Permit CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2004 -00175
�+ DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
'� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12290 SW THORNWOOD DR PARCEL: 2S110BC -05700
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 028 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: DM170QA2 STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 29 FIRST: 1,570 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.620 sf GARAGE: 405 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 TARO sf RIGHT: 5
VALUE: 308,390 00
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,190 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES' 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB/SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: ' VENT FANS: 3 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: 6 201 - 400 amp: 201 - 400 amp: 1st IMO SVCFOR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL Bt CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amp6- 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,002.47
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES DON MORISSETTE HOMES INC
Tigard
4230 GAL EWOOD ST., #100 4230 GALEOOD ST, STE 100 of other Code, State A of ll wo rk l wo rk will kwil Specialty Codes
done in
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 and all other applicable laws. A be done
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: 503 387 - 7538 Phone: ATTENTION: Oregon law requires you to follow rules
5p3�387 -7 3g adopted by the Oregon Utility Notification Center. Those
Reg 5. LIC 355533 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insf Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
/1 2______
Issued By : ,410_ , / _ _,,, N ! . Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
T G ?T G'-, 3 -0 ,Jai o5- i
Building Permit Application
I �R 1 " �` B ermitnoM37 ' D/75
,, •, . Date Iii City of Tigard ;. �E �y/ y 0
'' - � Project/appl.no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 JUN 4 2004 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: ` Payment type:
Land use approval: BUILDING DIVISInn1 1 &2 family: Simple( 776.— omplex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory Cl Commercial/industrial 0 Multi - family , 'New construction Cl Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: rr i7�� s � I 1 IVIE Bldg. no.: Suite no.:
Lot: A JAIIM Block: Subdivision: V ri Jjj r Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE IMINEAMEZTAIIIR A • (Floodplain, septic capacity, solar, etc.)
Mailing address: AexatirinuaggraimmarteR 1 & 2 family dwelling:
REINWRIMIIMIMIll i J ZIP: •' '1). 3 Valuation of work $
Phone: . r pl No. of bedrooms/baths 7 )
Owner's representative: , rariTair ,,, — Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.) C
A rL J A%. Covered porch area (sq. ft.)
Mailing address: ' , m Al: , a _ V Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industrial/multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
�" �� New bldg. area (sq. ft.)
Address: `► ��
City: Number of stories
ity: State: ZIP:
Type of construction
Phone: Fax: E -mail: Occupancy group(s): Existing:
CCB no.: New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER _ licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
&�
Address: _ ,L , �(�!�
jurisdiction where work is being performed. If the applicant is
.-
City: State: 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: ZIP: Amount received $
Phone: Fax: 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 l ws and o dinances governing this 0 Visa Cl MasterCard
work will be compli - • wi whether cifred here 1 tr r� tot./ _ /j/ j/ Credit card number. / /
Expires
Authorized si _ atu I U-- • , i ` A ( 21/1..- yyy ., e . Name of cardholder as shown on credit card
Print name: i - ' 't 1 r 1 I Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44o -4613 (doa'COM)
One- and Two - Family Dwelling
' ' Permit Application Checklist _ ,�, ., ►; Building Permit Application Chkli Reference no.: •
CuyofTigard Cl of Tigard Associated permits:
`, b 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 D Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TIIE 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.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
Water district approval. ,(
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc. J�
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�
I 1 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 ` ,.
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. n
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, X
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. J�
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. '�(\
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. x
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 (&00ICOM)
•
Mechanical Permit Application
. 4 i
.01. � . R C E `P/ E D Date received: Permit no. #$f2 oy / , I
�,� j y. t h I l
, T:f City of Tlgar Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hgllll13�vd, T �R 97223 r
Phone: (503) 639- 417'1t' VV Date issued: By: l Receipt no.:
Fax: (503) 598- 1960ITY OF TIGARD Case file no.: Payment type:
Land use apprBUILDING DIVISION Building permit no.:
lla TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi family 0 Tenant improvement
New construction 0 Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE -
•
Job address: r , r �arI f/_�T / Indicate equipment quantities in boxes below. Indicate the dollar
ar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit Value $ .
Lot: ,.ti IBlock: I Subdivision :11\0Y I- IA/ ' See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE •
Description and location of work on premises: AND COMMERICAL INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of comp letion /inspection: Description Qty. Res.only Res.only
Tenant improvement or change of use: Ii Air horn •
Is existing space heated or conditioned? 0 Y e s 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
MECFIANICAL CONTRACTOR Boiler /compressors
•
Business name:�� ` State boiler permit no.:
�.il!y =� /I_f1 _ HP Tons BTU/H
Address: tlr�b_ Fire/smoke dampers/duct smoke detectors
City: - L1r MN" ZIP: ° Illnean Heat pump (site plan required)
Phone ? - - ;j I I Fax: E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: .F-,,9L-7-- f) Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): Si p i p - t1/4-ELL___. Vent for appliance other than furnace
CONI TACT PERSON Refrigeration:
Absorption units BTU/H
Name: A � ` ► Chillers HP
Address: Compressors HP -�
�_ ♦ 41 Environmental exhaust an vent
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U lures. kitchen/hazmat
hood fire suppression system
al a k Exhaust fan with single duct (bath fans)
�—
VA, Mailing address: A, IA, } • 1 tri�� Exhaust system apart from heating or AC fi
Fuel piping and distribution (up to 4 outlets)
City: . . State ZIPR
Type: T LPG NG Oil
�
Phone: I/2 Fax: E -mail: Fuel piping each additional over 4 outlets •
.. ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: [ State: I ZIP: Insert - type
Phone: // Fax. �� -mail: Woodstove/pelletstove
g '�Xi.!I� NMI Other:
Ne Applicant's si natu D ate: / Other
Name (print)• .(r ' - l , , , • f
Not all junsd,cuons accept credit cards, please call junsdncuon for more Information. Permit fee $
Notice: This permit application Minimum fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number Ex
Expires w i t hin 180 days after it has been Plan review (at %) $
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
S
Cardholder signature Amount 440 -7617 (600/COM)
Plumbing Permit Application
, ,
. A �+ Date received: Permit no i „.• / , 0/ 7�
City of 11 a u � � [] Sewer rmtt no.: Building permit no.:
1` � 1 � Addr 13125 g al 3
City ofTigard Projectlappl. no.: Expire date:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 JUN 4 2004 Date issued: By: Receipt no.:
Land use approval: CITY OF TIGARf) Case file no.: Payment type:
BU e i, a . ,
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
►= New construcuon 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITEINFORMX1ION FEE SCHEDULE (for special information use checklist)
��,� /I J �/� Description Qty. Fee(ea.) Total
Job address: /� New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 9. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: ..I MI Block: Subdivision: . 4,%�/ I_'f� SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Drywells/leach line/trench drain
Est date of completion inspection: -- Footing drain (no. lin. ft.)
- ' PLU11I4ING ,CONTRACTOR Manufactured home utilities
Business name: p. ` 7 L • Manholes
Address: ') l Rain drain connector
State ZIP: Sanitary sewer (no. lin. ft.)
Ciry. iii►! _vim Storm sewer (no. lin. ft-)
Phone: 1 E -mail:
(L�>✓ �� Fax: -. Water service (no. lin. ft.)
CCB no.: i, c jQ;"7 I - 7 I Plumb. bus. reg. no: — win. '
Fixture or item:
City/metro lic. no.: N/A , Absorption valve
Contractors representative signature Back flow preventer
`
Print name: =S � r �& Backwater valve
. CON AC1• PERSON Basins/lavatory
Name:. l {\'-• -1 . P';' E Clothes washer
Dishwasher
Address: aah / , V D nnk ing fountains)
City: I State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
'•'•= = =�= r� ._ OWNER Fixture/sewer cap
Floor drains/ floor sinks/hub
(print): • 'of :aiC `� = Garbage disposal
•
Mailing address: • ' • }1 :owl Hose bibb
City• _ Enr�vilsgE OI�[rr�� Ice maker
Phone: J . — Fax: lifigTror E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Pnmer(s)
will be made b;. 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
ENGINEER Unnal
Name Water closet ,
Address: Water heater
City I State ' ZIP. Other.
