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Permit 4 •• CITY OF TIGARD MASTER PERMIT PERMIT #: MST2001 -00143 �Ij;� DEVELOPMENT SERVICES DATE ISSUED: 3/30/01 °` 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12925 SW VILLAGE PARK LN PARCEL: 1S133DD -02600 SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 ZONING: R -4.5 BLOCK: LOT: 065 JURISDICTION: TIG REMARKS: Construction of 616 square foot addition. Path 1 BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 11 FIRST: 616 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 6 VALUE: $ 53,161 00 OCCUPANCY GRP: R3 BDRM: 2 BATH: TOTAL: 616.00 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 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 c 3HP: VENT FANS: CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 4 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: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 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: EA ADDL BR CIR: 1 SIGNAL/PANEL: IN PLANT: MANU HWSVC/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: $ 1,189.99 This permit is subject to the regulations contained in the COUCH, LERON D AND TAMBERLY AN OWNER Tigard Municipal Code, State of OR. Specialty Codes and BY GREG SNOW all other applicable laws. All work will be done in 12925 SW VILLAGE PARK LN accordance with approved plans This permit will expire If TIGARD, OR 97223 work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: 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 Erosion Control Insp & Underfloor insulation Electrical Rough In Insulation Insp Final inspection Footing Insp Crawl Drain /Backwater Framing Insp Rain drain Insp Building Final Foundation lnsp Footing /Foundation Dr; Shear Wall lnsp Electrical Final Post/Beam Structural Mechanical Insp Exterior Sheathing Insl Mechanical Final Post/Beam Mechanical Electrical Service Low Voltage Plumb Final Issued By : T Permittee Signatur- : ' 111 ...ILI ► _ Call (5 3) 639 -4175 by 7:00 p.m. for an inspection needed the next busi : ss day 14 9 4 Building Permit Application • A Date received: deo/ Permit no.: pricer ,- OC/ ,':r ' z City Tigard = y of Project/appl. no.: Expire date: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard pn\ Phone: (503) 639 - 4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: 1 &2 family: Simple Complex: use approval: y� lex: p p TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition ,JerAddition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION • Job address: / J .� • i / • T - ix 0' i /„ Bldg. no.: Suite no.: Lot: — Block: — Subdivision: Tax map /tax lot/account no.: — Project name: — Description and location of work on premises/special conditions: n' (alto Fi OWNER FOR SPECIAL INFORMATION, USE CHECKLIST IMI (Floodplain, septic capacity, solar, etc.) , Mailing address: /,., illWr 1 & 2 family dwelling: // \ HE ,iii I ZIP: 9 2 Valuation of work $ 53) ( P l Phone: i r Fax: No. of bedrooms/baths 't 0 Owner's representative: Total number of floors `/ / Phone: Fax: E -mail: New dwelling area (sq. ft.) (D/ 0 APPLICANT Garage/carport area (sq. ft.) Name: Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) ..• City: State: ZIP: Other structure area (sq. ft.) Phone: Fax: E- mail: Commercial/industrial/multi-family: CONTRACTOR Valuation of work $ • alb` EL Existing bldg. area (sq. ft.) Business name: New bldg. area (sq. ft.) Address: City: State: ZIP: Number of stories Phone: Fax: E -mail: Type of construction CCB no.: Occupancy group(s): Existing: City /metro lic. no.: New: Notice: All contractors and subcontractors are required to be ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under \ /111 affalliMMEll provisions of ORS 701 and may be required to be licensed in the Address: r G gr . jurisdiction where work is being performed. If the applicant is City: Q •,. � /� ZIP: / exempt from licensing, the following reason applies: Contact person: i A /1 _ 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. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard • work will be complied with, whether s ified herein or not Credit card number: / / Expires Authorized signatur / Date: e 20 Name of cardholder as shown on credit card Print name �e_R n ve- 4 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 (M)0000M) One- and Two - Family Dwelling .. , ,.. 