Permit y r.
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00467
�ilI DEVELOPMENT SERVICES DATE ISSUED: 10/14/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12495 SW WINTERVIEW DR PARCEL: 2S110BC -03000
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 001 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: 1.620 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.790 sf GARAGE: 420 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE: 325 00
OCCUPANCY GRP• R3 BDRM: 4 BATH: 3 TOTAL: 3.410 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 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 FOR: 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 HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 000v: 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 & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,017.04
DON MORISSETTE HOMES DON MORISSETTE HOMES--INC This permit d Mu is Code, State Specialty to the regulations contained Co i ode s and
the
4230 GALEWOOD ST 4230 GALEWOOD ST, STE '100 all other applicable laws. All w
Municipal work w ill be done Ce
STE 100 LAKE OSWEGO, OR 97035 all other appl will 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
3 � forth in OAR 952- 001 -0010 through 952 - 001 -0080. You
Roy a: 1k 3877 5 5 5% 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control lnsp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain lnsp 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 lnsp Insulation Insp Appr /Sdwlk lnsp
Issued By : _t. , —,,.., ,41%L_,4 . Permittee Signature : C 74
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
29 � � � . lJ l o I ` lc 9.. p -a3 / ✓ n 1
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• • • • • s .. c y. r
.. A s g Permit Application - -- . �: ;.
Date received r 1 Og Permit no. S 0.j 3 – Q� c(
may :'; i � i �, City of Tigard CEIVED �h r 7
Address: 13125 SW Hall B14d, igard, OR 97223
Project/appl. no.: Expire date:
City o�gard
Phone: (503) 639 -4171 SEP 1 5 2003 Date issued: By l• or I Receipt no.: lt
Fax: (503) 598 -1960 Case file no.: Payment type: Lkt
Land use approval: t^.ITY OF TIGARD l &2 family: Simple Complex:
1 k DIVIbtON -
7 "11'E 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 0 Other.
;�
J,OB SITE INFORt�L�TQN ,--,u c:�F irw :,-,44.,:,- ,' .....4
. �c. .
Job address: `T �V\1 VU1��V��i1/�1 � l J Bldg. no.: Suite no.:
Lot: ( I Block: 'Subdivision: 1 ht3Y'Iti 0 I Tax map/tax lot/account no.,. .,./( O& - ()300
Project name:
8-1
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: Ly, � r � do ' ( Floodplain ,septiccapacity,solar,etc.) '
Mailing address: -e z ma nrcam p r aite lEgram 1 & 2 family dwelling: Go ,
City: 1M ZIP: � Valuation of work $3 ' / b'
Phone:. T"
jeti,rJ rafjelalEM No. of bedrooms/baths 4 7 1 — ,, 3 q_ 1
Owner's representative: L �� i f _ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) .r 5 /.J 0 " I
APPLICANT Garage/carport area (sq. ft.) y... S
Name: R s ia g a: Covered porch area (sq. ft )
Mailing address: Auria age Deck area (sq. ft.) r
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $
Business name: Existing bldg. area (sq. ft.)
ilb f/l <L� New bldg. area (sq. ft.)
Address: .L VL� �i
City: State: ZIP:
Number of stories
Phone: I Fax: I E -mail:
Type of construction
CCB no.: ?j 5 Cip Occupancy group(s): Existing:
New:
City/metro lie. no.: Notice: All contractors and subcontractors are required to be
• ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: (C .0..i,{ : - provisions of ORS 701 and may be required to be licensed in the
Address: ,L jurisdiction where work is being performed. If the applicant is
C � d' _Ls 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: IZ1P: Amount received $
Phone: I Fax: 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 1 ws and o inances governing this Visa 0 MasterCard
wr
work will be compl • • ., whether ifie l Ie O Vi
re t /a I Credit card number: / /
1j _ I l J� Expires Authorized Si ��� � ( �-�• U Name of cardholder as shown on credit card
Print name: w! Air �i '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 (6A0/COM)
•
r•
One- and Two- Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard g 0 Electrical 0 Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TI1E 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 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.
I l Sitelplot 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. 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
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)
•
I)
v
Mechanical Permit Application v T ' '
� Date received: Permit no.: � ;, (7 - CAD ...
I
�. i �•l i! City of Tigard II Project/appl.no.: Expire date:
City of Tigard Address: 13125 S v l;s 223 Date issued: By: Receipt no.: _
Phone: (503) 639-4 7
I Fax: (503) 598 -1960 SEP 15 2003 Case file no.: Payment type:
Land use approval: r Building permit no.:
G11 Y OF 1 l� r
_ TYPE OF PERMIT ,
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement •
XNew construction ❑ Addition/alteration/replacement ❑ Other.
- • - JOB SITE INFORMATION • .- • - COMMERCIAL VALUATION SCHEDULE _ - ,
Job address: 1 a , 1 j `j • V,(r (Vt'e-vv D Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 1 1Block: 'Subdivision: Lrkepo/nWa4IM 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: 1 ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE .-
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: IiVAC:
Is existin s ace 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.:
. / t„ HP Tons BTU/H
Address: gallr Fue/smoke dampers/duct smoke detectors _
City : ik,V MEM ZIP: i llri1 a Heat pump (site plan required)
Phone: Fax E -mail: Instal replacefurnace/burner BTU /H
�� ' ' Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: •?) InstaWreplace/relocate heaters - suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): d p p V' (EEu_ Vent for appliance other than furnace
CONTACT PERSON Absorption Absorption units BTU/H
Name: a �� • Chillers HP
Com. ressors HP
Address:
4_ ♦ �l Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
OWNER Hoods, Type U lUres. kitchen/hazmat
hood fire suppression system
_�.i. 1tL, •i Exhaust fan with single duct (bath fans)
Mailing address: Ixrip i / F O I a �1alaust system a. art from heating or AC
., uel piping and distnbutron up to 4 outlets)
City: �� gatffi vrimAN Type: LPG NG Oil
Phone. 1 4 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 [State: 1-ZIP: Insert - type _
Phone: Fax: E - mail: �y� Woodstove/pelletstove
pp g ��� - Kral her
Applicant's s si Hater Date:
Name (print): (,1 yr { 1rY T1r' / I
T
$
Not all jurisdictions accept credit cards. please call jurisdicuon for mare information. ermit fee
n
Notice: This permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: Expires with 180 days after it has been Plan review (at _ %) $ •
State surcharge (8 %) ...$
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 440 -4617 (44)0 C)OM)
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Plumbing Permit Application ... 4 A, - .
, . A
{ I� II \� /J � Date received Permit no.: Y� r�j� ) _00 . 7
1 0 l • City of Tig u � �U Sewer pernut no.: Building permit no.:
- � Ii � Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTi Phone: (503) 639 -4171 SEP 1 2003 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 CITY OF TIGARD Date issued: By: Receipt no.:
11 tilt\((, nl1/Ie1 A
Land use approvIiit1 Case file no.: Payment type:
- . . : TYPE OF PERMIT
0 I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
v. ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITE INFORMATION • FEE SCHEDULE (for special information use checklist)
Job address: 'C 5AN N.A\_' ( 1,4-e..,1/‘-/ Of, DescripdOn Qty. Fee(ea.) Total
New 1- and 2- family dwellings only
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax ma /tax lot/account no.: SFR (1) bath
Lot: [Block: i Subdivision: `T ( IN.V J V ST SFR (2) bath
Project name: SFR (3) bath .
City/county: 1 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'LUMIIIIG . CONTRACTOR ACTOR Manufactured home utilities
Business name: 11, `. L. i Manholes
Address:
i • Rain drain connector
► State• 5 ZIP: Sanitary sewer (no. lin. ft.)
City: � • 1 _v Storm sewer (no. lin. ft.)
Phone: y .-i- -' Fax: E -mail: Water service (no. lin. ft.)
CCB no [ (}? t_-( -] Plumb. bus. reg. no: - Fixture or item:
City/metro lic. no.: N/A — Absorption valve
Contractor's representative signature ✓i/ _ Back flow preventer
Print name: U to Backwater valve I
Basins/lavatory
Clothes washer
Name: \ {\' S_D1 1J E Dishwasher
Address: sa w - / ` , ,Ni - ' Dnn.king fountain(s)
City: l State: ZIP: ` Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Floor drains /floor sinks/hub
IIIIII
Name (print): - Garbage disposal
Mailing address: A•{�}2j L'9 Pcl _pfVT 1M ,i) Hose bibb
City: L_(l. State ZIP:L/ - )O ' Ice maker
Phone: -"� I Fax:a?7-%-6E-mail: Interceptor /grease trap
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
Nam e: Water closet ,
Address: Water heater ,
City I State: ZIP: Other , �
• Phone: Fax: E -mail: Total
Minimum fee S
'N.14 all lunsdxuons accept csedd cards, please call lunxb mom m
cuon far mofortnauon' Notice• This permit application Plan review (at %) $
C
Visa 0 MasterCard / / expires if a permit is not obtained State surcharge (8%) ..•• $ �—
C.edir card number w ithin 180 days after it his been
Expires TOTAL $ ------
accepted as complete.
Name of cardholder as shown oo credit cud
S
■ Cardholder si gnature Amount ssO -1616 (6•0coM)
y .
. Electrical Permit Application ,k �' .. . = ' } �r,t
m q( r , V E 11 � Date received: Permit no.: c j r ) v7 ) _00 e` „ 7
_.t,�. � • I � City of Tigard `� Proj «t/appl. no.: Expire date:
,
City of Tigard Address: 13125 SW Hall Blvd, Tigaj'() 97223 Date issued: By: I Receipt no.:
1. :7
Phone: (503) 639- 4171SEP Luse
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approvVj i pimp nIVISION
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
►' New construction 0 Addition/alteration/replacement 0 Other. 0 Partial
_.. - _ i . , - JOB SITE INFORMATION
Job address: (ag � A 1)]A Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ' Block: Subdivision: d`sQ /f
Project name: Description and location of work on premises:
Estimated date of completion/inspection: '
CONTRACT OR ,\l'I'I.IC:\ ION • FEE SCHEDULE " - 'z " ` , ., -, "-- :',:•-:- .-:
Job no: ` lath Fee Max
J v '— D escr i pt i on Qt y. (ea) Total no. map
3/1 / New residential - single or multi- family per
Address: r, _ `` �(`w �,����� ' UI / dwellingunit. Includes attached garage.
r:4I'M
t Wit' 1 Service included:
Phone: • ?j - I ` j Fax: E - mail: 1000 sq. ft_ or less • 4
... / �' Each additional 500 sq. ft. or portion thereof __
CCB no.: _ Elec. bus- lic. no. Limited energy, residential WM= 2
C Limited energy. non- residential ___ 2
Each manufactured home or modular dwelling ■■. ei
n ature o f supervising electrician (required) Da I[J// Service i and/or feeder 2
Ai l License no. I � Serricesor[eeders – installation, 11111
�I)L alteration or relocation:
P RO I' I :It I Y O \1' N I : R .. 200 amps or less 2
Name rint : 201 amps to 400 amps ___ 2
401 amps to 600 amps __
Mailing address � ����� � /,� • �� 601 amps to 1000 amps MEMO 2
City: • it , ��A��/ = Over 1000 amps or volts ___ 2
Phone: - '51 j'r2(Ik .%r Reconnect only _ 1
Owner installation: The installation is being made on pro I own wn T services or feeders - 1117 . 2
which is not intended for sale, lease, rent, or exchange according to installation alteration
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps _MIN _ 2
Owner's signature: Date: 401 to 600 amps MEMO 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 or feeder not included): ME
O Service over 225 amps- commercial 0 Health-care facility Each pump or imgation circle 2
n
O Service over family 20 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting 2
g :■ 2
family dwellings 0 Building ilding over 10.000 square feet four or Signal circutt(s) or a limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration, or extension
0 Building over three stories 0 Feeders, 400 amps or more •Descri . tion:
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 inspection EMI=
Submit sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions apt credit cards. please call jurisdiction for more information. foration. Notice: This permit application
Permit fee $
accept
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%) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 4444615 (6lV(COM)
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4 n � •. f- l,� —�S , Owner /Agent for D oy^ d r°S wife ►
�`� j (PERMIT HOLDER)
(PLEASE PRINT) ►
•
• ►
• •
• ■
• Do hereby ceftify t hat the following location V.
• meets City of Tigard /Was County ∎`
• • land use and development standards for street tree insta ■ ■
• • r � (,.J:r -j`'' vc��. Or� �e, ■ ■
ADDRESS: ►
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SUBDIVISION: --- FL-0 r IA.'-' c) a ■ ►
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BY: DATE: 3.;/..... " 2 1 2- 1 0° • - ► ■
RECEIVED BY: DATE: ►
•
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4yvvvyyvyyyyyyyyyyyyyyyyyyyyyyyyyvvYYYYYYYYYYYYYVVYYYYYTY'
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5W3) 639 -4175 r—v <16, 7
INSPECTION DIVISION Business Line: (503) 639 -4171 0111:0 ,
l BUP
Received �2q 7� 3 Z Date Requested ) ? D' - v ' AM PM BUP
Location 1 2 «'9 5 41/_:(-61---(-) Suite MEC
Contact Person /3-eai,e Ph ( ).0769 — 'V1P3 7 PLM
Contractor )01 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
! A-a - PART FAIL
IN
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
M �) PART FAIL
NICAL
Post & Beam
Rough -In
Gas Line
Dampers
4 la
r
PART FAIL
• ya4 ' ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL