TERR PARCEL: 2S109BA -09100
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 017 JURISDICTION: TIG
REMARKS: SF detached.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 22 FIRST: 2,089 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 640 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 209,322 60
OCCUPANCY GRP: R3 BDRM: 2 BATH: 2 TOTAL: 2,089 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 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: /� GREASE TRAPS:
(,�,
MECHANICAL 3 //7/Q y p � /4.�� OAR FIXTURE
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 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: 4 201 - 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: ALL - ENCOMP BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,454.80
This permit is subject to the regulations contained in the
GOODLET /MARSHALL • GOODLET /MARSHALL BLDG & DEV. Tigard Municipal Code, State of OR. Specialty Codes and
PO BOX 91551 PO BOX 91551 all other applicable laws. All work will be done in
PORTLAND, OR 97291 PORTLAND, OR 97291 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: 503 297 - 1881 Phone: 503 297 - 1650 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg #: LIC 100882 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 Insj Rain drain I :• Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm dr.' Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water ne Insp 'lumb Final
Foundation Insp PLM /Underfloor Framing lnsp Gas Fireplace Water Service Insp :uilding Final
Post/Beam Structural Mechanical lnsp Shear Wall lnsp Insulation Insp App P Sd � Ik Insp /
. ' i
1I p 1I%Issued By : Z/G C `— Permittee Signature : � � . _
yr
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the nex • usiness • ay
,
•
'Building Permit Application FOR OFFIcE. USE ONLY
Received _ ,, Building .
Date/By: ////ey a Permit No.: /45.7 — ,06teg
City of Tigard Planning ppr val
Permit No.:
13125 SW Hall Blvd. RECE1-',(.'::-..1) Date/By:
Plan Review Other
Other ,
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1' 4:0 t'z'icako/10*IiA Post Land Use
Internet: www.ci.tigard.or.us n _4_ ,,y.J li Date/By: Case No.
24-hour Inspection Request: 503-639_441'0 DIVISION IGARD Contact
Name/Method: 194s.; See Page 2 for
}/4 _ Supplemental Information
BUILDING
: . ; .:: : :.. : „ ;:z i--;....k.:::--, i =:.„ , ,, , ::, , - .. .:.:::.,-.-':;!;:, .'-'-`;-' :' -.W- ;,'-':' i ' .":* i:: ,,.
g New construction El Demolition :• , ,, .I':'' ' .: ' '
e:' ,,,----„,,,,,,,,,,,,,,,, '''''''''''' :,,,, :-;i-
0 Addition/alteration/replacement 0 Other:
,,.':;-::::::,::::•: - • - ,;-:= - :•_;:-.'/:-.7t:-C-4:T•E...001tV!01F. ,- .COISISTR:t.t.O.TION-4, , Ti'..-' , :-:-',..51. - -... - . i:-:' Note: Permit fees* are based on the total value of the work performed. Indicate
RI 1 & 2-Family dwelling I=1 Commercial/Industrial the value (rounded to the,nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
111 Accessory Building LI Multi-Family
III Master Builder El Other: Valuation $ t50,000
:I:0BiS.ITE'ilNFORMA-TIOI•EiiifditOC-ATIQN,6,.'ki-MnA No of bedrooms: 2.. No of baths: Z
Job site address: ' 15111 61.3 L.v.4164 (Tf..piiiae-S..- Total number of floors 1
New dwelling area (sq. ft.) iVeli
Suite #: I Bldg./Apt.#: Garage/carport area (sq. ft.) 40
Project Name: 9prffopi 1... \-I 1_.A.... Covered porch area (sq. ft.) 0
Cross street/Directions to job site: Deck area (sq. ft.) 66
Other structure area (sq. ft.) ;C
F.'; :
'''''kitti
. .. g
Subdivision: I Lot #: 0
Tax map/parcel #: A-09/ oc. Note: Permit fees* are based on the total value of the work performed. Indicate
7'- - ..,I,3 : : : ::,: :-, : the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
alairkorEgotowNEItitzw-M MEN:0411 Type of construction
Name: ‘ /1 WAN g- r;tv. Co- Occupancy group(s): Existing:
New:
Address: ?f, s cUsst
City/State/Zip: ?a,--ci, e 9 lz,
Phone: 217- 10f3i Fax 111- t Ce50 NOTICE: All contractors and subcontractors are required to be
, licensed with the Oregon Construction Contractors Board under
1E UPPOICANTArja'Ae5al tillgrat,0•80ret OtitiS0$
''''' provisions of ORS 701 and may be required to be licensed in the
Business Name: ?Pk Satfr,irr, pEsys,,Jr„.. iii- jurisdiction where work is being performed. If the applicant is exempt
Contact Name: ?pirc..kc_.y.- sck.ktri-- from licensing, the following reason applies:
Address: 61Zte 5L) t---PA 5T
City/State/Zip: PD)2. / o&.