1 ; ; Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard J b 0 Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 Cl Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I 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. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control litf plan CI 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 / 45 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 1 there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and h driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot ,' fi area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. . 1 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent ` V! 1 , i size and location. 1 / 41 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, u ,,-k 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. 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 (6/00/COM) Sio p p D - - vli,Lit 1 L -5 4_ - t .4- .g3L 4 4 l -t o rnedian 1_ ) Mechanical Permit Application .. A Date received: 3 86 0/ Permit no.:11S/ vi —tie/ ;'''`:i 1j ,' City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction .0 Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCIIEDULE Job address: / C A 5 ) (/ 1 J °""". L )J/ 1A/ 7, - d i ex Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: Suite no.: `/ value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ Lot: 'Block: ISubdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: I ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENT SCIIEDULE 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? ❑ Yes ❑ No Air handling unit CFM g p Air conditioning (site plan required) Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system - -_ MECHANICAL CONTRACTOR Boiler /compressors , ' ; State boiler permit no.: `' Business name: , r W �� HP Tons BTU /H . Address: Fire/smoke dampers/duct smoke detectors __ _ City: I State: I ZIP: Heat pump (site plan required) Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner ❑ Yes ❑ No CCB no.: Install/replace/relocate heaters—suspended, City/metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace 'o CONTACT PERSON Refrigeration: \-.4o Absorption units BTU/H Name: Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent \ Phone: Fax: E -mail: Dryer exhaust OWNER Hoods, Type 1/ II/res. kitchen/hazmat hood fire suppression system Name: Le e R • ?,ry I rf 0 Le6 Exhaust fan with single duct (bath fans) , Mailing address: „ " j /,_ . Exhausts stem a. art from heating or AC Fuel ' City: / 1 q � tate: 6k ZIP: "" 7 3 Type: p g aO� at oN p to 4 outlets) Oi Phone: p , p Fax: E - mail: 0046 (et Fuel i ing each additional over 4 outlets Process p p (schematic required) �� Name: Number of outlets _ Other listed appliance or equipment: : Address: Decorative fireplace City: I State: I ZIP: Insert —type Phone: I_ Fax: I E -mail: Woodstove/pellet stove Other: Applicant's signature-- ,--, I Date: 3/2 04 / Other. _ Name (print): Z.R. 12 o r1 Cv LA- G17 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $ Credit card number. / / expires if a permit is not obtained 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 (6/00/COM) • MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14.00 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond fraction thereof. footnotes below. Comp* *" 7) <3HP;absorb unit to 100K BTU 14.00 ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb Value Total unit 100k to 500k BTU 25.60 Description: Qty (Ea) Amount 9) 15 -30 HP; absorb Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00 ducts & vents 10) 30 -50 HP; absorb Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20 ducts & vents 11) >50HP: absorb Floor furnace including vent 955 unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM floor mounted heater 10.00 Vent not included in applicance 445 13) Air handling unit 10,000 CFM+ permit 17.20 Repair units 805 14) Non - portable evaporate cooler < 3 hp; absorb. unit, 955 10.00 to 100k BTU 15) Vent fan connected to a single duct 3 -15 hp; absorb. unit, 1,700 6.80 101k to 500k BTU 16) Ventilation system not included in 15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00 mil. BTU 17) Hood served by mechanical exhaust 30 -50 hp; absorb. unit, 3,400 10.00 1 -1.75 mil. BTU 18) Domestic incinerators >50 hp; absorb. unit, 5,725 17.40 >1.75 mil. BTU 19) Commercial or industrial type incinerator Air handling unit to 10,000 cfrn 656 69,95 Air handling unit >10,000 cfrrl 1,170 20) Other units, including wood stoves Non - portable evaporate cooler 656 10.00 Vent fan connected to a single duct 4 21) Gas piping one to four outlets Vent system not included in 656 5.40 appliance permit 22) More than 4 -per outlet (each) Hood served by mechanical exhaust 656 1.00 Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge $ • inserts, etc. Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ Each additional outlet 63 Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: Other inspections and Fees: 1. Inspections outside of normal business hours (minimum charge -two hours) $72.50 per hour. 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) $72.50 per hour 3 Additional plan review required by changes, additions or revisions to plans (minimum charge-one-half hour) $72.50 per hour * State Contractor Boiler Certification required for units >200k BTU. ** Residential A/C requires site plan showing placement of unit. i:\dsts\formsMech- fees.doc 10/11/00 Plumbing Permit Application ' Datereceived: C/ Permitno.: j- yr,.` -D/ 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 O 1 & 2 family dwelling or accessory O Commercial/industrial O Multi- family O Tenant improvement O New construction 6Addition/alteration/replacement O Food service O Other. JOB SITE INFOl MATION n FEE SCHEDULE (for special information use checklist) Job address: /9.9 0 9-5 — J //f , 44,1 ? Descri' [ion I . Fee(ea.) Total Bldg. no.: Suite L.: New 1- and 2- family dwellings only: Tax ma /tax lot/account no.: (includes 100 ft. for each utility connection) p SFR (1) bath Lot: (Block: I Subdivision: 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 Est. date of completion/inspection: Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: (:)(J.) f rL Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer Address: Dishwasher Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Name (print): , /,p R ,. .7q w av y 1 � [Pdl Garb a dis • s lnkstitib Mailing address: /,,,2 5 ,I,R - ill( ' L.-/ .) ; Po � 1 .�G \ ' I) j bibb • ol�l~OTtR�� *At City: _ ti State 'r ZIP: , Ic maker U Phone: 5 t 5,z4 -5 +'' Fax: E -mail: Inte = - ptor /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 (commeerr 'al)- employee on the property I own as pe/`�`— Chapter 447./ U o Sink(s), basin(s), lays(s) +7"- Owner's sign Date: d l Sump Tubs/shower /shower pan - Urinal Name: Water closet Address: Water heater City: _ I State: I ZIP: Other. Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information- Notice: This permit application Minimum fee $ U Visa U 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 TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00/COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (Individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavato 16 60 for each utility connection) ry One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3^ 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46 40 Lavatory Tub or Tub /Shower Hose Bibs p.lk1 I 16 60 (DU!? Tub • Roof Drains 1 7 16.60 Shower Only Drinking Fountain 16.60 Water Closet 16 60 Urinal Other Fixtures (Specify) Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL r 0 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL - Required only if fixture qty. total is > 9 TOTAL $ * Minimum permit fee is $72 50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts \forms\plm- fees.doc 10/10/00 Electrical Permit Application Date received: - /110 Permit no.: /'STS/ -ez,/143 l .i I City of Tigard _ Project/appl. no.: Expire date: Ciryq(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 ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction - Addition /alteration/replacement ❑ Other: ❑ Partial n .1011 SITE INFORMATION Job address: /a9a S $ uJ i / a R K , L;\ i Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivisi Project name: I Description and location of work on premises: Estimated date of completion/inspection: .CONTRACTOR APPLICATION FEE SCI !EDUCE Job no: Fee Max Business name: Le 10r ; l tribe' eoud1 or \� Description Qty. (ea.) Total no. insp Address: New residential - single or multi-family per dwelling unit. Includes attached garage. City: I State: I ZIP: Service included: Phone: I Fax: I E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: I Elec. bus. lic. no: Limited energy, residential 2 City /metro lie. no.: _ Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Services or feeders - installation, Sup. elect. name (print): License no: alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): Le Ro • f Q ,,,4 (/ • �,1 aci 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: `eG /,� 6� 5uu lb l Q P e LA) ' 601 amps to 1000 amps 2 City: -fl a , Q re ( I State: d2 I ZIP: 1 3 Over 1000 amps or volts 2 Phone:Zp l4I -J q I Fax: I E- mail: ebuch,gw##4 -,,, Reconnect only Owner installation: The installation is being made on property I an Temporaryservicesorfeeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: 200 amps or less 2 ORS 447, 455, 479, 670, 701. ' � 201 amps to 400 amps 2 Owners signature — !