Phone: I Fax: 1 E - mail. Total
Minimum fee $
Not ail )uns.:rcuona accept credit cards. please call funs icuon for more tnfonnauat Notice This permit application %
Plan review (at )
C Visa �tastcrCard / / expires if a permit Is not obtained State surcharge (3%) •••• $
C.edu ,aid number w ithin 180 da %s after it has been $ Eap1fes accepted as complete. TOTAL ----
Name of care-holder as shown oa credit card
S
Can holder signature Amount di0 -1616 (•01COM)
. ,
, , A Electrical Permit Application
® Date received: Permit no /�s� �0�'00/
, * a 1 1 1 I1 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171 JUN 4 2004
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
I' New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION
i �j Job address: 1 s , i� /rll� . , ./ .mod BId:. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ,11� Block: Subdivision: ( £ al.a of
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR OR API'LIC, \TION FEE SCHEDULE - -
Job no: Fee Max
Description Qty. (ea.) Total no. lnsp
Business name: - ' 1 New residential - single or multi-family per
Address: �, Iv ,,%,_ at` — dwelling wsit. Includes attached garage.
='
INIZIEMEIFICIESIL • _ Service included:
Phone: a , �j - I Fax: E -mail:
1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: Elec. bus. lic. no: /e C• Limited energy, res 2
C
Limited �� — Each manufactured energy, non-residential m! 2
d h home ome o or r modular dwelling
nature of supervising electrician (required) Date fr" / Service and/or feeder 2
Sup elect name (print) 1 , l'F- a lp 21 License no � Serrrcesorfeeders - installation,
�1>► alteration or relocation:
PROPERTY OWNER 200 amps or less 2
0 201 amps to 400 amps 2
Name (print): Ur. • ' C►A.rati� 2
401 amps to 600 amps
Mailing address: � �,� I( . /�,. r�• • • 601 amps to 1000 amps 2
City: c 6 s State siy ZIP: 70 Over 1000 amps or volts 2
Phone: , , 7- _ 2 Fax: _ 7-' 7 r jr -mail: Reconnect only 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 allation, alteration, or relocation:
2
200 amps or less
ORS 447. 455. 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 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
Cit I State: I 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:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
imgauon circle 2 i
h pump or mg
O Service over 22.5 amps-commercial O Health -care facility Each 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting
, family dwellings O 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 stones 0 Feeders, 400 amps or more •Descripuon:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan O Other Per inspection I I I I
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 jurisdicuoa for more informauon. Notice: This permit application
O Visa O 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 accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (&0000M)
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44 ®i I, 4-at y 7 • --- S ,� ®wner /Agent for / S 5 C r -
®� / (PLEASE PRINT) / ' \ (PERMIT HOLDER)
1 t ,'" '--- " V,I, :\ *GEM*
I Do hereby �cert ft t ha "t follow location SEP 2' 2
® meets ty of Tig d /Wash ri County Gvr iOG p 1 V 1 N
® l an d use and development standards for street tree installation.
BOLDING tit-
® ADDRESS: /22'?) 5. - t,,. -s r Or .