Phone: 5 ?tea- 4573 I Fax: 503- 2.4es - 551 .
*1
E-mail: 5ck4-wri ( - reLepolvr . (-0 fr■
RailiZiatACSIValiii:KTIRWCTIOVIEIC :' E
Business Name: F,,,01,6-1 Is" L co Fees due upon application $
Address: Pp. 30. 1155 I
City/State/Zip: R7rt,rsoo , e n A., Amount received $
Phone: Zn7 - Fax: 7511- I (0 5c) Date received:
CCB Lic. #: \ • 5S 2- .
•
Authorized -/' /
'
,/ — - - Date:_t_k6 Notice: if a permitis-notobtained
Signature:
180 days after it has been accepted as complete.
rPrulA. Sc..t-w-scrf *Fee methodology set by Tri-County Building Industry Service Board.
_ (Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
` Building Fixtures
Plumbing Per ,L A plica110 t , O � )\t V
Date received: Permit no,Vh. DiP
hi City of Tigard 1 �� Sewer permit no.: Building emlit no.:
�
Address: 13125 SW Halt Blvd, t, 97223 - D
City of?lgord Phnnc: (503) 639.1171 1 a 2O0 Projecc'cpp!_no_: Expire date: —
—
Cli .)ate issued: By Rxoipt no.: -____ —
Pax: ($03) 5 ?R -1960
Land use approval: 81 i 0 ®DT D Case t,1� no.: Payment t�
. i.•-: .:. TV OF rl
=. 1 & 2 family dwelling or accessory Cl Commercial/industrial 0 Multi- family 0 Tenant improvement
ion ❑ Additionfalteration/replacetnent i Food service U• Other _, _.
'
ew c ns ru . JOBi 'INFORlVti'1:10;IN i fE SCHEDULE (fur ge14t).
L Job address: AS S1J Description I two ree(ea.) ', Total
1 111d :to,: I Suite no•• only: ! ,
-... t FR(1 1
— 100 f . for each utility connection) Tax map /sex tobxcoouat no.: (includes
: bath 1
Lot; 1 lock: , ._ _
__.�____. j Subdivision: SFR i2) bath
rPro err name: - ( — _.
1 rvat, IAA SFR 13)- bath f
City/county: j ZIP: 1J ZPA' - - - - -- _ additiontif' thtkitchen i i I
i Description and :oration of work on premises: __ Site utilities: 1 I `
1 � - 1 1,J 5 - _ - Catch basin/area drain i
Est. data of completion/inspection: ' DtywellsfLcach iine/trench tfraln 1 ' '
.'
Poona _ �ittui (no . lino ft.) -} ._. � i
' IUl41BINO • ' G ` C NcriUAC I F'OR . . " Manufat vie. home utilities ! Business name ,
a
_� , �
• �11,�1�jy1�,�,tC_ • Vlan itolas " �
Address. J -" _ -
• _ _ Rain connector - `-
C .1tY: (t�,tt ia _ - State: i Zr?: 4 Sanitary sewer (no. lin. 1 ! 1 -��
_
Phalle be Fax: ,P6? $- taxi!: v Storm sewer (no. iin. ft.) - � I
V Gater setvics nn. fin. ft.) ►
CCB no.: Plumb_ bus. reg. no: 3...-7 P n • ( )
L Citylmeaa lic. nt >•: Op y 0 u : a _ - Fixture or I cmt !
( Con ractot's rcptesentat s F / . : �' 14 - . Absorption valve _ ! 1
_ - Back flow prev eater { t !
Print name r; e / / � Dat ( G • . Backwater va -
Ba Tie
•i ONTA(1, ON -.