� Date3/ / 401 to 600 amps 2 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 Q C ity: 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): ❑ Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2 O Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, \ Q ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* _ 2 V O Building over three stones O Feeders, 400 amps or more *Descnption: O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighungplan ❑ 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 Not all junsdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ O 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 accepted as complete. TOTAL. $ Name of cardholder as shown on credit card • $ Cardholder signature Amount 440-4615 (6/00 /COM) Electrical Permit Fees: Limited Energy Fees: T YPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit 1000 sq ft. or less $145.15 4 n A udio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33 40 1 0 Burglar Alarm Limited Energy $75 00 Each Manufd Home or Modular n Garage Door Opener Dwelling Service or Feeder $90 90 2 Services or Feeders • n H eating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 n Vacuum Systems 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 2 O ther 601 amps to 1000 amps $240 60 2 I i Over 1000 amps or volts $454 65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100 30 2 • 401 amps to 600 amps $133.75 2 Check Type of Work Involved - Over 600 amps to 1000 volts, see "b" above., Audio and Stereo Systems Branch Circuits n Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n . Fire Alarm Installation . or feeder fee. $4Fj.85 �� G' First branch circuit 1 HVAC Each additional branch circuit 2 -- $6.65 / 3,.J 9 Miscellaneous Ti Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 n Intercom and Paging Systems Each sign or outline lighting $53 40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 I 1 Medical Each additional inspection over the allowable in any of the above Nurse Calls Per inspection $62.50 • Per hour $62.50 In Plant $73.75 ri Outdoor Landscape Lighting Fees: Pi Protective Signaling Enter total of above fees $ dais" Ti Other . y / 8% State Surcharge $ ' / Number of Systems 25% Plan Review Fee • No licenses are required Lic@nses are required for all other installations See "Plan Review" section on $ front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i \dsts \forms \elc -fees doc 10/09/00 vv • - Permit #: 1 / — 00 /43 0 # . 4 ' F. Address: /A94, aw I i9- I itS -t �, _ I c .� Issued by: 1 Date: /3.4/46y • /: g9� 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: 1. I own, reside in, or will reside in the completed structure. E 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. n 3A. My general contractor is I I (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. OR g 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 Construction Responsibilities on the reverse side of this form. — .10 0 3 %04 / (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Information ©rrl Notice to Priiperty Owners About Construction Responsibiiiti s Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board 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 f-[ SPOl SVEIII VTlES: 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 Division at the - Department of Human Resources at 378 -3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mast 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 if one 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.- Ilnter°nal 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 RESPONSV VLVmmCES 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. lLiability 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 of rough -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 BUILDING INSPECTION DIVISION MST ,,,,,IOv/ o /'f 3 24 -Hour Inspection Line: 639 -4175 ` Business Line: 639 -4171 BUP Date Requested l /0 :- , _ 'AM ' PM BLD Location / 2- 6, ,P. S tl Partiz Suite MEC Contact Person `1 -- Q�yt. 0 n Ph So SAO Li PLM • Conttr. r Ph SWR t: UILDI Tenant/Owner ELC -` in ing Wall - ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear IM Framing `, Insulation 1 9 Drywall Nailing I /� Firewall fO A 01 1 Fire Sprinkler!