Permit r•
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 00514
At
DEVELOPMENT SERVICES DATE ISSUED: 11/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12435 SW WINTERVIEW DR PARCEL: 2S110BC - 03300
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 004 JURISDICTION: TIG
REMARKS: Construction of new SF detached residence.
BUILDING
REISSUE DM199 STORIES 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK. NEW HEIGHT' 25 FIRST. 1,536 sf BASEMENT. sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE SF FLOOR LOAD' 40 SECOND. 1,864 sf GARAGE' 412 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST 5N DWELLING UNITS. 1 THIRD sf RIGHT. 5
VALUE 324 60
OCCUPANCY GRP• R3 BDRM: 4 BATH: 3 TOTAL. 3,400 sf REAR: 15
PLUMBING
SINKS' 1 WATER CLOSETS WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN' TRAPS:
LAVATORIES. 6 DISHWASHERS. FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES. 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. 0 - 200 amp. 0 - 200 amp: WISVC OR FD R. 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. EAADDL BR CIR SIGNALIPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp' 601 +am ps-1000 v' 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: $ 6,010.37
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 Tigard Municipal Code, State OR. Specialty Codes and
STE 100 LAKE OSWEGO, OR 97035 all other r applicable laws. All work well be done i
LAKE OSWEGO, OR 97035 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
5o forth in OAR 952 - 001 -0010 through 952- 001 -0080. You
Reg # L
• I 3 87 3 7 5 5 8 may obtain copies of these rules or direct questions to
S OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insi Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service lnsp Building Final
Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Issued By : A_ _ i._____ !r / � Permittee Signature : X
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application
; .,`,. °i Cl of Ti CE! `� hD Date received: /D / 7/0 Permit no.4b12- J>1 -GYMS /
1 ! II OR 97223
g Project/appl.no.: Expire date:
CitynjTigard Address: 13125 SW Hall Blvd, Tigard, 1
Phone: (503) 639 -4171 t 11 I % ? 2003 Date issued: By: I Receipt no.: J
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD 0
Land use approvalaUILDIWG DIVISION 1 &2 family: Simple '/ G Complex: 6J
±.:;TYPE OF PERM IT .n. ;:., , . • . . ., 0
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family , 'New construction 0 Demolition
0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinlder /alarmm 0 Other. --
w , .
:T. - ... JOII''SiTE`INFORl1U1TION
Job address: � jrjA J ��� �r �� lm�� Bldg. no.: Suite no.:
Lot: — Block: Subdivision: V riE �' 1� Tax map /tax lot/account no.:, #4 -0330p C I
Project name: 1?_7
Description and location of work on premises/special conditions: / / 7 ,2 0
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
* miro • ( Floodplain , septic capacity, solar, ctc.) \
Mailing address: 'e alffiraa Ea'a 1 & 2 family dwelling:
Emigg rgm A ZIP: 7). "2 Valuation of work $
Phone: . r ,5 No. of bedrooms/baths L- _
Owner's representative: • L ' La if Total number of floors _
Phone: Fax: E -mail: New dwelling area (sq. ft.) 7 ,
'" `4AP IRI, C r+ `f4`,+ ,..41 (q• )
Garage/carport areas ft. i
Name: \ on ' Covered porch area (sq. ft.)
Mailing address: & ' , a _ Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E- mail: CommerclallindustriaUmultli- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
_fat• 11 .= 1111(4111M &L� New bldg. area (sq. ft.)
Address: &i
City: State: ZIP: Number of stories
Phone: I Fax: I E -mail: Type of construction
CCB no.: .?) 5 5.2j -7J Occupancy group(s). Existing:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /IIESIGNER licensed with the Oregon Construction Contractors Board under
Name: ( -lett ta, , : - provisions of ORS 701 and may be required to be licensed in the
Address: ) -tip c2' -�'�V jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: 1ZIP: Amount received $
Phone: IFax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A • rovisions of I ws and o dinances governing this O Visa U MasterCard
work will be compli - • w1.. , whether cified fiere i rrt. � Credit card number: / /
n 1 � — Expires
Authorized Si: dill _ �_ �i e: 'l Name of cardholder as shown on credit card
Print name: •: _ i •1 $
?�2 �! 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 (6/00/COM)
One- and Two -Family Dwelling v. # s �;: �,,,;,u;,� 4 : �
Building Permit Application Checklist- Reference no.: . .
Associated permits:
City of Tigard City of Tigard `7 g 0 Electrical O Plumbing O 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 NIA'
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. )(
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control l3 plan Operant required. Include drainage -way protection, silt fence design and location of r /
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 t/
if copyright violations exist. •
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,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable. J�
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards. •
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation. '�(\
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load. x
20 Manufactured floor /roof truss design details. •
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 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 (6,00/COM)
Mechanical Perm Application '; =:;
440 ,, . . .
' Date received: Permit no.: l ige _ ,
Y
y,�..� I i City of Tigarci E E I Project/appl. no.: Expire date:
City of Tigard Address 13125 SW Hall Blvd, tgard R 3
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 OCT 2 ( 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGARD Building permit no.:
B _ _ . , _ . • ■
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial Cl Multi- family ❑ Tenant improvement •
iew construction 0 Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION - _ _ COMMERCIAL VALUATION SCHEDULE" ,;.
