12959 SW GALLIN COURT 12959 SW Carlin Coui
CITYOF T I G A R D _ MASTER PERMIT
DEVELOPMENT SERVICES DATES UIED: 4/18/0101-00221
13125 SW Nail Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12959 SW GALLIN CT PARCEL: 2S104DA-03700
SUBDIVISION: QUAIL- HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT: 023 JURISDICTION: TIG
REMARKS: New SF detached dwelling. Path 1
-- �— BUILDING
REISSUE. STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,440 a1 BASEMENT. st LEFT. I', SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD, Ori SECOND: 1,419 of GARAGE. 1 FRONT 4 PARKING SPACES: 2
TYPE OF CONST: 514 DWELLING UNITS: I FIN88MENT: of RIGHT
: ; 50
OCCUPANCY GRP: R3 BDRM: d BATH: t TOTAL: 2,08500 of VALUE S64.;44REAR. I.,
PLUMBING
SINKS: 1 WATER CLOSETS 1 WASHING MACH: I LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS
TUBISHOWERS: 3 GARBAGE DISP: 1 WATLR HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTH: 1 GREASE TRAPS.
MECHANICAL OTHER FIXTURES
FUEL TYPES FURN<100K: BOILICMP c 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN1100K: I UNIT HEATERS: HOODS: t OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER —TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS 1 0 - 200 amp: 0 200 amp: WISVC 01 FDR: 1 PUMPIIRRIGATION: PER INSPECTION:
EA ADDT 500SF: 5 201 400 amp: 201 400 amp: 191 Wr0 SVC/FDR: nu SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 000 amp: Ani Soo amp: EA ADDL BR CIR. SIGNAL/PANEL: IN PLANT:
MANU HMISVCIFDR: 601 - 1000 amp: 601+amps•1000v: MWOR LABEL:
10004 amolvolt:
Reconnect only: PLAN REVIEW SECTION
4 RES UNITS: SVCIFDR),•223 A.: >000 V NOMINAL: GLS AREA/SPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL. --
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: L.ANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL: OTHR.
HVAC: DATAITELE COMM: NURSE CALLS: TOTAL.a SYSTEMS:
Owner Contractor: TOTAL FEES: $ 4,778.92
1&S CONCRETE ECK CONSTRUCTION INC This permit Is subject to the regulations ccntoined in the:
P.O BOX 821 PO BOX 204 Tigard Municipal Code,Slate of OR. Specialty Codes and
NEWBURG,OR 97132 SHERWOOD,OR 97'40 all other applicable laws. All work will be done in
accordance with approved plans. This permit will BxDire If
work Is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rog*: 11c ..4 forth In OAR 952-001-0010 through 952-001-0080 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Flnat
Sewer Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Footing Insp Underfloor Insulation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final
Foundation Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Wtr Proofing Bsm't'We Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Building Final
14 J
Issued By : _ — L ---—_ --- Permittee Signature ----- --
Call (503) 639-4175 by 7:00 p.In. for an inspection needed the next business day
CITYSOF TIGARD _ SEWER CONNECTION PERMIT —
DEVELOPMENT SERVICES PERMIT#E: SWR2001-00148
1315 jW Hall Blvd., Tigard, OR 97223 (501) 639-4171 DATE ISSUED: 4/18/01
SITE ADDRESS; 12959 SW GALLIN CT PARCEL: 2S104DA-03700
SUBDIVISION: QUAIL HOLLOW- WEST ZONING: R-4.5
BLOCK: LOT: 023 JURISDICTION: TIG
'TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: �
TYPE 07 USE: SF NO. OF BUILDINGS 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached dwelling.
Owner: — -FEES-- - -----—
- - - -
J & S CONCRETE �"" ---- ---
P.O. BOX 821 Type By Date Amount Receipt
NEWBURG. OR 97132 PRIVIT CTR 4/18/01 $2,300.00 27200100000
INSP CTR 4/18/01 05.00 27200100000
Phone: 503-538-8615 Total $2,335.00
Contractor:
Phone:
Reg 9:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The perrnit expires
180 days from the date issued ThP total amount paid will be forfeited if the permit expires l he Agency does not
guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001.0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued by: Permittee Signature:
Call (503) 539-4175 by 7:00 P.M. for an inspection needed the next business day
f
jd�st G� 7
Building Permit Application
_ Date received: '� /e O Permit no.:/'"/�7?00 J DOe7.2 !I
City of Tigard
City ufTigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Projectlappl.no.. Expire date,
Phone; (503) 039-4171 /� Date issued: By. 7Rcclpt no..
Fax: (503) 598-1960 /f Case file no.: Payment type: Z
Land use approval: 1&2 fanulv: il
PP : _ -- .SunIe Complex:
'o
I &2 family dwelling or accessory U Commercial/industrial U Multi-I•tunilyNew construction :] Demolition
U Tenant improvement J Fire sprinkler/alarm U Other:
Job address; Bldg. no.; Suite no.:
Lot: Block: Subdivision: Tax ma /tax IoUaccount
Project name:
Description and location of work on premises/special conditions:
Name: J S ��'t?�C"/''t' rN
solar,etc.)
.
Mailing add:t4ks _ 1 & 2 fantll) dvsclling j
City: ` Stat ZIP: `• -' r ---
_ Valuatiun of work......,af.�!.y..,��. ............. $
t►
Phone _ - Fax: E-mail; No,of bedrooms/baths..................
net s representative: — �
)wTotal It ember of floors................................. W/6
New dl��elli —
Phone; fax: r "-maiL
ngarea(sq, ft.) .......................... .
Garage/carport area(sq. ft.)......................... fi
Ntune: Covered porch area(sq. fl.) .........................
Mailing address: - beck area(sq.ft.) .. ... . ............................ -
City: _ State: ZIP: r Other structure arca(sq I I.)......................... --
Phone: --- Fax; E-mail: Commercial/indn.strial/multi-family:
711 mily to]t� Valuation of work........................................ $
Business name: �" Existing bldg.area(sq, fl.) ... ..............
Address: ��F; 0. New bldg.area(:.q,ft,) ........... .......
C ity:Z44State: 1ZIP; Number of stories......................... .............
I'Itune: '1!0 Fax ' ' Type of cuns.ruclion................. _.
- <._ - :-mail: �.... ..
CCB nu'; % �� -�.- "-- -- — Occupancy group(s); f Ext ung:
— - -- ------- _
C►ty/nutro It, nu.: New.
Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
[''f r:P. provisions of ORS 701 and may he required to be licensed in the
Addt•ess; l' ;-- -> > --- jurisdiction where work is being performed. If the applicant is
City _ St at• ZIl': , `exempt from licensing,the following reason applies:
Contact person: „�� Plan no.: _--1
Phone: - Fax: fr G-mail:
Name: Contact person: Fees due upon application $
...........................
_ Dar..received: —
City: / y. Fax: E-
Stat e' ZIP: Amount received
...... $'
Phone: _ mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all Jurisd{caom accept credit cad,,please call jurisdiction I'm mule intormetlon.
attached checklist.All provisions of laws and ordinances governing this U visa O MasterCard
work will be complied with,whether specified herein or not. Credh card number —L /
t �l —
Authorized signature: —--��" te: �(,/ EsExpiressL-11__fr 7 —" Nome of cardholder as shown on credit card
Print name: 5"�.�� - �_ y _
Cardholder s{6naturc Amount
Notice:This permit application expires if a penult is not obtained within 180 days after it has been accepted as complete. Waal a IMCOM)
Mechanical Permit Application
Da : S
Date received: _ Permit / 'I
City of TigardProject/appl.no.:
Expire date:
IL'i(ve1rTihard Address! 11125 SW ball Blvd,Tigard,OR 97223 -
Phunc: (:,t)3) b39-4171 Date issued: By: Receipt no,:
Fny; (501) 598-1960 Case file no.: -- Payment type:
Land use approval: Building permit no.;
J I .' -' latnily dwelling or accessory U Commercial/industrial U Multi-family J'1enant improvement
N ni clic ti en _l -lelditioii/alteration/replacement CI Other:
t t .
!ul addi Itis: MUM 1311 D!11 11111 L 1111101M LU=
' T L/ -�_ e , Indicate equipment quantities in boxes below. Indicate die dollar
Bldg.no.: tiuite ner.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: _ profit.Value$ _
Lot: Block: Subdivision: *See checklist for important application information and
Project name: / /�,� jurisdiction's fee schedule for residential permit fee.
City/county I ZIP: t
Description and location of work on premises: MaXIC1110 MIA M:1161 Flignahm"inffivi
Fcc(i�; t'osal
lst.date ol'completioll/inspection: Ikuriptinn__ ("X . RRes.onl
Tenant improvement or change of use:
Is existing space heated or conditioned'?U Yes U No Air handling unit CFM
k rxisling space insulated'?U Yes U No Air conditioning(site an re uire )
Alteration tem -
o er compressors
Business name: State boiler permit no.:
Address: Z!rjw
HP Tons BTU/H
it smo a am ers uct smoa eteclors
City: tat
Se: `1P; eat ump s to p nn reyutrec)
Pho e. Fux: E-mail; nstall rep rice urnnr. urncr
CCB tic+,; Including ductwork/vent linet U Yes U No
nsta rep ac re ocateeaters-suspen a --
C4011 1.,)he.no.: walI,orfloormounted
Nance( lease•print) Vent foi a i linncc o ei than furnace
CONTACT PERSON cfi gerallon:
Absorption units BTU/14
Name: Chillers HP
Address: _ - Cam iressors HP
City: State: ZIP: nv ronmenta ex oust an ren tit nn:
-L____ Appliance vent
Phone: �I . I l ryerex oust ""
l-loods,T-yp-e-VTVF-e-s-TT c i-IcN/inzmat
bund Ore suppression system _
Name: Exhaust fan with sin Ir duct bath fans
Mailingaddress: ( ) —
_ Exhaus system tiart iram seatin or AC
City: SState��(p; Fuelpiping an v of on a ep to 4 owlets) -
Phrmc Its l; -'_ 'rY e: __ —LPG +JCi Oil
rueinn eac ad itd ionnl"over out
Process piping(sc ematic required,)
Name: Number of outlets
- ter st a ante ore urn%-- - -
Address: PP q P
--- - - --------.-- __ Decorative fireplace
'lty: Decorative
I nsert-tv a
I'henlC: Fax: E-mail: oo stove pe et stove
Applicant's signuture: Date: tier:
Name (print): Other:
Not till poMdh:Uoos accept credit cards,pleat tall Jurisdiction for mem infornnrrion. Permit fee.....................$
U Visa U MasterCardNotice:This Permit application Minimum fee................$ _
Ordu card number. expires if a permit is not oh,.:tied
_ --� '_--�-- --L phe�— within ISQ days after it ha r en Plan review(at r;Y�) $
Name of card oldeissihowu an ere a tar -`- accepted as complete. State surcharge(89t) ...$
— TOTAL ...... ............... $
Cardholder..gnature S Amount
44041617 tMNAI.'OM)
Plumbing Permit Application
Dare received: Permit no.
City of Tigard Sewer permit no.: Building permit no,:
Address: 131'25 SW Hall Blvd, ftkard,M 4722 -- 1
City ajTrgurd Phone: (503) 639-4171 I'ro)ocdappl.no.: Expire dale:
Fax: (503) 598-1960 Date issued: By: Receipt no..
Land use approval L
t a.,e file rho., Payment type:
U 1 &2 family dwelling or accessory ❑Commercial/industrial j Oulu t,rmil" :]Tenant improvement
New construction J Addition/alteration/replacement J 1- ,I . i i_ J Otl:cr
J01111 St
I)cscri Rion htY•(ea.) Total
B1d4.no.: SUllf n0.: NeR I-mid Man0l}'d"ellings mily
_----
- Onvlude%100ft.forrathutflitt,ronnr(tioo)
Tax map/tax lot/account no.: si-H (I t Will
Lou Block: I Subdivision: SFR(2)bath - - —�
Project name: ! .j SFR(3)bath _
City/county: I ZIP: Eac additional bath/kitchen
Description and loca6un of work on pre nhises __�_— Site utilities:
Catch basin/area drain
Est.date of con)plctiun"Vin Spec tiun: i r wells/Ieac Iii ine/trench drain
t , Footin drain(no. in.ft,) _
Manufactured home utilities
Businessname: r( p Manholes
Address: _ _ Rain drain connector _
City: Stater ZIP: Sanitary sewer(no.lin.ft.)
Phone: �— Fax: L-mail: Storm sewer(no,lin.fl.)
CCB no.: Plumb,bus.reg.no -Water service(no.lin.ft.)
City/metro tic.no.: --- Fixture or Item:Absorption valve
Contractor's representative signature: Back flow preventer _
Print Hume Date: Backwater valve
Basins/lavatory
Name: Clothes washer
Address: _ ishwas er
Drinking fountain(s) _
City: State; ZIP: jectors/sum
Phone: Fax: E-mail: Expansion tank
MMFixture/sewer car _
Name(print): oor drains/fluor sinks/hub
Mailing address: -- Oarba a disposal
Hose bibb
City: _ State: ZIP Ice maker
Phone: Fax: E-mail: nterce�r/ tea a trap
Owner installati,n%residential maintenance only: The actual installation Primers)
will be blade by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on Lite property I own as rer ORS Chapter 447. Sin (s),basin(s), ays(s)
0%%ner's siE,nature: Date: Sum
ubs/shower/showerpan
Name: Urine
Address:
— ales c oset
-- Water heater
City: --- _ State: Z1P Other:
Phone: Total
Not all loisdicdons accept credit cards,pleau call Jurisdiction rot mote lnronnation. Notice Millimum fee................$
U Visa U Maif
expires f a MasterCard expires
permit application permit is not obtained plan review(at _._ %) $ _
�—
Credit card nutnher _ _ _ h within 180 days eller it has been State surcharge(846) ....$
pirer one or cudhn der as shown on credo TOTAL .......................$cud -- accepted ascomplete. ---
Cardholdet signature Ainuunt 4404616 t6M/(!0M)
lectrical Permit Application
Datcreceived: Permit nu.: HC7^ r
City of Tigard Project/appl.no.: Expire date:
City of Iigurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 -
I'Iwlle: (303) 639-4171 Date issued: liy: Receipt no..
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
TYPE OF PEIMIT 7
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant inlprms, ,enc
�IQNew construction U Addition/alteratioll/replaccnlclll U Other: U Partial
Job address: f" Bldg.nu.: Suite no.: Tax map/tax tat/account no.:
Block: Subdivision:
Project name: Description and location of work on premises: -- -�-� —`
Estimaled date of completion/inspec'tion: --
l
Job Ito:
FAY Max
Business name: -t L r UescripNon QlT• (ca.) Total no.ins
Address: Newreaidardal•abrgleormula fanllh Icer
City: dwelling wdL Includes anacltcrl I(ar itic.
y: State: 1,11'; Service included:
Phutte:+) o
E-mail-
—.L.i���2• E-mail- I W(1 s ,ft.or less
CCB no.: i Elec.bus,lie.no: Each additional Soo sq.ft.or Portion thereof
Cityhtletro lic.no.: l.unitedener ,resideulial 2
Lin,iiedener y,nun-residential 2
_ Each manufsoured home or niudulw dwelling
St nature of supervising electrician(required) pale Scry ice und/ur feeder 2
Sup.elect.name((print) License no: Nercevororlereedluercsa-Inslallsolo --
ILIcnnlfoflon:
200 as,s or less 2
Nanta(print): 201 amps to 400 ams 2
Mailing address: 401 snips to 600 strips 2-
City: 601 amps to I WO am s 2
Stale: ZIP: Over I(U)amps or volts 2
Photic: F ux: C-atoll: Reconnect out 1
Owner installation:The installation is being made on property I own Tempuraryservices orfeeders-
which is nut intended for sale, lease,rent,or exchange according to Installation,olieralion,orrelocation:
ORS 447,455,479,670,701 200 amps or less 2
201 tuops to 400 amps -- 2
ON'tter''s si natUrl' I l,llr' 4111 to b(i)tiny". '--� — - — --
_ 2
Broach circutis—ncw,all"."ll ,
Name: orexfensloa per finite.1:
Address: A Fee for branch circuits with purchase of
service or feeder fee,each branch circuit 2
City' _ Slate. Zlp; R Fee for branch circuits without purchase
Phone: ft1X: E-mail: 01'service or feeder fee,first branch circuit: 2
foollossial Each additional branch circuli --
WA Misc.(SleMee or feeder not included):
❑Service over 225 cups-conmcettial U Health-care facility Each punip or irrigaiun circle 2
U Seryice over 320 apps-rating of 1&2 U HazArdous location Each sign or outline li hting 2
fancily dwellings U Buildingover MAX)s uare feet four or Signal circuit(s)or a limited energy ,noel,
U System over 600 v,,lts nonujud 9 g gY i --
nnurc residential units in one elnvclwe eheration,or extension* ,
U Building over!brim duties U Feeders,4(X)amps or more
U tlecupau load over 99 persons U Manufactured structures or RV park *Description _
U Egress/lighting pial U Other Fach additional Inspection over file allowable In any of the above:
Submit - sets of pians with may-f the above. Per inspection
InvestiFatinn fee
The above are not applicable to temporary construction service,
Nor rill lurisd eons accepl crrdil cads,please call jurisdiction for nnnr infurrnatiol Notice:'I'llis pelalil application Pernlil fee.....................$
i visa Llbet: yard
rrexpires if a permit is not obtained Plan review(at — %) $
rdu cud number: within 180 days alter it has been State si,rcharge(8%) ....$
If yucs
Name ofcardhol r a,shown on ere a carr accepted as complete. TOUL .......................$ _
Card ioldei signature b nnouun
-- - 440.4615(hnx)/('oM)
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NORTH STAR PLUMBING 0('
COMMtiN11v pr-,; ,
1445 SE OREGON ST
SHERWOOD, OR 97140 `L4lk
Plumbing Signature Form
Permit #: MST200'1-00221
Date Issued: 4118101
Parcel. 2S I04DA-037 0C
Site Address: 1959 SW GALLIN CT
Subdivision: QUAIL. HOLLOW - WEST
Block: Lot: 023
Jurisdiction: TIG
Zoning. R-4.5
Remarks: New SF detached dwelling. 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 ycur company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER PLUMBING CONTRACTOR:
J & S CONCRETE NORTH STAR PLUMBING
P.O. BOX 821 1445 SE OREGON ST
NEWBURG, OR 9713 SHERWOOD, OR 97140
Phone #: 503-538-8615 Phone #: 625-2679
Reg #: I Ir 00090697
PI M 34-255PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Sign ture of Authorized Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLI'02001-00655
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6319-4171 DATE ISSUED: 12/17/01
SITE ADDRESS: 12959 SW GALLIN CT PARCEL: 2S104DA-03700
SUBDIVISION: QUAIL HOLLOW -WEST ZONING: R-1.5
BLOCK: LOT: 023 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPAC-7S:
TYPE OF USE: SF WASHING MACH: BACKFI-OW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STOFX-S: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CI-OSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device for irrigation systern.
Owner: I--- FEES
-- Type By Dato Amount Receipt
J & S CONCRETE --- ----- —
P.O. BOX 821 PRMT CTR 12/17/t11 $36.2.5 27200100000
NEWBURG, OR 97132 5PCT CTR 12"17/01 $2.90 27200100000
Total $39.15
Phone 1: 503-538-8615
Contractor:
GROVE R'S LANDSCAPE SERVICES
26485 S. MERIDIAN RD.
AURORA, OR 97002
REQUIRED INSPECTIONS
Phone 1: 503-678-1796
RP/Backflow Preventer
Reg #: LIC 11807 Final Inspection
This permit is issued subject t� regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This pc mit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than loL days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987,
Issued By: �'( 1 Permittee Signature: _
Call (503) 839-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
0atercccivrd: ! /7 C/ Perrnitno.: /1 0/•lt0�j�
City of Tigard Sewer permit•.o.: Building permit no.:
Address: 13125 SW FLlll 131vd,'I'igard,OIt 97223 Phone:
-
Cityuf"Tigard Phone: (50:3) 639-4171 ProjecUappl.nu.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt ao.:
Land use approval: Case file no.: Payment type.
i
❑ 1 &2 family dwelling or accessory ❑Commercial/induslrial J Mtilli-family U'1'rnant intpr.rvrntcnt
Q'ew construction U Ad;lition/alteration/repincenicnt U I ut;d service U ulltrr. ---
4
Joh address: / 9.�tl /��/ CT_ -- Description (!t '. I'(v(ca. o1a
) 1 l—I
Ne
Bldg. no.: Suite no.: - I-and 2-ramily,swellings only: 1
(includes 1001t.forearh utility.onnection)
Tax map/tax lot/account no.: on SFR(1)hath
Lot: I Block: Subdivision: , o 0 SFR(2)bath
Project name: _.— SFR(3)bath _-
City/county: %i ji�4 O !/ • ZIP:_ Each additional bath/kitchen
Description and location W vyork on premises: _— _— Siteutillties:
/L, 9 G f-- —_- Catch basin/arca drain -
Est.date of completion/inspection: Drywells/Ieach%ne/trench drain -
_hooting drain(no.iin 1:.)
Manufactured home ttilities
Business name: Z p✓Cti S �ii(J.S�� P tC.l.r rrJ a7wules — --
Address: S, 10 ���*+�' �� - Rain drain connector —
City: 20 2 — State:D ZIP: tj
7q 0
Sanitary sewer (uo,lin.ft.)
Phone: Fax: E-mail: Storm sewer(no.lin.ft.)
CCB no.: Plumb.bus.reg.no: ��--" Water service(no.lin.ft.;
Flxture or Item:
City/metro lic,no.: ----.. tion valve
Contractor's representative signature: _ _ Sack flow preventcr ,
Print name: r v'G� Date: /Z ��_Bac wa a vc
Basins/lavatory
Clothes washer
Name: Dishwasher
-----
Address: -
-- Drinking fountain(s) _
City: - State !.II': Ejectors sump
Phone: hax: I E-mail: Expansion tank —_
Fixture./sewer cap —
Ploor drains/flotrr sinks%Imh
Na-e(print):-- ---- -- --- Garbage disposal -- — -
Maih g address: _— Hose hibb
City: State: ZIP: Ice maker
Phone: Fax: E-mail: Interceptor/grease trap
Owner installation/residential maintenance only:' The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property 1 own as per ORS Chapter 447 Sink(s),hasin(s),lays(s) _
Owner's signature: — Date: — Sump —_
- Tubs/shower/shower an
Urinal
Name--- - ------ -- — -- Water closet --- ---- —
Address: _ _ Water heater
City: _ State: _ ZIP: — Other: —
Phone: -- —rFax: E-mail -_ Total —
Nct all jurisdictions ace credit cards,Please call jurisdiction for more informnion PlIllltlnntl Ice............ ) $
} ep Notice Iltis permit application Plan review tat _ �) �
O Visa U MasterCard expires if a permit is not obtained210
Credit card n:.mber: within 180 days after it has been Male surcharge(g96) ... } ��
Expires accepted as complete. TOTAL .......................
Name of cardholder as shown on cmda nerd $
-----Cartlholder afgnature Amount 440-4616(6011COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual.) _QTY ea AMO_UNT (Includes all plumbing fixtures In PRICE TOTAL.
Sink 16.60 — thr dwelling and the first'100 ft. QTY (ea) AMOUNT
Lavatory 1G^0 for each u!! connection — _
— O_ne(1)bath ___ $249.20 _
Tub or Tub/Shower Comb — 16.60 — Two 2 bath - $350.00 —
Shower Only 16.60 Three 3 bath $399.00
Water Closet — 16.60 SUBTOTAL _
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.00 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal -- -- 16.60 --- -- -- -,-,.--TOTAL —
Laundry Tray — '6.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3„ - 16.60 - PLEASE COMPLETE:
4" - 16.60
Water Heater O conversion O like kind 16.60Quanlit b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit.
MFG home New Water Service 46.40 Sink, _
MFG Home New San/Storm Sewer 46.40 Lavatory _ T —
Hose Bibs 18.60 Tub or Tub/Shower
_ Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Clcsel _ —
Other Fixtures(Specify) 16,60 _Urinal —_
— Dishwasher
-Garbage Disposal
— Laundry Room Tray
-- -- Washing Machine —
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3" ---
Sewer-each additional 100' 46.40 4^
Water Service-1st 100' 55.00 Water Heater _—
Water Service-each additional 200' 48.40 Other Fixtures
S eci —
Slorm 8 Rain Drain-1st 100' 55.00
Storm 8 Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 --
Residential Backn.-w Prevention Device' 27 55 -- — — - —
Catch Basin — -- 16.60 ----- `- --- --
Inspection of Existing Plumbing or Specially 7250
Requested Inspections er/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 1660QUANTITY TOTAL
TOTAL — —- ---- - ----."--
Isometric or deer diagram Is required If —
—
QuantityTotalls aB --__—_—
"SUBTOTAL ----- ------- - —
8%STATE SURCHARGE — -- - ---—
"PLAN REVIEW 25%OF SUBTOTAL_
--_ R.oyulred only it fiKture�trial is� I _- (�
--- ------- TOTA'-.L.—
'Minimum permit fee is$72 50.8%slate surchnrge,except Residential BaclMow
Prevention Devine,which Is$36 25+B%state surcharge
*AIL New Commercial Bulldings require 2 sets of plans with Isometric or rifer
dlagrarr for plan review.
I:\dststforms\pim-fePs.doc OB/29/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Bu3inass Line: 639-4171 MST
BLIP
Date Requested! D /l � _ ! ` J _qM - PM — BLD i---
Location 95e C2�CX��►-� ? Suite _ MEC _
Contact Person Ph W ) ��' 7 PLM
Contractor _ — Ph SWR
BUILDING Tenant/Owner �— _ EI-C
Retaining Wall ELR
Footing i �— _
Foundation Access �;�
ti
Fty Drain �^r- FPS
Crawl Drain Inspection Notes: —G� SGN
Slab — - "---
--- SIT _
Post&Beam
- - -_ - - -
Ext Sheath,Shear
Int Sheath/Shear --
Framing
Insulation -- _---
Drywall Nailing
Firewall --
-- - -
Fire Sprinkler _
Fire Alarm ,
- -- --
Susp'd Ceiling t"
Roof -
Misc:
Final
PASS PART FAIL.
- -- ---
PLUMBING �•
Ilost& Beam
Under Slab
Top Out —
Water Service
Sanitary Sewer --- -
Rain Drains
in I
AS PART FAIT_
- HANICAL
Post&Beam
Rough in
Gas Line -
Smoke Dampers - - ---- _—
Final _
PASS PART FAIL
ELECTRICAL - – -- —.. -- -
Service
Rough In ---
UG/Slab
Low Voltage ---�---------` -- -
Fire Alarm
Final - -- —
PASS PART FAIL
SITE
Dackfill/Grading -
Sanitary Sewer
Storm Drain [ J Reinspection fee of$—_ required before next inspection Pay at City Hall, 13125 SW Hell Blvd
Catch Basin
Fire Supply Line [ J Please call for reinspection RE:— [ J Unable to inspect-no Access
ADA
Approach/Sidewalk I //
Other Date / ' Q / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST l 6o a a
INSPECTION DIVISION Business Line: (503) 639-4171
BUP __—
Received .._ Date Requested_ - L Z AM __ PM BUP
Location _— 'Z �� -22 - �_Suite MEC
Contact Person -- Ph(—) - 1 ?— PLM -----
Contractor Ph(__.. ) _ SWR
BUILDING Tenant/Owner _ _ ELC
Footing ELC
Foundation _..--------------_._._._--
Ftg Drain Access: 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
Other: - - -- - - -
ART FAIL
PLUMBING
----- ------ -- - - --- -
Post& Bec.n - -
Under Slab - -
Rough-In
Water Service
Sanitary Sewer
Rain Drains - - --- --- -_ _ -- -
Catch Basin/Manhole
Stone Drain - ------- —- - ----- --
Shower Pan
Other: _._._ ------ -- ----- --- --- --
Final
PASS PART FAIL
MECHANICAL
Post& Beam - - - -
Rough-In - --
Gas Line ----- - �_
aS
Dampers
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 cell for reinspection RE:-_ _ - _.� [] Unable to inspect-no access
Fire Supply Line
ADA -�T -
Approach/Sidewalk Dab— �� Inspector --- Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST C'�/ !QC j
INSPECTION DIVISION Business Line: (503) 639-4171 �-
BUP
Received ____._._..—_______ Date Requested AM___.________ PM BUPLocation --Suite� �.L� __Suite_ — _ MEC
Contact Person t - Ph ( _—) ._,ci? z- UU PLM _ —
Contractor -- — -- -— Ph ( ----- ) ---._.--- -- ----- SWR _.------ —
BUILDING Tenant/Owner _ —_ ELC
Footing
Foundation ELC
Access:
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT — --
Post& Beane
Shear Anchors - -- - - -- -- - --
Ext Sheath/Shear
Int Sheath/Shear
Framing -- - -- - - - --
Insulation
r)rywall Nailing -----
Firewall
Fire Sprinkler ---
Fire Alarm
Susp'd Ceiling
Roof
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 7L —
MECHANICAL
Post& Beam
Hough-In - -- -- --- -----
Gas Line
Smoke Dampers —
Final
PASS PART FAIL - -. - —.-- -- —
ELECTRICAL _
Service —
Rough-In
UG/Slab
Low Voltage
Fire Alarm - - ------ -------- ----
J
PART FAIL Reinspection fee of$_._ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PIPase call for reinspection RE:_ ___—___ ._ Unable to inspect--no access
Fire Supply Line
ADA
Approach/Sidewalk Date — �_.=._[�!�.. Inspector ___ it, - =_'L�y�--—__
' J Ext ..._...--
Other:_
Final �— DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL