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FOUNDATION CORNERS AND PROVIDE
SUBSEQUENT MORTGAGE SURVEY.
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R_ 1098.75' CITY OF TiGARD
WASHINGTON COUNTY, OREGON
s� APRIL� 21 , 1997.. \ Centerline Concepts Inc .
--AN EIGHT FOOT PUBLIC UTILITY EASEMENT DRAWN BY: MSG CHECKED BY: WGDIII
- LL EXIST ALONG ALL STREET FRONTAGE. SCALE 1 ".=-20' ACCOUNT # 115
640 82nd Drive Gladstone,--- Oregon ' 7
---...
M: \MLI\PLAT\EAGLEPC\L4EP—A 503 650-0188 fiox 503 650—
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13973 SW AERIE DRIVE
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CERTIFICATE OF OCCUPANCY_
CITYOF T I GA R D PERMIT#: MST97-00165
DEVELOPMENT SERVICES DATE ISSUED: 6/11/97
13125 SW Hall Blvd., Tigard, OR : 7223 (503) 639-4171 PARCEL: 2S103CC-02900
ZONING: R-4.5
JURISDICTION: TIG
SITE ADDRESS: 13973 SW AERIE DR
SU"—DIVISION: EAGLE POINTE
BLOCK: LOT:004
CLASS OF WORK: NEW
TYPE OF USE: SF
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: SF - Path 1
Final Inspection Approved 4/6/99 by George Steele, Building !nspector
Owner:
JOHN MUNDSTOCK
13975 SW AERIE DR
TIGARD. OR 97223
Phone: 557-8000
Contractor:
RENAISSANCE DEVELOPMENT CORP
1672 SW WILLAMETTE FALLS DR
WEST '-INN, OR 97068
Phone: 557-8000
Reg#:
This Certificate grants occupancy of the above referenced building or port n II►ereof and
Confirms that the building has baen inspected for compliance with the Stat of Oregon
Specialty Godes for the group, occupancy, and use under which the referenced permit was
issued.
BUILUIN INSPE OR BUILDIWG OFFICIAL
POST IN CONSPICUOUS PLACE
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS OR 97015
Electrical Signature Form
Permit # . . . . : MST97-0165
Date Issued. : 06/11/97
Parce! . . . . . . : 2S103CC-02900
Site Address : 13973 SW AERIE DR
Subdivision. : EAGLE POINTE
Block. . . . . . . . Lc,t . 004
Jurisdiction:
Zoning . . . . . . : R-4 . 5 PD
Remarks :
SF - Path 1
Your company has been indicated as the electrical contractor for the permit indicated above. In
order for the electrical permit to be valid, the signature of the supervising electrician
is required.
Pease have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be authorized until
this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
ELECTRICAL, CONTRACTOR:
RENAISANCE DEVELOPMENT GAGE ENTERPRISES INC
1672 SW WILLAMETTE FALLS DR PO BOX 1429
WEST LIN14 OR 97068
CLACKAMAS OR 9701.5
Phone # : Phone # :
Reg # . . : 000345
x c .
Signature of Supervising Electrician
Please return this; completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171 , ext. ##3'0
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
BRIDGEVIEW PLUMBING INC
808 MOLLALA AVE
OREGON CITY OR 97045
Plumbing Signature Form
Permit # . . . . : MST97-0165
Date Issued . : 06/11./97
Parcel . . . . . . : 2S103CC-02900
Site Address : 1397.3 SW AERIE DR
Subdivision. : EAGLE POINTE
Block . . . . . . . . ,c_,t . 004
Zoning. . . . . . . R-4 .5 PD
Remarks :
SF - Path 1
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
PL[TMBING CONTRACTOR:
RENAISA_NCE DEVELOPMENT BRIDGEVIEW PLUMBING INC
1672 SW WILLAMETTE FALLS DR. 808 '"DLL•ALA AVE
WEST LINK OR 97068 OREGON CITY OR 97045
557-8000 Phone # :
Reg # . . : OQ0459
Signature of Authorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639 4171 , ext. #310
CITY OF TIGARD
DEVELOPMENT SERVICES MASTER P'*RMI7
F,ERMIT #. . . . . . . : MST97-0165
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 06/11/97
PARCEL: 2S 103CC-0c901?r
SITE IIDDRE ". . . : 13973 SW AERIE DR
SUBD I V I S I ON. . . . :EAGLE F'0I NTE ZONING: R-4. 5 F,D
BLOCl.. . . . . . . . . . LOT. . . . . . . . . . . . . .004 JURISDICTION:
Remarks: SF -- Path I
-•---------------------------------------------------------------- BUILDING --------------------------—--------------------------------------
REISSLIE: STORIES.......: 2 rrOOR AREAS---------- BASEMENT... : 0 sf REQUIRED SETBACKS---- REQUIRED-----------
CLASS OF WORK.:NEN HEIGHT........: 22 FIRS(....: 1364 sf GARAGE..... : 645 sf LEFT..........: 12 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1166 sf FRONT.........: 20 PARKING SPACES: 2
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBEMENT: 0 sf RIGHT.........: 12
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 2530 sf VALUE..$: 180661 REAR..........: 25
---------------------------.-------------------------------------- !1UMBING ------------------------------------------------------------------
SINKS.........: 1 WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 100 TRAPS.........: 3
LAVATORIES....: 5 D19HWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0
TUB/S11OWERS...: 3 GARBAGE DISP..: I WATER HEATERS.: I WATER LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS..: 0
OTHER FIXTURES: 0
-------------------------------------------------------- ----- MECHANICAL ----------------------------------------------------------------
UEL TYPES----------- FURN ( INK ., ; 0 BOIL/CMP t 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1
GAS FURN )=INK .. : 1 UNIT HEATERS.. : 0 HOODS.........: i OTHER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: I
__- -------------------------------------------------------------- ELECTRICAL ------------------------------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLnNFOUS--• - --ADD'L INSPECTIONS--
ION SF OR LESS: 1 0 - 200 amp..: 0 0 200 amp..: 0 W/SVC OR FDR..: 0 PUMPiIRRIGATIUN: 0 PER INSPECTION: 0
fA ADD'L 5005F.: 5 201 - 400 alp..: 0 201 - 400 asp.,: 0 1st W/D SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
! IMITED ENERGY.: 0 401 - 600 asap..: 0 401 600 asp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 iN PLANT...... : 0
MANF HM/SVC/FDR: 0 601 - 1000 alp.: 0 601+apps-1000 v: 0 MINOR LABEL 10: 0
1000+ alp/volt.: 0 --------•-------------------------- PLAN REVIEW SECTION ----------------- - _______-.____
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
---------------------------------------------- -- ELECIRICAL - RESTRICTED ENERGY -------- -- ----- - ---------------------------------
..
A, SF RESIDENTIAL---------------------------- B. COMMERCIAL----------------------------------------- _---_�-- -----------------------
OUDIO I STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC L.T:
BURGLAR ALARM..: 0TH: :: X BOILER...... HVHC...........: LANDSCAPE/IRRI6: PROTECTIVE SIGNL:
fiARAGE OPENER..: CLOCK..........: INSIR[NNTATION: MEDICAL...,....: OTHR:
HVA(............: DATA/TELE COMM.: NURSE CALLS....: TOTAL M SYSTEMS: 0
Owner: -------------------------------------Contractor: ------------------------------- TOTAL FEES:$ .3139.46
RENAISANCE "EVELOPMIENT RENAISSANCE DEVELOPMENT CORP
1672 SW WILLAMETTE FALLS DR 1672 SW WILLAMETTE FALLS DR
WEST LINN OR 97066 WEST I-INN OR 97066
Phone A: 557-8000 Phone M: 551-BOR
Req C.: 000049
chis permit is issued subject to the regulations contained in the Tigard Municipal Code, Statr of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspended for more than 180 days.
---- - - ------ -------------------- - ------ REQUIRED INSPECTIONS ------------------------------------------------ ---
Erosion Contol Post/Beam Median Electrical Servi Gas Line Insp Water Service In Buildiaq Final
Grading Inspect: Crawl Drain Electrical Rough Gas Fireplace Appr/Sdwlk Insp
Footing Insp PLM/Underfloor Framing Insp Insulation Insp Electrical Final
Foundation Insp Mechanical Insp Shear Wall Insp Gyp Board Insp Mechanical Final
Post/Dears Struct Plumb Top Out Low Voltage I, Rain 0-air. Insp P1 Final
F'ar-mittee Signo1,t , c Issr_red By :
I P°k
— --
Call for inspection - 639-4175
CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : SWR97-0170
DATE_ ISSUED: 06/11/97
PARCEL: 2S103CC--02900
SITE ADDRE'SS. . . : 13973 SW AERIE DR
5UBD T V I S I ON. . . . :EAGLE POINTE ZONING: R--4. 5 PD
13LOCI',. . . . . . . . . . LOT. . . . . . . . . . . . . :004 JURISDICTION:
TENANT NAME. . . . . :RENAISSANCE DEVELOPMENT
USA NO. . . . . . . . . . . FIXTURE UNITS. . . . 0
CLASS OF WORK. . . :NEW DWELLING UNITS. . : t
TYPE OF USE. . . . . :SF NO. OF BUILDINE33: 1
T N STALL TYPE. . . . :BUSWR I MPERV SURFACE: 0 s f
Remarks: SF — Path 1
Owner: __ .-_____-_.---.._-___-._...---.----.-----...-.--.-----.-------_______._._.-_._-...____ —.___.... FEES . - --
RENAISSANCE DEVELOPMENT type amol-rnt by date r,ecpt
1672 SW WILLAMETTE FALLS DR PRMT $ 2200. 00 B 06/ 10/97 MANUAL REE'
WEST LINN OR 9. 7068 INSP 6 35. 00 B 06/10/97 MANUAL REG
Phone #:
(;nntract or:
OWNER
Phone #: $ 2235. 00 TOTAL
Reg #. . .
-- -- --- REQUIRED INSPECTIONS — -- --This Applicant agrees to comply with all the rules and regulations Sewer- Inspection
of the Unified Sewage Agency. The permit expires 188 days from
the date issued. The total amount paid will be forfeited if th- _
permit expires. The Agency does not guarantee the accuracy of the
side sewFr laterals. if the sewer is nit located at the measurement
given, the installer shall prospect 3 faet, in all dirartions from
the distance given. If not so located, the installer still purchase
a "Tap and Side Sewer" Permit and the Agency will install a.l�lateral.
Issued B y : �l�V�"�44,
Call for inspection — 639-4175
Plan Check,
' OF TIGARD Residential Building Permit Application Recd By
125 SW IAALL BLVD. New Construction Additions or Alterations Date Recd G'
CARDI OR 9�223 Single Family Detached or Attached (Duplex) o,te to P e. 1'1
503-639-4171 nate to DST 1,1
503-684-7297 PennA
Print or Tvpe Called 'P:1) 0110
Incomplete or illegible applications will not be accepted
Name of Project Name ,
Job Apo/,VT--,E Ar Architect MaillAddress y
Address Site Addre�} oltrp- 0117t
_.—... Name - C/%G>9ir'O �TQ'� Phone
Name
Owner Malin Address _ 7/1-1'1 A,
f�ZZ-2 Engineer Maili Address
Cityf,9tan Phoc+s /(� 3xs _Ss�i �Ct,,.s:r il3frPl�
�c f1- .U1-✓✓ �! T �p�ck CirylStaaZp _
�"
General , C/1%q/HCl +c' Describe work New Addition:0 ',Itteratwn O Repair O
:Ontractor Mai Address to be done:
- Additional Descnption of Work:
CAy/state Zip . P
Oregon Const.Cpnt.Board Lio.N Exp. •ats v 6fiN�i�i f
rtach Copy of C r t
Current COT BusT or MetroN PROJECT
Llcenses - b? �' VALUATION
Nems
O'echanical `,lfj CvrI+!%y /ti,�y' �jyy�il�,( NEW CONSTRUCTION ONLY:
Sub- _17-Mailing Address Sq. Ft. Howe. Sq. Ft Gar
;ontractor �k.'�� £ Comer Lot YES NaFlag Lot YES N
citvleiste Zi Phone (check one) I' (check one) �f
1- I G (check --
regon ConstContBoard Licr Epp to Restricted Audio/Steno Burglar
Bch Copy of �� 3 �� f -7�' Energy System Alarm
current coT Bus eta tax or Metro a ate Installation Garage Dour HVAC
!-kens.,, 'i, 9 Opener Systems
Name ' (check all that Other
lumbinq / -f/�En� ��/76�NG apply) F I
Sub- Mailing Address Will the electrical subcontractor wire for all YE NO
;rantractor ,` /11E'/�//.4 iJi restricted energy installations?
Cr,qu�tate Zip P 9ne Has the Subdivision Plat recorded? N/AV� NO
Qregon Const.Cont. Board Liz s Exp. ste Reissue or MST# Solar Compliance
%trach Copy of y`xfZ3__ I -f _ _ (Calculation Attached)_y`
Current Plumping 1�.1�j'0 D• t I Nearby acknowledge that I nark- read this application,'".tai the
Licerses 3"�7 c r�6 / �/
COT Business ax or Metro� nformation given is correct, that 1 am the owner or authorized
C� s
o��� /p' agent of the owner, and that plansubmitted are in t ompGance
--- — with Oregon State laws.
Name r Signatu of /Agen Date
7 /
Electrical �.�+Cf .� 'z ;�i�if�t1 _t��,,.1
Sub- Mailing Address Contactp*mnN Pon
Contractor �/"c:. dc,-r' fwd y -re.-;�7 _�a9•^ �a c�
City/State Zip Phone FOR OFFICE USE ONLY: _
(,^y y ( P!at#: MaprrL#,
re�cr Const.Cont. Board Lic.ie p t �` 1 t L{( elp ^� Z
mach Copy of L E/ _ 5etba Z Solar
Current El Incal Lic�E ^— - p.Da �() ' ��p In I jti
Licenses S c f g,neering App al: F{��QQ r1q Approval: TIF:
COT Business Tax or Metro 0 F.�t a �,
lAsfili1pp.doc(dst) V97
1 ? t
pefriitj Account Ciescriotion Amount Amt. Pd. Bal. Due
L,r,l�l jt,,, MST. Permit (BUILD) X35, s_ 6,35 ."=
Plumb. Permit (PLUMB) Z 15: " + ZL.S.
Gtr
Mech. Permit (MECH) `}5 ✓ 4.5 �
ELC/ELR Permit (ELPRMT) Z ?5, v
State Tax (TAX) S
Bldg: jl. L'
Plumb: ll,
Mech: 1 1
Ef'.0/ELR: 13 r
Plan Check
MST: (BUPPLN) -4/ L'
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS) �V: ' — AO'
.� 47 011v Sewer Connection (SWUSA) ZZvy .Y ✓ ��cy
Reimbursement District
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
residential TIF (TIF-R) _
Mass Transit TIF (TIF-MT)
iN
Water Quality ONQUAL)
Water Quantity (WOUANT) _/00 ova
Erosion Control Permit (ERPRMT) C d
Erosion Planck/USA (ERPLAN) 2y'
Erosion Planck/COT
(E
Erosion 1-20•
Fire Life Safety (FLS)
TOTALS: rL,
�: tspp.doc (dst) 1127 i
Solar Balance Pei nt 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 perpendiailar to that point.
First, determine which prooerry line is the N4^h lot line. The North lot line is the line
with the smailest angle from a line drawn east%"est and intersecting the northern most
point of the logy
d5'
North-_oud,
N
Dimension for Lot.
,Veasure the distance from the midpoint of the North lot line to the South lot line along
the described line. feet
1
N
�rps�.fWfca6.l7N
Box 8 calculations: Shade paint height for your residence. Box B:
1. Determine whedtier measurements will be based on the peak or eave of your Which describes
structure. The orientation of the ridge is also importam your residence?
(circle one)
1 a: If the roof line runs North-South, measurements will .�
be based on the peak of ttre roof. 0000
.�«_.. 1A 16 1C
15: If the roar line runs East-West and the roof pitch is
less pian 3112, measurements will 'e ' aced cn tie
cave.
1 c: if the roof line run,, East-Nest and the roof pitch is
5/12 or steeper, measurements will be based on the
peak. a:..ac=
Box B. continued Box B:
2. Measure change in elevation (real front property line to finisheil floor elevation. If
die lot slopes up from the front lot line to the foundation, the figure is positive. If
the lot slopes down om the front lot line to the foundation, the figure is negative. -- ft
13* Measure distance from finished floor elevation to the affected peak/eave. + ------- h
a. If the roof line nuns North-South, deduct three feet. If the roof line runs East-West, ft
deduct nothing.
�. Subtract one foot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slope, up from the front to the rear. If the
lot has ro slope or slopes up from the res►to -fie fronr. Deduct nothing. - ft
r,_ Total Figure for box S. 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 alf'ect,ed peak or eave. +
3. Total figure for box C: ft
It is most useful to drsw a verdcW fine to reprt wa the appropriate f4um found in Lox'A-and a horizontal 6ne to represent the
appropriate Glue found in box"C'.The inwnecwi of the vertical and horkand lime detemrines the value found in Moor'D . The value
n bots '0'should be compared to the value in box'B'; if the value in boot'8'is kw dun or equal bo the value found in boot'D', then
the buiiding is in mmpGance w,th the solar balance code. If you haute any questions.pkase concia us at 639-4171,x304 or at the
Commuvey 0eveloprnent Counter.
MAXIMUM PERMITTED SHADE PAINT HEIGHT (In Peet)
oimnce to North-south lot dimension On feet)
shade 100+ 95 90 85 80 7S 70 65 60 55 50 45 40
reduction Gne
fnxn northern
lac 5m fin fKtl _---
70 40 40 40 41 42 43 44
55 38 38 38 39 40 Al 42 43 I
60 36 36 36 37 18 39 40 41 42
33 34 3-1 34 35 36 37 38 39 10 41
30 32 32 32 33 34 35 36 37 38 39 40
=3 30 30 30 31 32 33 34 35 36 3i 38 39
-0 23 23 23 29 30 31 32 33 34 35 Y 17 38
35 26 26 26 27 28 29 30 11 32 33 34 35 36
:0 24 Z4 24 25 25 27 '8 20 30 31 32 33 34
:5 2-1 2-1 22 23 24 25 :5 27 23 29 30 31 32
13 :0 20 20 21 22 23 24 25 26 27 28 29 30
15 18 1., 18 19 20 21 2-1 23 24 25 26 27 28
.0 16 tb 16 ti 18 19 _0 21 22 23 24 25 _5
14 14 14 15 16 17 18 19 20 21 22 23 24
Box D. Maximum allowed shade point height: feet
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DOCUMENT
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : P'LM97--0506
13',5 SW Nell Olvd., hyara,OR 97223 (503)639.4171 DATE ISSUED: 11/20/97
PARCEL: 2S103CC-02900
SITE ADDRESS. . . : 13973 SW AERIE DR
SUBDIVISION. . . . : EAGLE POINTE ZONING. R--4. 5 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :004 J(..JR T SD I CT T ON: T I G
------------------
C1_ASS OF—WORK. . :ADD GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW P'REVNTRS. . : 1
r1CCUPANCY GRP. , :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES--------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAP'S. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRP.IN (ft ) . . . : 0
Nemarks : Add residential backflow prevention device to new SFD.
Owner: ------------------------------------------------------- FEES --------------_..
RENAISSANCE DEVELOPMENT type amount by date recpt
1672 SW WILLAMETTE FALLS DR PRMT f 15. 00 GED 11/20/97 97-301030
, WEST LINN OR 97061 5P'CT f 0. 75 GED 11/20/97 97-301030
Phone #:
Contract
MOODY ENTERPRISE= INC
170 BOX 98
FSTACADA OR 97023 _____..__._____—_ ._------------•_____.---__-__. __.._
Phone #: $ 15. 75 TOTAL.
IE?g #. 000059
------- REQUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained in the RP/Backflow Prey
I igard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable lags. All work will be Bene in accord2nce with _
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
thae 18C days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952--MI-010 through OAR 952-9N01-N08A. you may
obtain copies of these rules or direct questions to OUNC by calling _
Issued By: � ----_.,,�� Permittee Signature: _
Call. 639-4175 by 7:00 p. m. for an inspection needed the next business clay
+4 ',-+.+i-t+++++t++++++++t++++++++++++++•F•+++++•f++++++.++t+t+.(-++•F•++•1 +++f+++a-+++i•+
CITY OF TIGARD Plumbing Application Recd By_ , ,
13125 SW HALL BLVD. Commercial and ResidentialDate Recd
_
'TIGARD. OR 97223 Date to P.E.
(503) 639-4171 =� Date to DST
� Permit# TI-1 -O 6v,
Print or Type "-t- Related SWR#
Incomplete or illegible applications Will not be accepted called
Name of Devat ment/Proj On back Indicate Work Performed by fixture.
Job �� �� 4 y FIXTURES (Individual) QTY PRICE AMT
Address ppSire Address su;te Sink 9.00
/3` S !z C r Lavatory _ 9.00
Bldg# Cit /Slate 9 Zip Tut ur Tub/Shower Comb.
/ _ — 9.00
2 2 '
N ma Slower Only 9.00
Water Closet 9.00
Owner Mail:.igAd1�7dyress _ Suite Dishwasher 9.00
Garbage Disposal 9.00
'C�'t /Std7vIp Pone
V✓`p 1_/� � � Washing Machine 9.00
Name Floor Drain 2' 9,00
� 9.00
Occupant Mailing Address Suite 3
i 3' — 900
City/StateZip Phone Water Heater O conversion 0 like kind 9.00
Laundry Room Tray 9.00
N me Urinal 9.00
^ e o�15,11S Other Fixtures(Specify) 900
Contractor iling A cress Suite
01 d 9.00
°hC
X `T
Prior to permit dyl tale Zip ne 9.00
issuance,a ropy i�Syak G .. glad 9.OU
of all licenses are Orego onst.Cont.Board Lic.# �x Date �j _ 9.00
required dG1�J r3 Sewer-1 at 100" 30.00 V
expired in COT Plumbing Lic.# Ex Date
database p Sewer-each additional 100' 25.00
Name' — - Watnr gPrvir'A.1st inn, 30.00
Architect Water Servica-eadh additional 200' 25 00
Or Mailing Address Suite Storm&Rain Drain-1st 100' - 30.00
_ Storm i3 Rain Drain-each additionaT 100' 25 00 I
Engineer City/State Zip Phone Mobile Home Space 25,00 ---)
�- An
Commercial Back Flow Prevention Device or ti- 25.00
Descnbe work New tr Ad (tion 0 Alteration O Repair 0 Pollution Device
to be.done: Pesidenlial Non-residential 0 - Residential Backflow Prevention Device' 15.00
lddihonal description of work: Any Trap or Waste Not Connected to i Fixture 9.00
Catch Basin 9 00
' ! , Insp.of Existlnc�lumbin9 40.00
e.,t per/hr _
Existing uQe of Specially Requested Inspections 40.00
building or prooerty.�._ __— Y_ _ per/hr
Rain Drain,single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property_— `—
QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the information Isometric cr niter dipgram.s required a nanny Total u >9
given is correct,that I am the owner or authorized agent of the owner,and — 'SUBTOTAL
that glans submitted are in compliance with Oregon Slate Laws. �'
SI a ure o 0 or/Age t r Data' S°/s SURCHARGE
(�
Co tact Person Name Phbho PLAN REVIEW 25% OF SUBTOTAL I j
Required only A Fixture qty total s>9 l
260,2q;o TOTAL
'Minimum permit fee is$25+ 5%surcharge,except Residential Backflew
Prevention Device,which is S i5+5%surcharge
1gWV 11jU)do:s
F'LEtiSE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved ! Replaced Removed/Capped
Sink
Lavatory
Tib or Tub/Shower Combination —
Shower Only _
Water Closet_
Dishwasher
Garbage Disposal
Washing Machine _
Floor Drain 2" �.
311
_ _4„
Water Heater
Laundry Room Tray_
Urina! --
Other Fixtures (Specify) _
COMMENTS REGARDIN ABOVE:
I WstWplmspo doe 5A7
CITY OF TIG.ARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -
BUP
Date Requested AM PM BLD —
Location Z �r • Suite MEC
Contact Person Ph r� PLM _—
Contractor _ G1.1 S X�Y�C Ph SV%JR
Tenant/Owner —_ ELC _
Retaining Wall ELR
Footing Access- FPSFoundation (i ---
Ftg Drain ` , SGN —�
Crawl Drain Inspection Notes: --
Slab -- — -- - SIT _ __--
Post& Beam
Ext Sheath/Shear — -- ------ --
Int Sheath/Shear
Framing —_ ------- -- _.� -- -- .. ._ -
Insulation
Drywall Nailing (r_ ,Y l _.� ------_. -- ---- _ -----
Firewall I — ------- -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _---�--
Roof
MIS
na
ASS PART FAIL ._..— -- --_ -- ---
PLUMBING
Post 8 Beam --- ----------__.
Under Slab --
Top Out -.__--------------
Water Service —
Sanitary Sewer
Pain Drains - -
Final
PASS PART FAIL --
MECHANICAL
Post 8 Beam -- - - -----.._---- --
Rough In _ —
Gas Line —
Smoke Damper _
Final
PASS PART FAIL _
ELECTRICAL —
Service - - --- - --
Rough In
UGISIab _ --_-- - -
Low Voltage
Fire Alarm ---_---_-_ --... -
Final
r,ASS PART FAIL) - -- — --------- -
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ -_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE:-_ [ ]Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector -_- -, —Ext
Other --
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.