® LOT: ... SUBDIVISION: 77 e � �-0 A
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�
® BY ` ? f'_ 21 0i
® DATE:
® RECEI ' D BY: ‘ I AP - 1 ' _ DATE: c�
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votuo LUU' 14 :0/ kAA 51.13511S1!!CU CITY OF TIGARD 2001
CITY OF TIGARD Credit No.: 2003 -00001
Date Issued: 3/28/03
\--, Engineering
4, - . ,: , .1. Authorization
i l
; a - `' Date: 3/28/03
TRAFFIC IMPACT FEE
CREDIT VOUCHER Land Use
Casefile No.: SUB 2000 -00008
In accordance with Ordinance 379 (Washington County Traffic Impact Fee Ordinance) Don
Morissette Homes. Inc.
n
(name •t
is entitled to $ 161151.00 in. rafi'ic Impact Fee Credits that can be applied to TIF charges for
development on lots all of the Thom
lot( s) � .od Subdivision Development. The use of TIF credits are
subject to the ruIe}s and limitations of the TIF Ordinance which are listed on the back of this
voucher. WARNING: This voucher must be presented at the time of issuance of the building
permit, or if deferral was granted, issuance of an Occupancy Pe it.
.1....c31.-- -?-4f-elti--,.
I Date Permit Numbers Lot Numbers Credit Used Balance
Beginning Balance $ 168,151.00
- F' 03 ^ rh <t ?no oo
3 - a?t /S"3yv /45;74/
N --1 -03 ytiST aeos• 9.2 T a f /G3� Vie
H�a a 1 1 51 �a3'0t 119 - 4 8390 llod g 44
o _ M s'r.t 03-00 133 /0 a 390 5 ' /
503 ►msraoa oo l() ,A390 /54 .sn1 29
5/aG /� AST •�)b Hi
A3�iO,r� / 5, 841.,sto 36
(o /05 0 S /fST,.7rn3_ ooi8o 4 ( q.3 5o ,a0
4,1 , m411.. 4 2- ooil9 oZ A fs 9C — JY ail ' C --fo
' a 3),- _ 1+f5r -n0I 3 a3 yQ- /94151 - buZ
6/ 1.3 grisr999D - a aago _ 141 t Vb /-
Balance carried forward to TIF Credit No.
• Ordinance 379 provides for an expiration 10 years from authorization. t
logemotawrzel
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST oZ'' d D 7
INSPECTION DIVISION Business Line: (503) 639 -4171
C BUP
Received Date Requested / ` ° AM PM BUP
Location 1 a a I v ' '>-AAA/ 1 LCI -zO Suite MEC
Contact Person - Ph ( ) a 1) — 4 7437 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 l
Fire Sprinkler
Fire Alarm 6'
Susp'd Ceiling / J
Roof 6
Other:
Final
P ART FAIL
• LUMM !P
Post & Beam
Under Slab
Rough -In 4
Water Service
Sanitary Sewer `i / �/ / �� 0
Rain Drains _ - — -
Catch Basin / Manhole �
Storm Drain
Shower Pan
Ot
0 PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
P ASS PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE E Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date //
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 al A4 (
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested Y 3 AM PM BUP
Location / Z 7—P) to Suite MEC
Contact Person (i/ttet7 Ph ( ) 5 - / 9 ‘ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: 4- Do 176
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing / 11/)
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
erv
e1 lab
•• Vo a,
Fire A arm
( F'na Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
•ASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA r� —.3- a
Approach/Sidewalk Dat • Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BU 0 Inspection Line: (503) 639 -4175 , MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested � AM PM BUP
Location / 7,T 9 6 . 1 .
.ts-/■ A/1 C.ch�ze Suite MEC
Contact Person p Ph ( ) — 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
E
Foundation Access: �_ o o ZS1L(
Ftg Drain •
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Framing Sheath/Shear (.)/ c j1` oS / O F//vA ._
Drywall on
Drywall Nailing
Firewall N S
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
C W PART FAIL
PLUMBING p
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
PAS PART FAIL
ELECTRICAL 0
Service
Rough -In
UG/Slab
Low Voltage CL 2oo y -co 2
F larm
•AS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE U Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Date q 0 /
Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this Inspection re • rd from the Job site.
PASS PART FAIL