Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00468
te- . .-�� � , DEVELOPMENT SERVICES DATE ISSUED: 10/22/03
s ' - " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12370 SW WINTERVIEW DR PARCEL: 2S110BC -04100
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 012 JURISDICTION: TIG
REMARKS: Construction of new SF detached residence.
BUILDING
REISSUE: DM181 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,616 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,684 sf GARAGE: 604 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THUD: sf RIGHT: 5
VALUE: 322,684.60
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,300 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 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 W/O SVC/FDR: SIGN /OUT UN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ ampNolt :
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 8 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: $ 6,004.40
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035 work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Rea #: ig3�, may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control lnsp & Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Gyp Board lnsp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
7
Issued By : Permittee Signature :
Call (503 6394175 by 7:00 p.m. for an inspection needed the next business day
- ,E 7 /G N - U3 P 1O g�,9
' Building Permit A Ideation � .,, - '" -- i
RE G I Dat received : /r p3 Pe no.: j
k � City of Tigard �ED I�sv3 .../6ir
Address: 13125 SW Hall Blvd,C rd, QR 97223 �ojecdappl. no Expire date:
City of Tigard Phone: (503) 639 -4171 "`" 1 c1 J Date issued: By:,j I Receipt no.:
Fax: (503) 598 -1960 �/( Case file no.: Payment type:
CITY OF TIGARD "�
Land use approval: BUILDING DIVSSi0N 1&2 family: Simple Complex:
TYPE OF PERMIT ,
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ,New construction 0 Demolition
O Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm O Other.
3011 SITE INFORMATION
Job address: 1, % � Bldg. no.: Suite no.:
Lot: siim Block: Subdivision: lik el Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
-• OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
ll v, , ( Floodplain , septic cnpacity;solar,ctc.)
Mailing address: aerow rAIR la RM 1 & 2 family dwelling:
EMIR1/11 EIMIIIM■ EMMA ZIP: itglArIPM Valuation of work 2- Io j
Phone: r` r� _ .: No. of bedrooms/baths
Owner's representative: , if _ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) ' ofd
APPLICANT Garage/carport area (sq. ft.) / I ir
e � i:-°l'IMIIIIM Covered porch area (sq. ft.) G
Mailing address: 41.11 a ,♦ _ Deck area (sq. ft.)
City: State: ZIP Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustrialmulti- family:
- -- .. ._ ___ CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
1211202VOMTIAMMINII MI <LI New bldg. area (sq. ft.)
Address: .� vL� W-
City: State: ZIP: Number of stories
gy
Type of construction
Phone: Fax: E -mail: Occupancy group(s): Exits g:
WLMIONMEMIMIIIIIIIII CCB no.: �''�
City/metro lic. no.: T Ne
Notice: All contractors and subcontractors are required to be
ARCI IITECI /DESIGN Fit licensed with the Oregon Construction Contractors Board under
MIMI ii� ��,- , provisions of ORS 701 and may be required to be licensed in the
r , t . jurisdiction where work is being performed. If the applicant is
"� � exempt from licensing, the following reason applies:
State: 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. • . rovisions of l ws and od�mances governing this ❑ Visa ❑ MasterCard
work will be comp] - • wt.. whether ifred Herein t. I l Credit card number- / /
A i1 5
Authorized Si i • • i i_ A I� Name of cardholder as shown on credit card expires $
eti
Print name: v!>_S t 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 (6r0O/COM)
One- and Two-Family Dwelling
Building Permit Application Checklist
Reference no.:
CuyofTigard Cl Of Tigard
Associated permits:
`J b O Electrical O Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other.
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control O plan ❑ 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 r/
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, `l
fireplace construction, thermal insulation, etc. J�
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 Y
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 f
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 ". x
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 (daoicoM)
• • • • 4...f - .' -. *:-.4.r "ii x- . +4. r G` a y�G,ne y _ .�.p-
Mechanacal • Permit Applicati "
•
A � Date received: Permit no 5 00 03 -coif •
� City of Tigard x .11 ty g Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Bl 972 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 P
Fax: (503) 598 -1960 SEP • 15 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGAHO Building permit no.:
t. a ■ •∎,
TYPE OF PERMIT , . .
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement •
XIew construction 0 Addition /alteration/replacement 0 Other.
• JOB SITE INFORiMATION - ' - r : ' COMMERCIAL - VALUATION SCHEDULE
Job address: TV N 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: (Subdivision: `TROY l 6 '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/IlNDUSTRIAL EQUIPMENTSCIfEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
•
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
MECIIANIC AL CONTRACTOR RACTOR Boiler /compressors
S=IN�� � �I.0 State boiler permit no.:
�! /_�i HP Tons BTU/H
Address: i w'; F dampers/duct smoke detectors
City: �� 02150122fi'lleilaill eat pump (site plan required)
Install/replace furnace/burner BTU /H
Phone: _$ . 'Fax: E -mail: Including ductwork/vent liner O Yes 0 No
CCB no.: 'F . 9 C. "7()' 1 Install/replace/relocate heaters — suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): 1.(2 .1p ' 1•10.-L_ Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: .1 ... 41 ' � #� Chillers HP
Com.ressors HP
Address: t �� R 41•I
Environmental exhaust and ventilation:
e City: State: ZIP: Appliance vent .
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: , Ri Exhaust fan with single duct (bath fans)
Mailing address: I WIT. / ila � *A Exhaust system apart from heating or AC
City: , r , State•�� 4 ZIP V) ,5 Fue piping an distribution up to 4 out
Type: LPG NG Oil
Phone: t 7- _ r Fax: 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:
W oodstove/pellet stove
PP g �', �_ dr I OOther: A Applicant's si natu ":� � f Date: I. /� Other.
Name (print): ( . ( r f 1D rg. l 1
lir
Permit fee $
Not all junsdicuons accept credit cards, please call junsdiction for more information. Notice: This permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number I Plan review (at _ %) $
Expires within 180 days after it has been
re bed as complete.
State surcharge (8 %) .... $
a c
Name of cardholder as shown on credit card p p TOTAL $
Cardholder signature Amount 4444617 (6 )0/COM)
Plumbing Permit Application -:.. - .
Date received: Permit no.:11*A . • 3 _00 . I,
• City of Tigard
� Ali p (i ce Sewer pemut no.: Building permit no.:
` Address: 13125 S al� s po 6223 Project/appl.no.: pire date:
City ojTigarQ Phone: (503) 639
Fax: (503) 598 -1960 SEP Date issued: By: Receipt no.:
15
Land use approval: D Case file no.: Payment type:
IT'? or t I ur� 2003 _ .
TYPE OF PERMIT
0 I & 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.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: a, 0 �L, ( (r Description a • Fee(en.) 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.: SFR (1) bath
Lot_ l w all Block: Subdivision: ��J 7 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
_ Footing drain (no. lin. ft.)
PLL S1l3ING CONTRACTOR , .• : s Manufactuted home utilities
Business name: IN `, L i Manholes
Address: 1 '. • Rain drain connector
City: ` , • _amp ■ _ i�'al ZIP: Sanitary sewer (no. lin. ft.)
E -mail: Storm sewer (no. lin. ft.)
Phone: y f Fax: Water service (no. lin. ft.)