PLRRS ,. , '• Basins /Ir;vntory -- 1 1 -i 4. Name: r101-. ^ -_ -- ----- .........._ Clothes washer r ... _ j
i Address: _ 5_12 -CP W M /•,,Ay, 6T Dishwasher i -
�� State ..- T— ._- .._... -. prinkin+�fountain {s} .__.._.._— --_ --
�. �— Ci7� ;.....51tiZ d: ZIP: 1'121°!. '
Ejector >rsnm i
Phone.: .� r 45,•15 Fax: $ -m ail: te w1 • ? __ _ _ -r-
Fxpansto; t i ! i
/ Tu �, � . Fl oor -- — I" T -
Mailing address: Po �x I Ga r dratnar ciis[loor poea! sinks/hub _ } i
Name (print): {
— t / - - -__.. _ q
City: f t ok1, State Qvt. 1 Zt.l � l o � Ice Maker 1
' Phone: . � Bn.Y:217 -145 E•rnail: - -•- o -•_..' _ - - -- -- �.�
l Z I-j _ 05_1 _ Interceptor /areas trap i
- -_._ —;
Owner installation msiden:lai maintenance' only: The actual installation Prim
will be mode by me or the tntint:mance and repair made by my regular Roofdra:
employee en the pzoperty I own as per O1tS Chapter 447. - -' -
5ink(vasth(s), lays(a) i
Owner's signature: _ Date: Sump . —
Tubs /siiZI r /,shower pan
Name: Urinal _- .- -.....
■' Address: Water heater
I C,h�. _ �� __... State: , ZIP: Other: . ..
PhOno _____.. Paz: L 1,-mail: 'Yowl t
!_.... _ - l
Nit aUrw;.iogaat .00ept credit outdo. plume estl )oriselttltn fa 1 1‘0 4 infofmatioo. Minimum fee $
Notice: 'I1tis perrnit appiiaaticn d
I U Visa U Muter' erd expires if a permit is not obtained Plat! review (at /o) _
C■aQN cord number. — — .__.{, 1
xp within 1110 d after it h b State surcharge (8%) .... S —.._._
TOTAL b
i goon of cardtiolder to ebown on eftdit -lift - 1 accepted of complete.
1 111 �-'- -
' ' - Catilholdet signature_ .. Mwont _-� au+ �b15 idlOOtCOMI
A ,
Mechanical �s� li L? lion ' t , -' : .- -:
Date received: Permit no.: fLI S f Ot 9 ?
�;, City of Tigard JAN 15 2004 : -.. � �b Project/appl.no.: F.xpireda[e:
City of7igara Address: 13125 SW Hall tBId Tigard, OR 97223
Phone: (503) 639 -417 TIGAAD Date issued: By: Receipt no.:
Fax: (503) 598 -1960 cUiLDING DIviSION Case file no.: Payment type:
Land use approval: Building permit no.:
�„t;� a �' ,>, � ,, c]lI.OI 1IR11lIM � — , ,
. r _.. ,...__. . . r � ... ' . � , ,
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
New construction ❑ Addition/alteration/replacement ❑ Other:
." ' f t :f Al' JOII SI I I iINU O101' ION ' �
_ (n111 RC 11L A N.1,1; 1710iti aS(11f: - .
Job address: 7 7_ 1 . 1 , ! Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materi s, a uipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ fc7 .
Lot: _ Block: Subdivision: • • LL„. *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: 97Zt.• , ... a 2 FAMILY., DN E ELI N(.; , PLRIII'[ FEE DULL ,.
Description and location of work on premises: (_ c.) ' • 4"D COl111LRIC 1LiJNDUS I1RI 1F LQU1P,MMLN ISCIILI)ULE
Fee(ea.) Total
Est. date of completion/inspection: Desaipdon Ell Res. only Res. only
Tenant improvement or change of use: RAC: ■ �-
Air handling unit CFM
Is existing space heated or conditioned? O Yes ❑ No Air conditioning (site plan required) 11111 Is existing space insulated? Cl Yes ❑ No Alteration of existing HVAC system MI
# y'' _ ':AyiLCI111S16L •(O!'tItir UR 6 :,, fwE.,� Boiler /compressors
Business name: D ' E ' State boiler permit no.: 111 ■■
HP Tons BTU/H
Address: 7 1 • v. 80 , 2 , Fire /smoke dampers /duct smoke detectors —
i S tate : 0 : ZIP: 970/3 Heat pump (site plan required) 11111 Phone:, 50. f,(,_ h . Fax:5o3. i E -mail: Install/replace furnace/burner BTU/H .
Including ductwork/vent liner O Yes O No
CCB no.: / x{008 EX 9 - /7 Install/repla locateheaters suspended, ■ --
City/metro lic. no.: / / 32, wall, or floor mounted
Name (please print) Go4. eG Ec, p Vent for appliance other than furnace M
,. (ON I 1G , PI`RS()N o hs � "^_"-'l ■ _—_-
- r E m . Abs u. Ab un it s BTU/H
Name: A it , p,, Chillers HP
Address: 5 h.14CLlF+O�p 1 - Comp ressors HP IN
City: • ,1i toot,. Statep(\- ZIP: 9 7 Zl and v . , Istioo ■�
�� �� Apphanceven
Phone: . ?(e i -" ?l�iltl� Dryerexhaust Iiill
s,k ,,` # � , 011 NI R ' : ' t - -c. � �� ' H...s, Type UI ires.kitchen/hazmat ■
. --
, _. . , _ ,.... , , ..:. I ,. : .,. ,. 1
_ , v a ''( ._.,....._,, hood fire suppression system
Name: ■ ,t. . 44 1 G .., • . co ; E (bath -
1/ : , g. 'dress: •• ', , -- ` • !
i °t.p ., •Y•5�ii ul LI-At l7.gr nE Si is)iinI-
a Fuel piping and ■II • on (up to 4 outlets) III
(, State p{1. ZIP: O PG
Phone: , i ; Fax 2°(j Ua50 E-mail Fuel •1• in each addict over outlets _
� NG Oil
n • eac o ver 4 �
u1!,i q s r i��r s ",hNGii i 1 12; k . PIP 'S(sc ematicrequired) -
Name: Number of outlets
1 d A!ic �_�ci �t.:i- -:!�' 1111 Address: Decorative
City: State: ZIP: Insert -type IN
Phone: Fax: E-mail Woodstov pellet stove =
Applicant's signature: Date: Other: IIIII
Name (print):
11111
Not ad jarisdictona accept credit cards, please call jurisdiction for more information_ Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minitnum fee $
expires if a.permit is not obtained
Credit card number: / /— —
Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440.4617 (60(VCOh't)
A. ElectricalPermitA lication , ' " .. ° _ r
w7v ECE ` • D Date received: Permit no. .0 p _, f 4i) 6
14 ::'.?■ 'j ? of Ti - l Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Bi, 70047223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval:BUILDING DIVISION
" S ' ' a' -- ; s ; '� F v { • 71 PL O r PL It,\lt �. s . ,--‘'•
�
CY1 & 2 family dwelling or accessory O Commercialfindustrial O Multi- family C] Tenant improvement
INew construction 0 Addition/alteration /replacement 0 Other. 0 Partial
•
JOBSI 1 1ORi\1:kIION .„ „ t. '� e a.,
Job address: k$ 7 SIB - r - Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision: p • , r t_ \) -
Project name: Description and location of work on premises: (QE, W Fit—. ,
Estimated date of completion/inspection:
,
CON112,tCIOlt.111 11IOi\ . k . _ 1 FL', SCIILDLLC!- t'R , r ; -.v . .1,-,%,-,. " '
Job no: .•1 / Fee Max
Business name: Ate. ! /,/ ' Qty. (ea.) Total no. Ins ,
Address: / ' S"L,/ ' ,. ,s AllIFENIIIIIMIIIIIIIM Newt mast -single attache i-fam0y per
dweHingmdf. Ltatfadredgarage.
State: bit ZIP: 5' 7 0 - Servicehidnded:
Phone: l ' g_ -- E-mail: 1000 sq. ft. or less 4
nn.:/ !r `AP� • Elec• bus. lie. no: y
Each additional 500 sq. ft.or portion thereof __
Limited energy, residential —__ 2
City/metro . c. no.: Limited energy, non- residential ___ 2
l ~ / ' i Each manufactured home or modular dwelling
,, .. n: icing e1- (required) Date Service and/or feeder ■■ 2
Sup. elect name (prun) / e -I I License no: ? y Services or feeders — Installati ,
on
- alteration or relocation:
'� I
:.� , .1 '' llOPER '011'N ill �, , z
r 8 .. , .. 200 amps or less 2
Name (print): ,..• . r _ AS-C, p. • 4 l r a 201 amps to 400 amps ___ 2
Mailing address: •:, r - 1 55 I 401 amps to 600 amps NM EMI _ 2
601 amps to 1000 amps —_ _ 2
City: • ' Lroht,. State: on.- ZIP: ¶7 7,54 Over 1000 amps or volts =Mil _ 2
' one: 7 17 . 4= Fax: V 1 -1450 E -mail: Reconnectoni 1111.1111 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to relocation:
ORS 447, 455, 479, 670, 701. 200 or less 2
201 amps to 400 amps 11111111111111 - 2
Owners signature: Date: 401 to 600 amps __ • 2
'` ' a - ,, - °. 1.1\ & Il\ L1 R , r : s i ■ i s Brach drums - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. ut
Phone Fax E-mail: Each additional branch circuit: Fee for branch circuits without purchase
of service or feeder fee, first 2
ition tan atwit: __
*kk4 , I'1-'1`N ENV (Ple'ise clttchu 1114 l it r, appll% ') m v:2--;•:-' r A 3 N Misc. (Service orfeeder not included):
O Service over 225 amps - commercial 0 Health• caefacitity Each pump or irrigation circle ■■ 2
O Service over 320 amps -rating of 1812 0 Hazardous location Each signor outline lighting __ _ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* ■■ 2
O Building over three stories O Feeders, 400 amps or more s on:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the show:
O Egrestdightingplan 0 Other __
Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other •
Not all jurisdictions accept credit cards, please call jurisdiction far mom information. Notice: This permit application Permit fee $
l] Visa O MasterCard expires if a permit is not obtained ' Plan review (at %) $
_ _ cradle card number: / / within 180 days after it has been State surcharge (8%)..... -$
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit and -
$
Cardholder signal= Amount 440 -4615 (6r00WCOM)
/ y --vim k
T EET TREE CS R ..
..
, .
�4
I, ,_ f _ / , 1 1 a , Owner /Agent for al /LI ,L1111 !
PLEAS PRINT) (PERMIT HOLDER)
1 ,I :
Do hereby ' t y a , 3. l ;
�certif' i a =tat , e following location '
1 meets ,City of } t'County figar / C
_s Y : r, , fi �,, ,H. ,, ,, ,. a . , . .
land use an development standard for street tree installation.
• ADDRESS: /7j7
c�e- Oi-
• LOT: 1 SUBDIVISION: rhibC)1 1 41)41 0-
1
• BY: LL . . ! 4 or l ?L ix/ 0 ' DATE 9 ll 4 ot
-4 i l 4 / _ i' i 0-
RECEIVED BY: �� /'�,l DATE: , - -f -
� `
A
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175 ° MST °96' c762
INSPECTION DIVISION s- Business Line: (503) 639 -4171
BUP
Received 2 Date R nested AM PM BUP
/ 3
Location / l 7 �c .,AA.. Suite MEC
Contact Person � c.g.--vl/ Ph ( ) 7 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing 'I/ 4.)11.42(it,--/c.ro car 141/;s:��.�. tG`!�� — .
Insulation
Drywall Nailing
Firewal I
Fire Sprinkler
Fire Alarm -
Susp'd Ceiling
Roof
•ther:
a� l
46 PART FAIL
-
P UMBING ` ' -
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�
os eam
Rough -In
Gas Line
• e. Dampers
Fin.
- ASS RT FAIL
RICAL
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: L Unable to insp — no access
Fire Supply Line —
ADA Q+ P
Approach /Sidewalk Date "/ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGAR.D 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST ;) 1 4" .°°°°
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested l AM PM BUP
Location / 37 7%-P/L'2) Suite MEC
Contact Person a) Ph ( ) - 76 9c 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
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:
410 r
PAS' 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 - - - — - - - -- - — - -- - - - -
Approach /Sidewalk Date 71,1)10 Inspector C-7) "'' ��� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line 03) 639 - 4175 - Z
INSPECTION DIVISION Business Line: (503) 639 -4171 MST 0(3
BUP
Received Date Requested 3 3/ AM PM BUP
Location 1 37 / Suite MEC
Contact Person Ph ( )
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
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
U -.
• Voltag
Fir arm
Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
•ASS PART FAIL
SITE ❑ Please call for reinspe tion RE: Unable to inspect — no access
Fire Supply Line
ADA
D C� cr
Approach/Sidewalk - Inspector Ext
Othe r:
Final DO NOT REMOVE this inspection record from the te.
PASS PART FAIL