Job address: 'yrw�MILML 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: Z..1 'Block: - I Subdivision`:"r KOMIAZW, 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: : 1 & 2 FAMILY DWELLING PER111FF IIESCHEDULE
Description and location of work on premises: AND GOi<L'VIERICAIJINDUSTRIAL EQUIPII'IENTSCI ®ULE
Fee(ea.) Total
Est. date of comp letion /inspection: Description Qty. Res. only Res.only
Tenant improvement or change of use: HYAC: •
Is existing space heated or conditioned? 0 Y es ❑ No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
,..!..L„:,;;; ,MECHAN \L,, yCO. N ,I RnCTO , �,� Boller/compressors
State boiler permit no .•
II(a MI,� - HP Tons BTU/H
Address: rMa Fire/smoke dampers/duct smoke detectors
City: \,-f � r ____ ieffi7 Heat pump (site plan required)
Phone : ,. ) . - 3j), I Fax E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner Cl Yes Cl No
CCB no.: •F--) '(f) Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): j fp a" 1 hig• t -LC_ Vent for appliance other than furnace
CO NTACT PLRSON
Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address: Com . res sors HP
�_ ♦ �1[ • Environmental exhaus and ventil ation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type If lures. kitchen/hazmat
hood fire suppression system
Name: Mat .A Exhaust fan with single duct (bath fans)
�'
Mailing address: it% ) / , _ draw draw Exhaus[ system apart from heating or AC
City: State ZIP GZ�1j Fuel piping and distribution (up to 4 outlets) t
Ty pe: LPG NG Oil
Phone: 7 - �li 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: Woodstove/pelletstove / Fax: E -mail: m
Other
. Applicant's g �'��� rjI /�7,g /� Other.
A /icon[ s si naru" Date:
Name (print): (. I 'r f If\r f'71r' i 1
Not all jurisdictions accept credit cards, please can junsdicuon for more information. Permit fee $
Notice: This permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained Credit card number Ex tr / w i t hi n 180 d after it has been Plan review (at %) $
Expires State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440.4617 (6•03rCOM)
Plumbing Permit Application ' ,:,,° ',
, • Permit no ; .J , 4D 5
Date received:
• 4-111r; City o f Tig " t' ° V ® Sewer permit no.: Building permit no.:
Address: 13125 S ; M. ► tgard• 97223
City o phone: (503) 639 -4171 Prolect/appl. no.: Expo date:
Fax: (503) 598 -1960 OCT ry 2 / 2003 Date issued: By: Receipt
Land use approvalCITY OF TIGARD Case file no.. Payment type:
: I ■ _ ! IVISION
- TYPE OF PERMIT' .
O 1 & 2 family dwelling or accessory O 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: dp , vl At op . k 1�1 , 1(N� L 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.: SFR (1) bath
Lot: P' Block: Subdivision: �i 11a 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.)
. I'LUNIl1ING CON", RACTOR Manufactured home utilities ME
Business name: Pb ` I, L i Manholes MI
Address: .. Rain drain connector 1111.1
IBEIVAt,.t EEN ZIP: Sanitary sewer (no. lin. ft.)
_ ��
E -mail: Storm sewer (no. lin. ft.)
Phone. y_ 1 Fax Water service (no. lin. ft.) �-
CCB no : [ ' d• .- Z L - I Plumb. bus. reg. no: - ~
Fixture or item:
City/metro lic. no.: N/A ' Absorption valve
Contractors representative signature Back flow pre:•enter
i
�� • i gPpr� Backwater valve _ III 1
' - CON 1'AC' `I'1:Rso .. . ~
, ,.., ` Basins/lavatory
Clothes washer
Name: {N‘ , - - 1 1J e Dishwasher
Address: ma " / AP , ■I - Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: {Fax: E -mail: Expansion tank 1111 I
OWNER N E R Fixture/sewer cap M
„ , T t r >; ;:: Floor drains/floor sinks/hub IIIIII - I
Name (print): \ ;S HP lc _alt A . 4 - G arbage disposal
Mailing address: 1 {� j (2? . � a Hose bibb
II
City: L_ l . State a ice maker •
ir E -mail: Interceptor/grease trap -
Phone: f . — ,� Fax: � p � p
Owner installation /residential maintenance only: The actual installation Pnmer(s)
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
ENGINEER Tubs/shower /shower pan
Urinal �
Name" Water r closet
Address: Water heater ■
City State: ZIP: Other. _
Phone. - 1 Fax. E -mail. Total
Minimum fee $
information
all jurisdictions accept credit cards. please call jurisdiction for more infoution Notice. This permit application %C
Plan review (at _ %)
C Visa 0 MasterCard expires if a pe tntt is not obuined State surcharge (8 o) .... $
C.edlf card number / / within 130 days after it has been
Expires TOTAL $ _.---
accepted as complete.
Name of cardholder is shown oa credit card
$ Amount 440 -3616 (6' OM)
Cardholder signature i
•„ Electrical x;1_ '�'° � I i l. l. �, � oil e ., ,r' 4'. ',, �� � rh _ ; :_;�, •
Date received: Permit no t. ,1 3 • id
„:21 City of Tigard f�(�T9 t'°J Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, lg R 3 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 CITY OF TIGARD
Fax: (503) 598 -1960 BUILDING DIVISION Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
L New construction 0 Addition/alteration /replacement ❑ Other. ❑ Partial
y,';: a; .' JOB SITE INFORMATION - . . . •
Job address: ♦ / �MI Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: 11 ' Block: Subdivision: V a
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
. , r'.., CO NTR \C I OR:: ?\l' I'IrIC A LION -- ,, m :. 7 . g i1 - SCHEDULE ,
Job no: .3471 Fee Max
Description Qty. (ea.) Total no. imp
V
/ New residential - singk or multi-family per
Address: ir. t§ ra dwelling mtit. Includes attachedgarage.
L� '4 ZIP: # Service included:
Phone: r. . - I . ij Fax: E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof __
: no.: T� Elec. bus. lic. no:
e9/ ti energy, residential ___ 2
C` Limited energy, non- residential ___ 2
1 — Each manufactured home or modular dwelling ■■
nature of supervrsrng electrician (required) Date • r zj i, Service and/or feeder 2
w � License no.�
Smites or feeders — installation,
AIL alteration or relocation:
PROI'lil(Y OWNER` - " 200 amps or less 2
P 201 amps to 400 amps ___ 2
Name
(print): � tl���tlLa /EP 401 amps to 600 amps ___ 2
Mailing address: 1 L:n _ ii (�� / ,1111 S". ' f 601 amps to 1000 amps ___ 2
City: .I �a+
iZ1P : _
Over 1000 amps or volts __ 2
t
Phone: , AEL�.I[�'._ T il�lfi�r T� Reconnect only _ 1
Owner installation: The installation is being made on property I own Temporary sersiees or feeders - 1111..11111M . 2
which is not intended for sale, lease, rent, or exchange accordin g to altaaon,atteration
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2
Owner's signature: Date: 401to600am•s MEN 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: k Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: 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 feeder not included): ME
O Service over 225 amps - commercial 0 Health-care facility Each pump or imgation circle 2
O Service over 320 amps - rating of 1&2 0 Buildings location Each sign or outline lighting 2
8 :■ 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
O Building over three stories 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/lighting plan 0 Other, Per Inspection __
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8%) .... $
Ex accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (603CCOM)
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ERT
STREET T ► ■
I, gu►xa 46,E -T� , Owner / Agent (or AA.,/ � or isE h ,'ie S ■
( ►
(PLEASE PRIN "I) PERMIT HOLDER)
1
I • Do hereby cel-tify that the following location ►
j meets City of 1. igard /Washington County `
• • land use and development standards for street tree installation.
I ■
■
ADDRESS: ) 21/35 5 vu v� � ,�rE,e vac %G✓ /2 g _ E.
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SUBDIVISION: _ - j �wll✓w7
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A / RECEIVED B 4 I _ DATE: - ■
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 _. 4,v`5--i t
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re., ested S AM PM BUP
Location / � u f,, , Suite-- MEC
Contact Person ' Ph ( ) 47Z0 "'4/073-7 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 ; 1N 5 1 A�- C3-ST U (, 1�1 �(�VILE
Drywall Nailing 1 � - p
Firewall I N fvMVr(Z. S O 1 z .L s W A ( 5 •
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS . PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_ ' SS PART FAIL
SI ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Date 0 Inspector � N6) Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
►•BUILDING • Inspection Line: (5 639 -4175 CO 3 _(50 Jam-- /cd
1115PECTION DIVISION Business Line: • • 03) 639 -4171
J BUP
Received (.- S 3 27 Date Requeste 3/ / 0 AM PM BUP
Location 24 ' Suite MEC
Contact Person • h ( ) 2Of Y 3 7 PLM
Contractor Q 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 ,-p
Int Sheath/Shear _ f o 5 r /� 1�1-� L1 •
Framing 11
Insulation Z Y1 , r
Drywall Nailing -�Y C�c�� l
Firewall S C
Fire Sprinkler —
Fire Alarm
Susp'd Ceiling
Roof
f
4-ti'+-' PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In Z-r\)
Water Service
• <Lp
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Other: Pan
Other: 1 Y
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
_• • e Dampers
• • S 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: U inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / /
Inspector /_. _ � _ Ext
Other:
Final DO NOT RE OVE this inspection r : rd from the job site.
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour
503
Inspection Line: 3 4°6-71
BUILDING p ( ) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
2 BUP
Received Date Reque ed J AM / 65-1 PM BUP
l
Location �� .� V� Suite 0' - MEC
Contact Person Ph ( ) o� q c ! - y837PLM
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 44k 1 \ ►n/'
Framing
Insulation t o C) O C 3( S — �-" 1.�t/� -� ` cc.12, Drywall Nailing
f /� l� � 4
Firewall
Fire Sprinkler -
Fire Alarm
Su
o sp'd Ceiling 1 to r L
Roof c Q
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
a=
PART FAIL
ME HANICAL
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: D 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