: no.: to - 7 t_ Plumb. bus. reg. no: - _
V Fixture or item:
City/metro lic. no.. N/A �/ / Absorption valve
Contractor's representative signature /�.�(/ Back flow preventer
Print name: , `� ` Backwater valve IIII
"'' CON IAC1' PERSON Basins/lavatory • Clothes washer
Name:,1{�� - i ���11�E Dishwasher
Address: - mik es / f IC ,V - Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E - mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): 1 :att Garbage disposal
Mailing address: • - • Lta► 11 • , - Hose bibb
ligl
City: LEVIAlbZii Ice maker
Phone: j . - Fax: AMFZEOBIED Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Pnmeris)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s). basin(s). lays(s)
Owner's signature: Date: Sump
Tubs/shower /shower pan
ENGINEER. Urinal
Name: Water closet
Address: Water heater
City I State• 1 ZIP. Other ,
Phone. I Fax: I E -mail. Total
p pp Minimum fee ...........% .... $
Na all I insdicuonr accept tredrt cards, please colt tuns licuon for more tnfomuuon N otice: This 'rmit l ication
Plan review (at _ %)
0 dil c 0 �tasterCatd ard number / expires if a permit is not ob State surcharge (8 %) ..•• $ �-
C.cdit c within 130 da.s after it has been a
Empties accepted as complete. TOTAL _.-------
Name of cardholder as shown oa credit card
S 4404616 (bOdCbM)
Cardholder signature Amount
a. . ,,-7 r T .w M1x n1N e. ' . • s S Y
Electrical Permit Application � � �v � Z ` :: `X 3:
Datereceived: Permit no.:/ A po 61,
:•� City of Tigard,. . e ..p c ll Project/app1.no.: Expire date:
City of Tigard Address: 13125 S�t1J l ), 1 ig OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 b 1 ;) 816 Case file no.: Payment type:
Land use approval: ��;.� rc Tl( ?HIV
_ S
. TYPE OF PERMIT ,
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
►' New construction 0 Addition/alteration /replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION
Job address: t ' Js 0 Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: , Block: Subdivision: (rh,(flfl
Project name: li Description and location of work on premises:
Estimated date of completion/inspection:
- - : . CON I Rr \CfOR APPLICATION '7 - FEE SCHEDULE
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. hasp
New residential - s or multi -fly per
Address: ' e� �` �(
7. dwelingunit . ingle Includes attached garage.
EMI t � CiliiL'I7t.'.� service included:
Phone: 22 l ` Fax: E -mail: 1000 sq. ft. or less 4
'J r �J � Each additional 500 sq. ft- or portion thereof
`Kai: to -11/10-1t11111 Elec. bus. lic. no: �%y'tall Lim energy, residential 2
C' Limited energy, non - residential 2
Each manufactured home or modular dwelling A'r
nature of supervising electrician (required) Date Off
Service and/or feeder
�i 2
�� Se rv i ces or feeders - installation
Sup elect. name (prtntp 1 _ rF w Z, License no.
�I)► alteration or relocation:
PROPERTY OWNIN:R 200ampsorless 2
l
Name (print): 201 amps to 400 amp 2
(P ) . �. �, '������ 401 amps to 600 amps 2
Mailing address: '��� , �t I ,�� �• 40 601 amps to 1000 amps 2
City : ► b St ate 41 ZIP: 20 Over 1000 amps or volts 2
Phone: , ✓ ':j Fax: _Z- 7 _,Ar• -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporaryservicesorfeeders - -
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
ENG INEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 1 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 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of l&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration. or extension* 2
O Building over three 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:
O Egress/lightingplan 0 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 jurisdictions accept credit cards, please Permit fee $
lease call jurisdiction for more tnfarwuan. N 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
S
Cardholder signature Amount 440 -4615 (6430PCOM)
4 A 57,2003 - 0 4/0 g
A ►
i ►
►
E CERTIFICATION THE STREET
• 0- I, U SE PRIN , O wner /Agent for Po I t '( ci.•s sak ;M d S
(PLEASE PRINT) (PERMIT HOLDER) ►
►
1 ►
• Do hereby ;certify that the following location ►
• ►
• meets City of Tigard/Washington County ■
• land use and development standards for street tree installation. ■
• ►
• P
•
t ■
i ADDR / Z 3 7 5,..) WiAir viF D'2 , ■
•
• LO / S UBDIVISION: / ,2n� c-✓.aJ /� R
• ■
i _�
4
■
a BY: - - - DATE: ..2 - /o - 0 V ■
fl- .■ 111. DATE: E RECEIVED BY
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection a (503) 639 -4175 3 -ODc6pe
INSPECTION DIVISION Busines tie: (503) 639 -4171
BUP
Received Wi to Date Requested / 7 t PM BUP
Location l 2 2) 7b 60i44,& (Lii) Suite MEC
Contact Person ./ 2Jet Ph ( ) n � C f '— 141 PLM
Contractor U fig 1.11444- Ph ( ) SWR
BUILDING " 12e Tenant/Owner ELC
Footing •
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab - Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear • .( m S (§.)
Framing 0 2 • � l J G
Insulation
Drywall Nailing `�� `—
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
( : IN G R T FAIL Post & Beam 4 1 1
Under Slab � Agri ,
Rough -In /
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
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: El Unable to inspect — no access
Fire Supply Line
ADA - /Z -
Approach/Sidewalk Date ( Inspector v . ■ �
Other:
Final DO NOT REMOVE this inspection r rd from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection.Line: (503) 639 -4175 MST 3 — Oa (4
INSPECTION DIVISION Business Line: `1503) 639 -4171
BUP
Received Date Requested o —0 AM PM BUP
Location / a 37b Suite /,� MEC
Contact Person o Ph ( ) ol c ?" . 37 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 /14 `g 4% PQ 5' 7 S s/ , ,
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ot�
P SS • • FAIL
P Il 'l 4 l ; ea •
P. . Slab NO : /- {d«iL�/L £;"/k
Under Slab
Rough -In / c
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O I:r:
PART F L
M ANICAL
Post & Beam
Rough -In
Gas Line
Smoke D. pers
ICAL
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: D Unable to inspect — no access
Fire Supply Line �,
ADA , . /1e
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
• BUILDING Inspection Line: ' (503) 639 -4175 MST ` - at) yc, a c�
INSPECTION DIVISION Business Line: ••(503) 639 -4171
BUP
Received Date Requested 2 -/D AM PM BUP
Location I 3 746 Suite MEC
Contact Person — Ph ( ) d5 F 3 7 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 sSO N � �+ 1 !PIN I IN 5 A ►� c1 -
Suspd Ceiling
Roof
Other:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage N° L 2,A F rn
Fire Alarm
If *k PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Ext
Approach/Sidewalk Date2 - Inspector
Other:
Final DO NOT REMOVE this Inspection record from the Jo site.
PASS PART FAIL
CITY OFTIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 a, 3 _ l ezi& S
INSPECTION DIVISION Bu ss,Line:: (503) 639 -4171
BUP
Received *b 3 5 Date Requested c.2 — 1/ - 10 4 /AM PM BUP
Location / 3 70 GI);tiv 7Li_. k u) Suite / / MEC
Contact Person Ph ( ) 20 _4 �3 7 7 PLM
Contractor G O/Y1 Ph ( ) SWR
BUILDING /2c 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 (J P / ,
wA�S c,v cE
Drywall Nailing �-
Firewall yC U M NT— �TA-�� &r ' Y T� W^ f .S
Fire Sprinkler 1 6 YV /'1r
Fire Alarm APP S Tsy
Susp'd Ceiling �° _` ' p ,, r
Roof \TR U c T V KAL �r 16; :77 1Y
Otbe`
Final
PASS PART
PLUMBING r `a ( _ ( at • ■ 4.7 S
Post & d Slab i - 7-0 � - 4- A/. \ _ _
Under Slab • W / !t/
Rough -In ay
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL p
Post & Beam
Rough -In
Gas Line
Sig . e Dampers
PART FAIL
RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
1111
ADA
Approach/Sidewalk Date Inspecto L� — — �— Ext
Other:
Final DO NOT R MOVE this Inspection record from the job site.
PASS PART FAIL