` 1 iNA Fire Alarm - Susp'd Ceiling Roof j Misc: COP - A 1�j PART FAIL ■ clio:-.._-,. 11---'1111M • :eam Under Slab ibtfe61 Top Out Water Servi - _ Sanitary Sew r _ Rain Drains 0" 60 -/e L..-- a:F*1 • ' T FAIL �/�J Pos : =eam Rough In Gas Line -. • • Smoke Dampers / J- -�:b_ - ART FAIL Service Rough In UG /Slab /...' Low Voltage Fire Alarm _ er" IMM PART FAIL E Backfill/Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA �—,_ Approach /Sidewalk /0/9/0 I / 0 Al Ext Ex D / Final PASS PART FAIL DO NOT REMOVE this inspection record from thejob site. MST = Master Permit • Zo -0 0 43 43 4 Inspection Description Date Pass By ; Notes Grading Footing /Setback q f �' . Foundation walls a, Slab Footing drain Waterproof basement walls Plumbing underslab Crawl drain Post/beam plumbing s p J eik Post/beam mechanical ti pi Rate Underfloor insulation / Post/beam structural -'9) S/, le/5 Shear walls /anchors Exterior sheathing H - i /_ a b/d\ Plumbing top -out Gas line & test Mechanical rough -in Electrical rough -in Electrical service Low voltage Sprinkler rough -in Backflow preventer Roof nailing Firewall Framing _ 6 - i /- el MFG -Home set -up Insulation 6/04101 g101 Drywall nailing Masonry/Reinforcement Rain drain ) 6/ Sanitary sewer • Water service Pump /fill septic tank • Approach/sidewalk Grading final _ Mechanical final Plumbing final Electrical final Final inspection Special Reports SWR• - Sewer Permit 4 Inspection Description Date Passed By Notes Sanitary sewer Final inspection INSPECTION RECORD — MST (MASTER) =PERMITS L CITY OFTIGARD R'JILDING DIVIS' V MST y3 24 -Hour, Inspection Line: 3-4175 - Business Line: 63b -4171 BUP Date Requested //'? ' AM • PM BLD - Location /Lt/ z- S4/ (Jl l(4�� �/ -v /! ( Suite MEC Contact Person Ph 51 Y -- 5' z i PLM Contractor ()wit/ E v'— Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN • Crawl Drain Inspection Notes: Slab 6/4 011 IDrj SIT • Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL go 1� J — SS' • PLUMBING ( /l CPt /h Post & Beam Under Slab Top Out Water Service Sanitary Sewer _ Rain Drains Final . PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line • Smoke Dampers Final • _ PASS PART FAIL Service u gh I lab Low Voltage . Fire Alarm C PASS PART . FAIL SITE Backfill /Grading Sanitary Sewer • Storm Drain [ ] Reinspection fee of $ required before inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date C //, D/ Inspector l4 / Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF 9TIGARD BI "' .DING INSPECTION DIVISIO MST Q ' • 214ur Insp'ction Line: 6. 4175 Business Line. 639 1 -l am �?1 Datj Requested AM PM BLD SN - ‘ Location L41//, Suite MEC - Contact Person • Ph o S4- PLM Contractor Ph SWR UIL 1p Tenant/Owner ELC • Retaining Wall ELR ( Footing Access: 1 Foundation FPS Ftg Drain SGN Crawl Drain - Inspection Notes:. 6� „ Slab SIT Post & Beam Ext Sheath /Shear - Int Sheath /Shear Frami 4 rywall Nailing Firewall Fire Sprinkler Fire Alarm - Susp'd Ceiling Roof Misc: Fi PART FAIL • g BING • Post & Beam • Under Slab Top Out Water Service Sanitary Sewer • Rain Drains • Final PASS PART FAIL MECHANICAL Post . o4C In Smoke Dampers Fi AS PART FAIL • CTRICAL Service Rough In UG /Slab Low Voltage . Fire Alarm . Final . PASS _ PART FAIL SITE Backfill /Grading Sanitary Sewer Storm -Drain • [ ] Reinspection fee of $ required before next inspection: Pay at City Hall, 13125 SW Hall Blvd j Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA / Approach /Sidewalk (601(‘1161/ ���/pC/ Ext Other Date Inspector Final ‘■ PASS PART FAIL DO NOT REMOVE this inspection record from-the job site. G fy P ,CITY OF TIGARD P' IILDING - INSPECTION DIVISI ^N MST .4-66/-00 ,l3 y~ 24- Hourinspection Line: 3 -4175 • Business Line: 6S. .171 / BUP Date Requested L� �r ' AM PM BLD Location / 2.9Z r - S' ill / ? 4. < v Suite MEC Contact Person Ph 524 C PLM Contractor Ph SWR UILDIN Tenant/Owner ELC ° Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab S IT Post & Beam � iwfi. heath 1i s 4 . CS .o/ �. - sulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling . _ Roof • F nal ASS PART FAIL PL ING Post & Beam Under Slab Top Out V _ Water Service Sanitary"Sewer Rain Drains Final . PASS PART FAIL V - Post & Beam • as Line Smoke Dampers Final - • PASS PART FAIL ELECTRICAL - • Service _ Rough In UG /Slab. Low Voltage Fire Alarm . _ Final . PASS PART FAIL SITE Backfill /Grading • Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hail Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other ns P. D C� `l-�Dl Inspector Ext • Final • PASS PART. FAIL V DO NOT REMOVE this inspection record from the job site. fi L G,sz-P 3 ,. sl CITV,.OFTIGARD R'IILDING'INSPECTION DIVISInN . MST /oaf -Gv /ci 24 -Hour Inspection Line: J -4175 • Business Line: 63 171 BUP Date Requested 4 4' 2 5 ' AM • PM BLD Location t � ? t St• 0h/4y 91 /( 6^. Suite MEC Contact Person Ph 6 t- , l-3 z-/ PLM Contractor Ph SWR =1_ _DIN Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain • Crawl Drain Inspection Notes: - _ SGN Slab -SIT �1*�& B- Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Fin I PAR FAIL UMBIN _ 13 ea Under Slab Top Out • Water Service Sanit wer in Dra' Fi - "AS PART FAIL G1�nct R.. Roams Rough In Gas Line Smoke Dampers Fina S PART FAIL CTRICAL Service / Rough In , UG /Slab \/ Low Voltage Fire Alarm Final . PASS PART FAIL _ SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: • - [ ] Unable to inspect - no access ADA Approach /Sidewalk Date i InS ect ‘/6 E r! Other p Final . • PASS - PART FAIL DO NOT REMOVE this inspection record from the job site. • I1YOF -TIGARD P' IILDING INSPECTION DIVIS' MST G .3 24 -Hour Inspection Line: ,9 -4175 • Business Line: 63.. -4171 BUP• Date Requested 4 ' AM PM BLD Location /e-4 S /(4u l4( Suite MEC Contact Person Ph 5 Z i -- Lv( PLM Contractor Ph SWR UI Tenant/Owner ELC Retaining Wall ELR Footin Access: FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT - - . Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing -/ Aif'- . , .�. c C� . Insulation Drywall Nailing. u Z 4. 475 . – .v Firewall _ Fire Sprinkler . Fire Alarm Susp'd Ceiling _ Roof Misc: Final SS PART FAIL PLUMBING Post & Beam • Under Slab TO Out , Water Service Sanitary Sewer - Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line - • Smoke Dampers • Final • PASS PART FAIL ELECTRICAL Service Rough In . UG /Slab Low Voltage . Fire Alarm . Final PASS PART _ .FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: - [ ] Unable to inspect - no access ADA Approach /Sidewalk - Other Date « /"- -fJ / Inspector Ext Final PASS PART FAIL . DO NOT REMOVE this inspection record from the job site. I p,; WIZARD BUILDING •INSPECTION DIVIS' MST 02o a- aCJ 5/.3 24 -Hour Inspection Line: ;9 -4175 • • Business Line: 6b.. -4171 BUP Date Requested '7 1 ( ' AM PM BLD Location /2y ZS S lid/ /p 1...„ Suite _ MEC Contact Persor( am,,& t 4) Ph 51 t( 3 2U4 PLM Contractor Ph SWR BUI N Tenant/Owner pa-- 1L a- pay.k- ELC Retaining Wall EL R _ , Footing Access: FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab SIT - Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing � • Insulation Drywall Nailing Firewall Fire Sprinkler . Fire Alarm Susp'd Ceiling Roof - Misc: Final • - PASS - PART FAI PLUMBING Post & Beam • Under Slab Top Out Water Service Sanitary Sewer Rain Dra ins _ Final PASS PART FAIL MECHANICAL Post & Beam • - Rough In Gas Line Smoke Dampers Final PASS PART FAIL • . ELECTRICAL Service Rough In . UG /Slab_ Low Voltage . Fire Alarm Final . PASS PART FAIL SITE Backfill /Grading V • Sanitary Sewer Storm Drain ' [ ] Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk D / �� t ° Inspector /1 Ext Other p Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. . • • F TIGARD RVILDING-INSPECTION DIVIS'"'N MST c/".— - 24- HourInspection Line:. ,9 -4175 • Business Line: 63..4171 " • BUP 6 g Date Requested ° f y ` PM BLD_ Location /02 V- S #1. 4 - Suite MEC Contact Person / in Ph 59(,-6 PLM Contractor Ph SWR BUILDING Tenant/Owner ELC R- Wall ELR ooti : Access: OFF l/o 4JT� LAk C / \ 3d"I FPS oundation Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear • Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling . Roof Misc: F a l PA S O PART FAIL UMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer • Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam - Rough In Gas Line ' - Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART - FAIL SITE • • Backfill /Grading Sanitary Sewer Storm Drain . • [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: • - [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date / to —el Inspector Ex Final PASS PART • FAIL • DO NOT REMOVE this inspection record from the job site. •