Case File l
w f
w
N
En
n
tzjz
En
H
O
z
d
H
I
13132 SW ASCENSION DRIVE
C.TV OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171
Date Requested: A.M. _ P.M. MST:
Location: ��'�„� L�t%�(! t�f_ — - BUR _
Tenant: _ Suite: Bldg: _ MTC: _
Contractor:_ �1.�= -` —Phone: � � t'LL� I'LM:
Owner: Phone: F,LC:
/ ELR:
1!5. Zt,4q SpeChcn, d.X SIT:
BiJILDING L on't) PLUMBINd MECHANICAL P",CTRICAL SITE
Site earn Post/Beam Post/Beetn Cover/Service Sewer/Storm
Footing Roof OndFVSlab Rough-In Ceiling Water Line
Slab Framing Top Out Lias Line Rough-In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire Spkir/ -�� Crawl/Found Ir Heat Pump Low Volt
,"TPProN'qP Approvett Approved Approved Approved
Appr/Sdwlk val Not Approved Not Approved Not Approved Not Approved
NAI, FINAL FINAL. FINAL FINAL,
C3 Call for reinspection II '' n Reinspection fee of S _requiredd before
next inspection M Unable to inspect
Inspector:---Vk L.�� ------------- I)ate:.-- �_/�=L�— Pag° —of
CITYOF TIGA D CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES DATE ISSUED:PERMIT 01/10/1199788
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104CB-03300
ZONING: R-7
JURISDICTION: TIG
SITE ADDRESS: 13132 SW ASCENSION DR
SUBDIVISION: HILLSHIRE WOODS
BLOCK: LOT:079
CLASS OF WORK: NEW _
TYPE OF USE: SF
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: New single-family residence. PATH I
Final Building Inspection and Certificate of Occupancy
Approved 7/29/97 by Rick Bolen, Building Inspector
Owner:
Phone:
Contractor:
R FULLERTON COMPANY
6426 SW BEAVERTON HILLSDALE HW
PORTLAND, OR 97221-1128
Phone: 297-4433
Reg #:
This Certificate grants occupancy of the above referenced building or portion thereof and
confirms that the building has been inspected for Compliance with the State of Oregon
Specialty g6ds for the group, occupancy, and use der whi h the referenced permit was
i3SUed.
_�r�,.�----------' - -_ 4DN
BUILDING INSPECTOR BUIOFFICIAL
POST IN CONSPICUOUS PLACE
CITY CF TIGARD
tiikDEVELOPMENT SERVICES tIASTE=R PE'RMI'T
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 F.,ERM I T #. . . . . . . : MST13604 88
DATE ISSUED: 01/1.07'37
PARCEL : 2Si 104CC--HW07r3
I TC r)DDRES'=;. . . ! ',1.32 SW ASCENIS I ON Dr
".UBD I V I S I.0n1. . . . H I I_.I-SHIRE WOODS 70N I IVIG: R -7 IDD
`-'L_OCV. . . . .. . . . . . , L_0T. . . . . . . . . . . . . :07`:3
Qemarks: New single-family residence. OATH I
--------------------------------------------------------------- BUILDING ------------------
PEISSUE: STORIES.......: 2 FLOOR AREAS--------- BASEMENT... : 0 5f REQUIRED SETE4CKS---"- REQUIRED----------
'LASS OF WORK,:NEW HEIGHT........: 21 FIRST....: 1786 sf GARAGE.. ..: S82 sf LEFT.....,,,,.: 20 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR '_OPD....: 40 SECOND... : 894 if FRONT.........: 9 PARKING SPACES: 1
TYPE OF CONST.-.5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT..,...,..: 41
,,CC',PANC'Y GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 2680 5f VALUE..1: 191350 REAR..........: 7
.----------------------------------------------------------- DLUMBING -------------- -----------------------
INYS..,......: 1 WP'ER CLOSETS.: 3 WASHING MACH,. : 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS.........: 0
.AVPTORIES....: 5 DISHWASHERS..,: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS..: 0
TUB/SHOWERS...: 3 GARBAGE DISP..: 1 WATER HEATERS.: I WATER LINE ft: 1.00 BCKFI.W PREVNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
-------------------------------------------------------------
MECHANICAL --------------------------------------------------------------
UL TYPES----------- FURN ( 1001( .,: 0 BOIL/CNP ( 3HP: 0 VENT FANS.,,,,: 4 CLOTHES DRYERS: 1
'GAS/ / / FURN )=100V ..: I UNIT HEATERS.. ; 0 HOODS......... : 1 OTHER UNITS.... 1
MAX INP,: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES..... 0 GAS (YUTLETS...: 1
--------------------------------------------------------- ELECTRICAL
-RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MiSCELLANEDUS---- --ADD'L INSPECTIONS
000 EF OR LESS: 1 0 - 200 amp.. : 0 0 - 200 amp.,: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
FA ADD'L 500SF,: 5 201 400 amp.,: 0 201 - 400 amp.. : 0 1st W/O SVC/FDA: 0 SIGN/OUT LIN LT: 0 PER HOUR,.....: 0
I.;MITED ENERGY. : 0 401 60@ amp..: 0 401 - 6A@ amp.. : @ EA ADDL BR CIR: 0 SIGNAL/PINIEL...: 0 IN PLANT......: 0
MANF HM/SVC/FDR: 0 Set - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0
1000+ amp/volt.: 0 ----------------------------------- PLAN REVIEW SECTION --------------------------__---.
Reconnect only,: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
-------.._.__-__------ ELECTRICAL - RESTRICTED ENERGY ---------
1. SF RESIDENTIAL----------------------- B. COMMERCIAL-----------------------------------------------—-------------------•-----
DUDIO d STEREO.: VACUUM SYSTEM., : AUDIO I STEREO,: FIRE ALARM,,.,,; INTERCOM/PAGING: OUTDOOR LNDSC LT:
nURGLAR ALARM.,: 0TH. :: X BOP_ER......... HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIAM.:
'GRAGE ODENER,.: CLOCK.......... . INSTRUMENTATION: MEDICAL,..... . . OTHR:
'a'JAC...........: DATA/TELE COMM.: NURSE CALLS.... : TOTAL # SYSTEMS:
-.-..---------- -Contractor: -------------------------------- TOTAL FEES:1 46'4,2@
W FULLERTON CO R.W. FUU-ERTON
"e6c'' SW BVTN-HLSDL HWY 9700 SW CAPITOL HWY
SUITE # 275
'OPTLAND OR 97221 PORTLAND OR 97219
''hone #: 297-4433 Phone f. 293-2277
Reg #..: 40671
This permit is issued subject to the regulations contained in the -igard Municipal Code, State of Ore. Specialty Codes and all other
pplicable laws. All work will he done in accordance with approved plans. This permit will expire if work is not started within 190
:ays of issuance, or if work is suspended for more than 180 days.
------- - ----._.... _ -- ------------------- REOUIF�D INSPECTIONS ------------------------------------------------------ -
"ooting Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
''aundation Insp Mechanical Insp Shear Wall Insp Insulation Insp App►!5dw1k Insp Erosion Control
r'ost/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
'ost'Beam Mechan Electrical Servi Fireplace Insp Rain d'•ain Insp Mechanical Fina'
'ravel Drain Electrical Rough � 35 Cir Insp Water Line Insp P1 Final
f?y Ini1;1;c n r ii a� iirL►!• TS5�.1@ri By : ' 1 � l.._
•n .. C,39-.-41.7.5.1 _
CITY OF TSEWER CONNECTION
DEVELOPMENT SERVICESr-I
ERrriIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)5 _39.4171 I'ERM I T #. . . . . . . : SWR'?--,-048P
DATE ISSUED: 01/10/97
PARCEL: LS104CC4414079
=;ITE ADDRESS. . , 131.:is SW A`CE'NSION Dr,
>UBDIVISION. . . . : HILLSHIRE WOODS ZONING: R-7 PD
)i_OCK. . . . . „ . . . . . LOT. . . . . . . . . . . . . :079
I FNANT NAME'. . . . . :
JSA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
LASS OF WORK. . . :NEW DWE'._l._I NG LJN I TS7 . I.
-r'VPE OF USE. . . . . :SF NO. OF BUILDINGS: !.
T NSTAI-I._ TYPE. . . . :SU9WR I Mr,F RV SL1Ri'AC;F.: Q, s f
Remarks : New single--family r,r_ sidence.
1wrlet- : _.._ . _. ____---...-_.___...__...._..._ ..._ _. .._ _.__.. ___..------- ____ FEES
9 W FULL.ERTON CO type amount by date recpt
(146 ' SW DV'TN•-HI..SDL HWY r1RMT 1 22:'ON. 00 P 01 / 10/97 97--283751
I NSP 35, 00 D 01/10/97 97 -2 88757
PTJRT!-.AND OR 97221.
Ph o n N #: ;:-:197-4433
Cont r act or- :
CONTRACTOR NOT ON FILE
Fi o n e
#: 'b 2235. 00 TOTAI.-
__._._ _._.._. REDUIRED INSPECTIONS
.•;s Applicant agrees to comply with all the rul.e<_ and regulations sewer Insulecti.on
^f the Unified Sewage Agency. The permit expires IN days from
'he date issued. The total amount paid will be forfeited if the _
permit expires. The Agency does not guarantee the accuracy of the _
ide sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
'he distance given. If not so located, the installer shall purchase �� _
P "Tap and Side Sewer" permit and the Agency lateral.
' e V-m i.l;t, e
t s s li r-d By
Cal 1 for i.ns>ppc. t ton 839-4175
' Plan ch.** I o 7
�ITY.OF TIGARD Residential Building Permit Application aec'day 7 • �new,w
1 a125'S`!V HALL BLVD. New Construction Additions or Alterations Date P•cA -
'IGARD, OR S7223 Single Family Detached or Attached Date to P E. ;h-//e-9i'o
543 639-4171 Date to DST 40-/7'f('
Permitr ► ) Vg
Print or Type ratted l o-Z04, zl,wir. r'i?t
Incomplete or illegible applications will not be accepted
Name of Subdivision lot fi Name
Job ,,--i t t�L�i-ti t, .f ut.t l._ 19
Architect Ma
Address Site Address mailingAddressIli yr
JIStAh Zip Phone '
fe i - c
i 01
Owner Marling Address
Engineer Address
J!'yfstate ZP Phone 9. - T►-) ,
1 L1 �j
Name state zip Ptione
T nZttLa �C
General \,\ ^ r Describe work new , addition O alters ono repair O
i Contractor Matting Address to tw done:
I Additional Description of Work:
jQvistate Zip Phone, �1 SF
IOregon Const Cont.Board Lica Exp.Date __r
Atrscih Copy o1 C_�v c 1 1 5 �Projed �-
C noir t COT Business Tax or Metro 0 - Valuation )5R, 000
_uC'ns" c,�, t t
Name NEW CONSTRUCTION ONLY:_
Sq.Ft. House: Sq.Ft.Garage:
Mechanical -1 �, L� l^� L
Sub- Mailing oliddress
Contractor j ] r _ r r
Comer Lot Yes N Flag Lot Yes No
city/state Zia Phone (check one) (Check one)
J `YPO '�j`� �a. Restricted Audio/Stereo Burglar
Oregon Const Cont.Board tx.s DateSystem Alarm
Attach Copy of t I Energy
Current COT Business Tax or Metro a E4V.pate Installation Garage DoorHVAC
Ucensas Opener X Systems
Name (check all thatOther.
apply) Ed
Plumbing _ ZSR tern Q INCA_. Vlfilt the electrical subcontractor wire for all Yr No
Contractor ptc
Sub- Mailing Address
�j �j 144- restricted energy installations?
(State � P Has the Subdivision Plat recorded? WA Yes No
��e,RO OR 8 Z t� u —
Oregon Const Cont Board Lra Q to Reissue of MST# Solar Compliance
Attach Copy of �� ) 1 2 9` (Calculation Attached)
Current Plumbirg Lie. bit I hefebv acknowledge that I have read this application.that the
Ucenses - Irj� ,� (U 'SQ Q information given is conecz, that I am the owner or authorized agent of
COT Business Tax or Metro a Exp D to the owner. and that plans submitted are in compliance with Oregon
CU c)C) Z I i State laws. —
Nart+eto 0
HA enE
1 Electrical A t .t l ntaet Person Name Ph&ie
Sub- r Mailing Address i 1Zl t t r _
Contractor 1 "-T'A FOR OFFICE USE ONLY:
_/state Zip Phone Plat p L,,i( MapfrL#:
O Const Cont Board Lit. Ex .Date r - `��+ ) +� i
Attach Copy rr _ Setbacks one. Soar.
CurrenIt ecu=l Lir.M ate I_
l 1l � � 1 li
Ut�netas _ _
COT TAX or Matto N vate.7 Engineering Approval: Planning Approval: TIF:
.istslimsbpp doc
1
em_o= Amt. Pd. �1. QUe
Permit (BUILD) -
Plumh. Permit (PLUMB) ? _;
Mech. Permit (MECH) U,)
ELC/ELR Permit (ELPRMT) L�9 5-
State Tax
(FAX) v.
Plumb:
Mech:
i
ELC/ELR:
Plan Check
MST: /�
(BUPPLN) U ' �J _ f
Plumb'. (PI-MPLN)
Mech: (MECPLN) / Z
CDC Review (LANDUS) , v> L a
Sewer Connection (SWUSA) a u U Gv
Sewer Inspection (SWINSP) .3 s^ 3 ) --
Parks Dev Charge 9 (PKSDC) U v
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT) �, c1 _ -/V0
Erosion Control Permit (EF WT)
Erosion PlanckJUSA (ERPLAN)
Erosion Planck/COT (EROSN) __ �✓
Fire Life Safety (FLS)
TOTALS:
Odsts4mtamdoc
Rev ','n6
1
,. APR-17-1996 07:19 SHELBURNE 5036925760 P.03
JM Aldnch
try aiP qpd
13125 SW MR Blvd
7%KA ar.�7ZZ3
i
Asir ML AkkvcA,
W ' Sd&Afit%Mx POW-Lots 71 ft 79,H,}W&-nv Woo&
1
4f� a
Pa my 4 nonion""a Rdpk Mum m of The W-Fyi{�ypp Cpq�6t!o%an auct 79
Md ite WoW ft e;,%ftm*bow to be bash by liptra an Lot 7S tiller Wooft eau
aot hsv.,6a�rriado.vs ac d�e.idt a�oCnt oo Lot 79 woad 'TAi�aboaW se,eo�t.e�solar
b4mm Pdac*am with Imped to a iob.
TOTAL '.05
TOTAL P.03
Solar Balance Point Standard Worksheet
Address
Box A calculations: North-South dimension for the lot. Box A.
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point.
First, determine which property line is the North lot line. The North lot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot..
7-L'i
450t N ..MI N "01 w North-South
` Dimension for Lot:
Measure the distance from the midpoint of the North lot line to the South lot line along
the described line.
�?� �� feet
1jN
G POOMSOUH oma+
Box B calculations: Shade point height for your residence. Box B:
1. Determine whether measurements will be based on the peak.or eave of your Which describes
structure. The orientation of the ridge is also important
your residence?
1 a: If the roof line runs North-South, measurements will (circle one)
be based on the peak of the roof.
1A IB /1C/1'
1 b: If the roof line rum East-West and the roof pitch is
less than 50 2, measuremei,is will be based on the
eave.
�: If the roof line runs East-West and the roof pitch is
(((, 5/12 or steeper, measurements will be based on the osx��
peak.
I
Box B. continued Box B:
2. Measure change in elevation from front property!int to finished floor elevation. If
the lot slopes up from the front lot line to the foundkon, the figure is positive. If _ ft
the lot slopes down from the front lot line to the foundation, the figure is negative.
3. Measure distance from finished floo -levation to the affected peak/eave. + 3 ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, - — ft
deduct nothing.
5. Subtract one foot for each foot of difference in elevation from the front property
line to the rear properly line, if the lot slopes tip from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing. - "L ft
6. Total figure for box B: ^_ ft
Box C. Distance to the shade reduction line. Box C:
1. Measure the distance from the North property line to the foundation near the ft
affected peak/eave.
2. Measure the distance from the foundation to the affected peak or eave. + G" I ft
3. Total figure for box C: .32- __ ft
It is most useful to draw a vertical line to represent.die appropriate figure found in box'A'and a horizontal line to represent the
appropriate figure found in bout'C'. The inteizec uon of die vertical and horizontal lines determines the value found in box'D'. The value
in box 'D'should be compared to the value in box'B'; if the value in box'B'is less than or equal to the value found in box 'D', then
the building is in compliance with the solar balance code. If you have any quesuors,please contact us at 6394171,x304 or at the
Community Development Counter.
MAXIMUM PERMITTED I HADE POINT HEIGHT (In Feet)
Distance to Worthsouth lot dimension fn feet)
shade 100+ 95 90 f 5 80 75 70 65 60 55 50 45 40
reduction line
from northern
!adhne Cin feet)
70 40 40 40 A 1 42 43 44
65 38 38 38 19 40 41 42 43
60 36 36 36 7 38 39 40 41 42
55 34 34 34 5 36 37 38 39 40 41
50 32 32 32 3 34 35 36 37 38 39 40
45 30 30 30 1 32 33 34 35 36 37 38 39
40 28 28 28 9 30 31 32 33 34 35 36 37 38
35 26 26 26 7 28 29 30 31 32 33 34 35 36
—09----------- -N- - - ?4 -24- - 26• 27- -28
25 22 27 22 3 24 25 26 27 2P, 29 30 31 32
20 20 20 20 1 22 23 24 25 26 27 28 29 30
15 18 18 18 ll9 20 21 22 23 24 25 26 27 28
10 16 16 16 11117 18 19 20 21 22 23 24 25 26
5 14 14 14 115 16 17 18 19 20 21 22 2.3 24
Box ►l. Maximum allowed shade point height: _ feet
h:Wrx:*u ncYNven to ralsol a r.ch p
Revived 2f26,'96
503-225-0933 htASCORD DESIGP4 ASSOC
\ ` f 227 P02/04 OCT 02 '96 10:50
�1-1t"Rl.rs W IUu�
2269B
BY :
R.W. FULLERTON COMPANY
CITY OF TIGARD
HILLSHIRE WOODS
1 LOT 79
0•22'45- E Citi
tOQ54. (9,6 SQ iJ,)-
7w
�JIti1G,
1 1 NWi�" 2.S104
L - I-Iw 019 C
1 --- - -- -- -_--- -----�_ti--==------- i 1 480
u I l t 1
y" I
rt60- i ; SILT FENCE I..
1 f
1 �
11Z•. t� � � I
` I
I a
N 1 1 N
LOOK
I 17
1 ► ala
1 1 GARAG
1 492.5' I
•� N
i ' 1
1
I
9-.9' -
4- COl1C.
� O�nEMMr
13b00''SN
1
P.
Li 6NT
IZAI
S.W. ASCENSION DRIVE R
10/02/96 MRR
ILM rwyWAe oaaN As omit re O
Npf 1MMt MNI ui Acaom ar ne
Ia001MA�>��>N►n R 7M Q
�01/0�4�NIRt M An Rte►
An
oft NOO�CAIONt
ALAn 11A / COAD D [ / 1411 AI / OCIATCf InC
1303 NM 16TH AVENUE. PORTLAND, OREGON 97209 19031 223-9161 S C A L E t ' i 0 ' • 0
TYPLUMBING PERMIT
_. DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM97-0201
13125 SW Hall Blvd., Tigard, OR 97223 ;503)639.4171 DATE ISSUED: 05/20/91
PARCEL-: 2SIO4CC-HWO79
SITE ADDRESS. . . : 13132 SW ASCENSION DR
SUBDIVISION. . . . : HILLSHIRE WOODS ZONING: R-7 PD
BL-OCK. . . . . . . LOT. . . . . . . . . . . . . :O79 JURISDICTION:
__ ________ _ ___ --_---___-_-.---------:______ .
CLASS OF WORK. . :ALT _ GARBAGE DISPOSAL.S. • 0 MOBILE HOME SPACES. . 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 1 CATCH BASINS. . . . . . . : 0
FIXTURES------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . : 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Installing residential backflow rt - vention device
Owner: ------------------------ FEES --------------
R W FULLERTON CO type amount by date r•ecpt
6462 SW BVTN-HLSDL HWY PRMT $ 25. 00 B 05/19/97 97-294725
F'O:tTLAND OR 97221 3PCT f 1. 25 B 05/19/97 97-29472:5
Phone #:
I:ontr-actor-------------------------------
MICHAEL & CO PLUMBING
P 0 BOX 23008
TICARD OR 97281
Phone #: 639-3189 26. 25 TOTAL
Reg #. . : 000678
------- REQUIRED INSPECTIONS
-------
This permit is issued subject to the regulations contained in the Misr. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with --
approved plans. This permit will expire if work is not started
within 198 days of issuance, or if work is suspended for more _
than 198 days. —
Permittee Si nature:
Tssf_ied Py : _. {�i....
Call for inspection - 639-4175
Y U "i 1GARG Plumbing Application Fec'd By !�
3•'25 SV1f H kh `_ BLr Commerulal and Residential Dale Recd
117 "17
Date to P E.
-fa�,l�^�, OF; W213Date
toD5•i� _
504) x.39-417 Permitill f'1 1 / 't24-J
Print or Typr Related SWR B
Incomplet. or illegible applications will not be accepted Called
—( Name of Developm�tntiProject FIXTURES (Individual) _ QTY PRICE AMT
Sink 900 j
Job _
,;_�-- --- Lavatory 9.00
Add,ess I 't-let. ,rrPis Suite _
?/ ' 2 )c Aso C,x h f
Tub or Tub/Shower Comb 9 00
,:dg x Chy'Slate 7 Zip Shower Only 900
_
It /�,'2 Water Closet 9.00
Nam,. Dishwater 900
Owner Mailing Address Suite Garbage Disposal - 900
Washing Machine 9.00
City/Stale Zip Phone Floor Drain 2' 900
- — 3' 9.00
Name
4" 900
Occupant Mailings A6dress -,u;tn Water Heater - V 900
Laundry Room Tray 900
CityiState Zip Phone Urinal 900
N me
Other Fixtures(Specify) 9.00
900
Contractor M !ling Address Suite --- - 9.00
i 1"
900
5,yr
e Zip Phone --- -- 900
Oregon Const.Cont.9oard Lic.0 Exp 0$$to _ 9.00
Attach Copy of ,,-,)" 2.23 J / - Sl1-l j --- --- -- 9.00
Current Plumbing�Lf�c-.S Exp.Date Sewer-1st 100' 30.00
Licenses (f. Sewer-each additional 100' 25.00
COT Business Tax or Metro+K Exp.DateWater Service- 1st 100 -- 3000
- Name Water Service-each additional 200' 2590
Architect Storm&Rain Drain- Ist 100' -- 3000
Or Marling Address Suite Storm&Rain Dram-each additional 100' 2500
Moble Home Space 2500
Engineer City/Slate Zip Phone Commercial Back Flow Prevention Device or Anti- 2500
Pollution Device _
`escribe work New O Addition Alteration O Repair O Residential Backflow Prevention Device' 1500
)be done: Residential O Wn-residential O Any Trap or Waste Not Connected to a Fixture 900
.dditional description of work -
/� Catch Basin 900
/S-11C1( /c Insp.of Existi,g Plumbing 4000
per/hr
Existing de of I Specially'.eques, Inspections 4000
building or property I_.—... _ per/hr
Rain C ain.singir family dwelling — 3000
Proposed use of t rer ze Traps —� 900
building or property—__ _ —
_ QUANTITY TOTAL
I Are you capping. mt ving or replacing any fixtures? Yes Q No p —ia or nser diagram is required A Ouandy Total is >9
(If yes see back of ft,rn) *SUBTOTAL
I hereby acknowledge ihat I have read this application.that the information
given is correct.that I am the owner or authorized agent of the owner,and — 56o SURCHARGE 7`7
that plan�,submitted are in cumpliance with Oregon State Laws.
Sign tgttedf Ownef/Agent Date PLAN REVIEW 25%OF SUBTOTAL
j Reawrad wry 1 fixture oty !otai is>9
.G/ (1--r:/ (3 ..-/C - `, 7 I. . ---- — - TOTAL —
C ct Penon Name Phone L-
Minimum permit fee is 525-5'6 surcharge.except Residential Backflow
/fes,7 U �� 3c�-3jJ Prevention Device,which is S15-5%surcharge
ldsts,plmapp dor 8196
PLEASE COMPLETE A$-APPROPRIAIE IQ PROJECT:
Fixtures to be capped, moved or replaced Qty
_Sink _
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain _2"
3"
Water Heater
Laundry Room Tray
Urinal _
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Mow 6394171
Date Requested: — '" 9 7 A.M. P.M. MST:
Location: BUR
Tenant: Suite: Bldg: MEC:
Contractor: /���� ,(('1/L/� "Y�— _Phone: PLM:
Owner: Phone: ELC:
—-- r% T ted ELR:
SIT:
BUILDING BLDG(con't) UMBL'YIMECHANIC_At ELECTRICAL SITE
Site Post/Beam —I'5Wffcam Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinider
Foundation Insulation Sewer Ilood/Duct Reconnect. Vault
Ilsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire Spkir/Alm Crawl/Found Dr Ileal Pump Low Volt
Approvedov Approved Approved
Appr/Sdwlk Not Approved ed ved Not Approved Not Approved
FINAL FINAL XA
L FINAL FINAL
C3 Call for reinspection/� M Reinspection fix of S required before next inspection O Unable to inspect
Inspector:�r- — Date _� Page__-__of
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171
Date Requested: �a %% ! - A.M. — P.M. MST:
Location: 3��.� C��'i.rQ LlJ7'y BUR
Tenant: ) Suite: ldg: NEC:
Contractor: /�-W Phone: .)PLM:
Owner: Phone: - ELC:
ELR:--
SIT:
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Pos eam Cover/Service Sewer/Storm
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
13smt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rein Drain A/C UG Slab
Sheer/Sheath Fire Spklr/Alm Crawl/Found Dr
Heat Low Volt
Approved Approved
Approved Approved
pin
Appr/Sdwlk Not Approved Not Approvedved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
/ _
D Call for reinspection 0 Reinspection fee of S required before
next inspection 0 Unable to inspect
Inspector: _ 17ate:_ =l Page---of