Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00289
4 DEVELOPMENT SERVICES DATE ISSUED: 7/18/03
'�' - 1
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
SITE ADDRESS: 12285 SW WHISTLER'S LN PARCEL: 2S103CC - 11100
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 058 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM170 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,637 sf BASEMENT. sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,553 sf GARAGE: 654 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE' 312 20
OCCUPANCY GRP: R3 BDRM: 6 BATH: 3 TOTAL' 3,190 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 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:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K• 1 UNIT HEATERS' HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU 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: $ 5,655.45
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
Tigard other Muni a Code, State work k w Specialty Codes and
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 all other applicable law All work will be done i
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 t
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: 503 387 - 7538 Phone' Oregon Utility Notification Center. Those rules are set
5 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
L
Reg #. k387 may obtain copies of these rules or direct questions to
5 OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
, Erosion Control lnsp 8A Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insf Gyp Board Insp Water Service Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Appr /Sdwlk Insp
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Electrical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Roof Nailing Mechanical Final
Post/Beam ral Mechanical Insp Shear Wall lnsp Insulation Insp Water Line lnsp Plumb Final
Issu d By : ■ f :i? 4/1 t u . Permittee Signature : thl*Vte---- C
(503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Building PerF .. � . . - , 1 . ' on
Date received:6 1,43 Permit no.:1 {f .e -,90,a 8 9
.4 14':::iiii City of Tigard
�,Q
y" Project/appl. no.: Expire date:
CuvofTigard Address: 13125 SW Hall Blvd, rd3 Ze833
'hone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file Payment
BUILDING DIVISION type:
Land use approval: 4, 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family , 'New construction ❑ Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: .p!i/ ��'1 i Bldg. no.: Suite no.:
Lot: a' Block: Subdivision: T /'= LIV.l�M NI Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
,= ' , (Floodplain, septic capacity, solar, etc.)
Mailing address: ' esre ff ea ia_1 _=a..iartall 1 & 2 family dwelling:
EDR1111 '� ZIP: ' J Valuation of work $ 33/0 b VI, Ztj
Phone: , ralaal f j] g No. of bedrooms/baths sa
Owner's representative: , Wall' i _ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) 1 lS
APPLICANT Garage/carport area (sq. ft.) -CV
l� J!• ^211111 Covered porch area (sq. ft.)
Mailing address: �L2 t Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindastriallmulti- family:
CONTRACTOR Valuation of work $
- �� (� Existing bldg. area (sq. ft.)
Address: -l� v< s �i New bldg. area (sq. ft.)
C
Number of stories
City: State: ZIP:
P
•
hone: Fax: E -mail: Type of construc
CCB no.: Occupancy up(s): Existing:
New:
C •¢ ` t , " " Notice: All contractors and subcontractors are required to be
. ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
= - , provisions of ORS 701 and may be required to be licensed in the
Address: • jurisdiction where work is being performed. If the applicant is
` � .A C` � exempt from licensing, the following reason applies:
City: State: ZIP:
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 r rovisions of 1 ws and o' din aces governing this 0 Visa ❑ MasterCard
work will be compl - • wt whether ifterl Berelrl ? t. Credit card number: / /
1� �j
Authorized Si y atu r , / f .1 �.:re: Name of cardholder as shown on credit card Expires
Print name: T! ' ' f t l -e- 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 (6roWWCOM)
One- and Two - Family Dwelling
Building Permit Application Checklist
Referenceno.:
City ofTigard C of Ti and Associated permits:
J g 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, 04 97223
Phone: (503) 639 -4171 t 0 Other:
Fax: (503) 598 -1960
`THE FOLLOWING ITEMS ARE•REQUIRED FOR PLAN REVIEN1' Yes ''NO' N /A'
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V
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. k
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 k/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area building coverage area; percentage of coverage; impervious area existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location. -
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, 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.
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 (6/00/COM)
•
Mechanical Permit Application • >- ,'` - . ,.
��� Date received: , Al. 7 p Permit no.: �yj , „.3- o oa.
�t1i�l City of Tigard ty g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
Cl 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi family ❑ Tenant improvement
lew construction ❑ Addition/alteration/replacement ❑ Other:
- 'JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE -
Job address: a .,. j 1./.) n . i ■ 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: • val Block: Subdivision: na.l f�rot.`.'7 `See checklist for important application information and
Project name: 'wr r jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: '.`:; I 14 FAMILY DWELLING- PERDIIT•FEE,SCI(IEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
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
a;) r s 'i 4 4 "j � ig; ! RINC.fnR x ,., T* , '' . Boiler /compressors
.,, ?
Business name: a' State boiler permit no.:
B
t -�' ■_�I.J - HP Tons BTU/H
Address: �� iM Fire/smoke dampers/duct smoke detectors
4. Li f ZIP: iii 1 1 Heat pump (site plan required)
Phone:,,, � . ' Fax: Email: Install/replacefurnace/burner BTU /H
y � Including ductwork/vent liner ❑ Yes 0 No
CCB no.: ') 1j
r9( lnstall/replace/relocate heaters - suspended,
City/metro lic. no.: N/A wall, or floor mounted
(please print): �'
Name (P P ) 6 fp j 1 - . jai •a..-(___ Vent for appliance other than furnace
:z1 -i'r� x ,F 4 =} t 1" r PERSON Refrigeration:
-. rs , ���, o: -. 4 j_, "f I LIZtiON Absorption units BTU/H
Name: 0 -7 1`i-k Chillers HP
Compressors HP
Address:
-. AA__ 1 .6 (' 41 • Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
V.,_ Hoods, Type I/ lures. kitchen/hazmat
hood fire suppression system
EN/Lik.i l ql! el_ ■ Exhaust fan with single duct (bath fans)
Mailing address: III ZTI ) / �_� ea] Exhaust system apart from healing or AC
City: ' Fuel piping and distribution (up to 4 outlets)
y' �i��i �� Type: LPG NG Oil
Phone: . E -mail: Fuel piping each additional over 4 outlets ,
'ENGINEER , . . • Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City I State: I ZIP: Insert - type
Phone: Fax: E -mail: I ,,,,yy Woodstove/pelletstove
g ��AP��� gL����(J17 oth Applicant's si na[u" : Date:
Name (print): ( ; . i Yr f N n .
Not all jurisdictions accept credit cards. please call iunsdtcuon for more information. Permit fee $
Notice: This permit application Minimum fee $
CI Visa ❑ MasterCard expires if a permit is not obtained
Credit card number Expire w 180 days after it has been Plan review (at — %) $
State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440-4617 (6RXI/COM)
Plumbing Permit Application .,y ; s - i -. t
Date received: , bc 6 Permit no.: ► c o . ; -
^`,.. City of Tigar d • Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard. OR 97223 ProlecUappt.no.: Expire date:
City ojTigard Phone: (503) 639 -4171
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Case file no.: Payment type:
Land use approval:
. 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 Food service 0 Other.
..
t ' JOB SITE INFORMATION _ :.,. - 'FEE 'SCHEDULE • (for speci s l information use checklist) ` -
Job address: 1 .-75 5UV 9r ' ( 1A'-\. Description Qty. Fee(ea.) Total
New 1- and 2 - family dwellings only:
Bldg. no.: Suite no.: ('includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: _ n � SFR (I) bath
Lot � j Block: I Subdivision: SFR (2) bath _
Project name: \ �V ot\ 1V �r — SFR (3) bath
City /county: f 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.)
' PLUMBING.: CON FRACTOIi..... Manufactured home utilities
Business name: 11.,(Z_p‘ L i Manholes
Address: T .eb_ l • 40 Rain drain connector
��
• -Ia. State ZIP: Sanitary sewer (no. lin. ft.)
• Storm sewer (no. lin. ft.)
one: y�� Fax: E-mail: Water service (no. lin. ft.)
CCB no.: t, 09) •
"7 ∎-1 Plumb. bus. reg. no: - - - Fixture or item:
City/metro tic. no.. N/A — �` / Absorption valve
Contractor's representative signature Back tlow preventer •
Print name: • • / I U. i r Backwater valve •
• CONTAC 1 ('I RSON ' Basins/lavatory
Clothes washer
Name :. 1`"i V���i 1.....1 E Dishwasher
Address: _ aA , / 0 I , • V Drinking fountain(s)
City: I State: ZIP: Ejectors/sump
Phone: 1 Fax: E -mail: Expansion tank ,
- - , ,. OW Nl li, • • Fixture/sewer cap
Floor drains/floor sinks/ hub
Name (print): :. t� ( Garbage disposal
Mailing address: -�•{�} -ej (27 PCLP \ 4 " -� Hose bibb
City: L _ f l , Statea I ZIP:Cl - 7C�S Ice maker
Phone: —' - i Fax: ?7 l 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
ENGINEER Tubs/shower /shower pan
Urinal
IIIIMJ,
Name .
Water closet
Address. Water heater
City: - State. ZIP. Other.
Phone Fax. 1E-mail: Total
Minimum fee $
Notice. Na ill cunsd coons acce credit cards. please call tuns h m m
cuon for ore in(ouuon \ Ni This permit application % $ �_
Plan review (at _ )
0 Visa 0 MisierCard expires if a permit is not obtained State surcharge (8 %) ..•• $ � —
C.edu ;aid number _ w ithin 1 80 d ais after it ha_s been $
Expires accepted as complete TOTAL --'
Name of cardholder as shoaln oa credo card
S 44 16 (GOU('OM)
■ Cardholder signature Amount
Electrical Permit Application ,..).' : ' , '''' ": •:- - . , ,-- ' ,-, - ,.
Aii. Date received: . If p Permit no.: i - j _,. 3, DD �;
�` :�}.. I'� P ro ect/a 1 no.: Ex
r ,�y ; ..� I Ci of Tigard J PP • Expire date:
P
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171 .
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
: r . c 0 r ,, . „ �^ `Y r .74;, htis OFP '''P',;•`, }Il " ` }' ' • .
'" = t } A . „-#y'r. ?ley rP" ,d , •; f '1.';'..'-'-'. � .�i` ".tj J
l '. ' Y "'' r 1 �; • . s SAS, Y . , ;• ',.,
❑ 1 & 2 family dwelling or accessory O Commercial/industrial ❑ Multi- family 0 Tenant improvement
►: New construction 0 Addition/alteration/replacement ❑ Other. 0 Partial
. JOB SITE INFORMATION
Job address: ,.:rl�''7.� n Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ' f2' Block: Subdivision: 1 AM T
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CON I RA(; I OR Al'I'l.IC \ I ION FE E SCHEDULE
Job no: / -7". Fee Max
Business name: . 1 Description Qty. (ea.) Total no. lnsp
_ i '— New residential -single or multi - family per
Address: /111W.- dwelling unit Includes attached garage.
1213C �t�
ettnitNIZEI Serriceincluded:
Phone: .j - I rj,J Fax: E -mail: 1000 sq. ft. or less 4
z Each additional 500 sq. ft. or portion thereof
CCB no.: y ,�� Elec. bus. lic. no: � p� Cs Limited energy, residential 2
C' Limited energy, non - residential 2
Each manufactured home or modular dwelling
nature of supervising electrician (required) Date , r ii • Service and/or feeder 2
Sup elect name (print) 1 ef_ _ aJ', License no 9a. Services lon or or eders — installation,
_AL alteraton or relocation:
PROI'I It "I'Y OW-NI•:lt 200 amps or less 2
0 201 amps to 400 amps 2
Name rint t..
(P : � 'I� �-�� 2
40l amps to 600 amps
Mailing address: ��1 �( ! _� 601 amps to 1000 amps 2
City: c. State ZIP. - 20 Over 1000 amps or volts 2
Phone: ,''y - Fax: - a, -mail- Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation: 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
X• °t a,, '� r 4 ENGINEER ti: « f l Branch circuits - new alteration,
i s .... _.. , _ or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 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):
O Service over 225 amps - commercial O Health-care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 O 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
0 Building over three stones 0 Feeders. 400 amps or more 'Description. .
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other Per inspecuon 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 lurisdreuons accept credit cards. please call lu isdicuoo for more information Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card amber. / / within 180 days after it has been State surcharge (8%) .... $
Eap'res accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440 -4615 (6■3i'COM)
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1 STREET TREE
CERTIFICATION
•
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I 8 L. v...6 LEAS , O w ne r /Agent for f Ai,„.L„,_, - /- e s
(PLEASE PRINT) (PERMIT HOLDER) ■
1
I
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1
• Do hereby ceiiify that the following location ■
• •
•
meets City of Tigard /Washington County •
.
land use and development standards for street tree installation. •
•
• ADDRESS: Zd5 50) mm- /57 L/1) ■
■
• A 7-
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i LO 4S SUBDIVISION: L✓4 %s' .Lee3 1ri/4 - Ll c Ot
• BY: X DATE: /a -5o -L3 R
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EIVED BY: �/ ■ DATE: // - D - �e , 3 P
• REC �, L.
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CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 639 -4175 MST 3 '.0 d -.8 ?
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested f / AM PM BUP
Location / 2 Z gS Le) Suite MEC
Contact Person Ph ( ) d 1 — L/ 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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
EF AL
��
Gas Line
Smoke Dampers
•
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
ASS ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
.AT Please call for reinspection RE: LI 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 d O
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date R q est d I/ 1 in 0 3 AM PM BUP
Location I a- a.'� S h41 \ 1 'a % Suite MEC
Contact Person V Ph (E" 1) 1 —1 \ S31 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner V ELC
Footing ' ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing .
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Otherr. _
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
RT FAIL
Service
Rough -In _
UG/Slab
Fire Alarm
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
Approach /Sidewalk Date / Inspector A!Cd'P 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 O 2.87
INSPECTION DIVISION Business Line: (503) 639 -4171 _
BUP
Received Date Requeeste� /6 — 3 ( AM PM BUP
Location gcc r,eL4 Suite MEC
Contact Person �� Ph ( ) c J - { 3 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:
0/
gsg PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Fi -
PART FAIL
TRICAL
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: 111 Unable to inspect - no access
Fire Supply Line
ADA �r11 i�.
Approach/Sidewalk Date I/O 13 1 (o 3 Inspector 1 s , L `c_ 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 - D O c O
INSPECTION DIVISION Business Line: (503) 639 -4171 .
BUP
Received / Date Requested ( AM PM BUP
Location / a-a- S Suite MEC
Contact Person Ph ( ) d ? C le 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
— i•ASW 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
W 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
ADA fl —
• Approach /Sidewalk Date Inspector • Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•