15865 SW OAK MEADOW LANE-1 i
w MOQd3W NMO MS 59856
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._, 15865 SW OAK (MEADOW LN
CITY OF T'IGARLI
ELECTRICAL PERMIT
CITY �„/ PERMIT N: ELC2005-00661
DEVELOPMENT" SERVICES- DATE ISSUED: 9/8/2005
13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171 PARCEL: 2SI l lDC-13600
SITE ADDRESS: 15865 SW OAK MEADOW LN ZONING: R-7
SUBDIVISION: SUMMERFIELD NO.11 LOl : E32 JURISDICTION: TIG,
Project Description: Reconnect furnace&AIC unit.
RESIDFNTIAL UNIT TEMP ERVC/FEEDERS MISCELLANEOUS ��
1000 LESS: � - 2C0 amp: 1 11� �
EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL./PANEL:
MANF HM/SVC/FDR: 801+amps-1000 volts: MINOR LABEL (10):
SERVICFJFEEDER BRANCH CIRCUITS ADO'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER. PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: } IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1,100+amp/volt: >-4 RES UNITS: >600 VOLT NOMINAL:
P,econneat only: SVC/FDR>-225 AMPS: CLASS AREA/SPEC OCG:
Owner: Contractor:
HARRY HILTON TRI COUNTY TEMP CONTROL INC
15805 SW OAKMEADOW LN 13150 S CLACKAMAS RIVER DR
TIGARD,OR 972.24 OREGON CITY,OR 97045
Phono: 503-620-4543 Phone: 503.557-2220
FEES_ Reg M LIC 72623
Description Date Amount ELE. 5271,HR
[TAX]8%State Surcharge 9/8/2005 $4.28
[[LPRMT] ELC Permit 9/8/2005 $53.50 REQUIRED ITEMS AND REP')RTS
-- Total $57.78�
This Permit is Issued subject to the regulatior.s contained in the Tigard ML nic;pal Code.State of OR.Specialty Code,and all other applicable laws. All
work will be dale in accordance with approved plans. 'i his permit will oxp�-e If work is not started within 180 days c issuance,or If work is suspei.dQd
for pore than 160 days. ATTENTION: Oregon law requires you to follow i ales adopted by the Oregon Utility Noll'ication Center. Those rules are sr;t
forth In OAR 952-001-0010 through OAR 952-001-0100. You may obtain copit s of these rules or direct questions is OUNC at 503-246-6699 or
1-800-332-2344.
4. Issued By: '12"ZAA Permittee Signature: ^ _
OWNER INET ILLATION ONLY
The Installation is being made on property I own which is not Intended for sale,lease,or rent. ew
m OWNER'S SIGNATURE: DATE:
W CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503-6394175 by 7:00 a.m.for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on+he job site at the time of each inspection.
FRGS :Tri County Temp Control FAX NO. :5035570919 Sep, 08 2005 02:20PM P3i4
Electrical Permit Application
City of Ttga rt
t.1125 RW Hall Blvd,Tigard,OR 9 ) ��
Pam*No.:F�G01 • A.KO
Faxun.59N.NX.IPhano: 501.439.4:71
ImpoctimTJno: 503.69.4175 Twr RvxA�
Internal: 1WrW.cI.N8 W&or.W NUfr,d AWIIeJ by Ste}'aRe]Par
I
_. SE o _ � _ _.1.. 1 U_ �T.prlarnatrd wArn.erlan
_ _.__._ °R`�l s�F N1s` N_ PUK RMIEW
T1Tli: Oil 1{
Nm —m huMitm i4ddltitxt/alteTnti�I�ient S;; ohoek d1 got ilpply:
�{ Ufitrvim over 225 amps,anmc:. ❑1burtkme to..urr
❑Tirnulllbon (Ifhrr: nHorvloo over ago. nlw-mi.ljr ❑nalMng twee In,00n,q.tt.,
(.ATR(x)IM Or Ir"NNTRTICTION of I-and 2-family dlwdNnM d ne mm i new rw:idantial
l-wW 2-family dwelling Caron m iaUndwimal Q AcoalRnry hutldieg l ISyMtm over MO Wtv.:-mini umle in One rtnm1nre
1-1
Multi-fanuh' ❑Mader builder ❑(Fiber. UlluddinR ever three Atowica ❑wooaem,400 antp-R,x mom
.IOB BTTR IN171TtMATTON .t+NTI 1AW ATION —"_...._— U11)ooupenl land�,vcr 77 pernnna DManutl,atured structures or
', " nB i n plan RV park
i h MV R D Clothe,;
Jolt qtr.: hrh vile.wlt6ey!1;_I � ^` /�/�_ []HORM uAre 1it��lily ---
city/Statet/.IV: � �� N.,� • yobr..it 1 eel's otplmx with Any of thn Above.
__....__ ...._ ... The Ahove are rot Applicable to tsMvrlay ootrtnrction sarvioe.
Suitelbldg./apt.no.: I Project 11nme; —
Cmse street/dirmtiotw tr job site: tr..Rtrn,. tiw tie ..r r J ••
Nct, rrmblvief A)-male-or nmki-fAm*">tl111111111 aW.
' 1.rrly�fR a1tRclrtd M e.
4ulxlivinitm: 1�tNN) n 'x le"' 145.11
l,ul 110. Fa_Add'l 50n Aq.ft.or portion 13.40 1
I'nx tnap/ixln:el no.: I imfud energy,remidentlal 75A0 2
UHfi('RIPTN:IN OF {{'l1Rd Umhed a
qtly.nun-vasidentiAl 730) Q
�/1�jy�r�/� Rech mltmttiraurud or morhtlar ___._... ..
'W1 11 1b.d f#MCUX) 4 AleJttcllinit Wert isr and or f-Jar 911.H0 I 2
1- Sarvkra or kvdenr 100,20110m,dterMlof_u atiorel
r allocation
200 or lea -- —N0.34.. 2.
PROTRRTV 011 NRR l� TFNANT 201 >t Io 400 a 106,85 2
_ —_...._--__.._ _...__._._...... .... _. 401 to!Lo ampA — 160.60 2
Nam: —_�..__.__
601 tot 000 2�O.tlU 2
Adds sd: Ova 1,000 At1tp1 or whr
R000nneut only �.�.I+s 2
C It!.'.tYAte/%ll!; Tempvrnr�sml- n tot k,drrn hr+tnllmlom.wl/r1 oflum,RR4149r
-Fax:lX:� � 2M Amps or lea
Coater Immallodon:1111t/tllfttallllfllnl 04bellla made on 11m11e1Y1'that T mill Mllcll iw IN11 201 mmp W 400 mop 100.90 '
intendal for.ante.term.rent.til'mbange.accmlinp to OM-1d7.449.6741,and Ill I. -- -—'
• 401 am to 6fM1 137,73 2
Chvncr signahtr : hate: Bnmb ch Wb new.mile
or Per .net
AI'1'LIt'ANTCONTA(T PwRNON ..k.Fe fm mdl clrclit"+tort,
— _..__.__._.,. ........_._. . .. ntrvia or lbeda Am,eauh
FliminaM name; branch cinvlt 6.65 2
j
Contact tlnnle r�p�,' ^ B.Fee for broach cimits
I W 11 �( 11 _.._....___. w 1howr rarvice or tbmcr fbc, I
each branch eire111t 46.115 4
AQdri:Ri:
l'.aeh am,I branch vircult 1.63 2
_M
CityMn�) _ ....�._
/Slelt,/7.TI': brafloletAw(arrrkv or tlydar trot
Pary 4W!2jvtiUnvirtdu33.40 7
Phom( ) !''Int::( )
RI at nitlino I to - 39.10 1,
LL E-MRW 14ignol circult(n)or Iltn c —"
-------_a._. f'nNTRAf'TOR energy ponel.alb►atimor
oxtconlon. I'lam:riho Pyp 2 2
N I l»RIneR11 ��(�►"� — ---_----- ---
_w1y�+ ��/.�y� FAch RdJNMwd to�ectlRn mar doweMa fn qtly of tlwn aMwr
Addrntal: W V ht ritrl 62,10
4ity/mat ar: 10 l 1 a� 1 km Mr hent►(I lr eNn) 62.10 - ---
._ _ -.—---._ .
����/A� ��,,��//����, [[y�� hw latriltl how _ 73.71
LU P n7- )gb?,j --- -- l nx:�'L� �V'{ IL6(TRIt:A.I, MART PINfo
CCR Lic,: "� F.Iccbical Lic.: L� 41gxv.T lc 4u111om1
S N.lecttic(an W ulrod: Flan review(:5e*of permit ko)
ttpty. gnaftme,,req _
- - .... - Maw`mr1m p(1%of pomm the)
I _ ..
1?int ftAfRe: I r 1 Detc: TOTAT,
Antiltniml aiMmttn ;: nor,t rrT,arrnearlNl egMlw ten PrrRYt M nwr n vn
dwtn,otter r tow Nrww Ar-erfed We nrnrOkte
NO
Print nmm: I .rKA1.,hUJ.yy at M l'n•CauAy nuildins rn hs tn'Sen+rr hnnnl
�INtI:: !�N,mtlwr;.(mvlww4.nrw pw Iv.nit alk.we.L
1�tMMIAYNNUnullalQlt'-MtdWroJuc IV03 e•v.-*6151Y1MMk-OWW...
CITYOF T'G A R MEC HANIrAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC200 -00563
13125 SW Hall Blvd.,Tigard,OR 97223 503-6394171 DATE ISSUED: 9/8!2005
PARCEL.: 2S11 1 DC-13600
SITE ADDRESS: 15865 SW OAK MEADOW LN ZONING: R-7
SUBDIVI BION: SUMMERFIELD NO.11 LOT: 632 JURISDICTION: TIG
Praject Description: Replace furnance A/C unit.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIFS: r BOILERS/COMPRESSORS HOODS:
FUEL TYPES _ 0 - 3 HP: 1 ! DOMES. INCIN:
3 - 15 HP: COMML.INCIN:
MAX INPUT: BTU 15-30 HP:
REPAIR UNITS:
FIRE DAMPERS?: 30-50 HP:
OD
GAS r P FSSl1RE: 50+ HP: CI-A DRYERS:
FURN< 100K BTU: 1 _ AIR HANDLING_ UNITS
OTHER UNITS:
FURN>-100K BTU: <=-10000 cir
>
GAS OUTLETS:
10000 cfm:
Owner: FEES
HARRY HILTON Description Date Amount
15865 SW OAKMEADOW LN
TIGARD,OR 97224 [MECH]Permit Fee 9/8/2005 $72.50
[TAX]8%State Surcha 9/8/2005 55.80
Phone: 5()3-620-4543Total------------•—
$78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY,OR 97045 __ REQUIRED ITEMS AND REPORTS
Phone: 503-557-2220
Reg#: LIC 72623
IL
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This permit is issued subject to the regulations cootained in the Tigard Municipal Code,State of Ore.Specialty Codes and all other
applicable laws. All work will be done In accordance with app roved plans. This permit will expire If work is not started within 180 days of
issuance,or if work is suspended for more than 180 days. /,TTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set fort!i in OAR 952-001-0010 through OAR 952-001-0100. You may obte'n copies of these
UU rules or direct questions to OUNC by calling 503-246-6699 or 1-800-332-2344.
.r
Issued By: �,� Permittee Signature:
call 503439.4175 by 7:00 a.m.for Inspections that business day.
This permit card shall ce kept In a conspicuous place on the Job site until completion of the protect.
Approved plans are required on the job site at the time of each inspection.
FP9M ;Tri County Temp Control FAX NO. :5035570919 Sep. 68 2005 02:19PM P'.1i4
Mechanical Permit Application
City of Tigard Received t — 77�_
,
1312$SW Hall Blvd.,TiWd,OR 97113 unwmy.
Phone: $03.639.4171 Fax: RK598.1960 v.w-^ � PlanRevtaw It
�/ namsr.lnspecdon Line: l03.630.4175 nate RlldylBY to,s.�ry..re:
tnternor www.ei•dptrd.o(r�w O 2t� Noai6ed/Metbodt aapptemtltal I„formaetoa
EJ
New cortatn,otitm Additit:;Wb Mechanical permit feet"are brand em the value of the W0*
pMormed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition []Other'. mechanical+natmialaLe uq iPmmt,lahm,nverhoad u d twofil,
Value.S _
I•and 2-family dwelling r]Comm ruJaVilldusttial' Q Accessary building 19Y> > Se
Ntu{tl fatttily Muster bolder ❑Other. For spacial i.Vbrotatior.was checklist.
Decors dtm Qty. I @a. Toni
r +iY a: '' K �, ,Ill rut Haatio t nulla` —-- 1
Iob site addresa. Wehft law)
Air cand tkming or heat pump
_ (requirn Ifte Pim Imerlea Plaoemant f 14.00 _
Ciry/statow: Furnace 100,000 BTU duces vV-) . 14.00
Suite/bldgiapt,no., Projoatname. Furnace 100,000+BT�II�`x411i_
�.., Oai heat U!!E 14,00
C,ju streeddirecdow to job site: IAtat warts 14.00
H dromic hnt murr s•stern 1400
P.Wdontial boiler(radiator or
h ♦a) 14.00
-----—
Unit healon(noel-type,not eloetric),
in-wall its-duct edletc. 10.00
Plue/vmt far an of above • . 10.00
Suhdivision: Lot no: -
-- 00" — 1U.00
Tax reap/parcel no.: +�rer I antes
" E;tidl r _ ► ' ti^ water heater _._. _.. _ .10.00
Oae flit lace 10,00
_ Flue Vent far water heater or gas
Oreplaw 10.00
--- -- W flet stove 10.00 _
wood mraplaccAnscm 10.00
Chirtmy/Ilrrodflue/vent 10.80
Iiia 4 .,a _. ' a�.. bl!i4,f I ,! MR.. �t _ .�:._ t
- L- Other; 10,00
Name. n gavironmant■i aahaMet►nd vendladen
Address: Range hood other kitchen
equipment — 10.00
City/State/ZIP: Clothes dryer exhaust _ 10.00
ELEVILyindleAuet exhauet(bathrooms,"
Plow. � Fax,( ) �-r..�^�~• toilet c b,utilityl�_W�m 6.60
1- , Attic/:.rawispace Ntu 10.00
/ . Ods 10.00
Btu VAU WN!
trtttl Ii�ns��q
a Contact name: S5.46 hr AM bur-, 1.06 hr each additional
!)' '►pFumes,oft,
Atidtda; t^ 1. �► / �1 ,_- Qws hat pyttq _
CitylStatdZlP: f'1 -r iwall/tn ded/unit heater
_J Phour( ) Fax::(C ) .55700 Water heater
m
8-mail:
Ran _
ll� Batbocue
Cbdtw
Business name: lb ___� _ .. .......,.....
,/r►r e_ ` _ Other:
Address:
City/state/W; 1 Cr
Minimum it fee(S72.50)
Phone; v,2
!_ Fax;( I' f l I JIV — - plan revises( of permit lbe _
Vale euro 11%of omit
C 72� f C!t�C 7L—�
TOTAL PERMIT Ft
Authori2ed signature, 1 bit permit application eft t has expire
If a tt"pirnta a net VI In
_ _ day/eller It IwI twr ace�prsd as cempHtc.
Pant name: Qn C NIt�.S�i'1 — Date: _� Pee meuvxlnlnay,et by TH-County BtdWill Indus"%rviee Hoard
R"l ;Tri County Temp Control FAX WJ. :50.-Z5-70919 Sep. 08 2005 02:20PM AP2/4
INSTAi.L,&' ION ADDRZ!CRr
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CITY OF TIGARD
BUILDING DIVISION PERI AIT#: MCC2005,00563
13125 SW Hall Blvd.,Tigard, OR 97223 DATE IS>UED: 9f8/200c,
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 911 fi/00! TIME: 7.01AM PAGE: 91
SITE ADDRESS: 1150664.3W OAK MEADOW LN CLASS OF WORK:
SUBDIVISION: SLJMME-RFIELD NO-11 LOT #: 632 TYPE OF USE:
PROJECT NAME: HILTON
DESCRIPTION: Replace furnance& A/C unit
OWNER: HILTON, HARRY PHONE #: 503.M45 q
CONTRACTOR: TPI COUNTY TEMP CONTROL. PHONE #: 603667.2720
Inspection Reqoest Scheduled For: Date: 9/1612(li Pour Time:
C de # Inspection Description Confirm # Contact # Message
Mechanical final 0158A1 01 E.03 67-2710 Y
Corrections/Comments i Instructions-
I
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W
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APASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL POR INSPECTION ❑ ADDITIONAL FEES ASSESSED
l�V
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD
-BUiL-DING DIVISION PERMIT#: EL.C200r-OG661
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 902005
Phone: (503) 639-4171
Inspection Raquests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/77/2001 'TIME: 7:05AM PAGE: 87
SITE ADDRESS: 15%5 SW OAK MEADOW LN CLASS OF WORK:
SUBDIVISION: SLIMMFRFIFI D NO 11 LOT #: fi32 TYPE OF USE:
PROJECT NAME: II. 'ON
DESCRIPTION: ReronneA1 tumace& !UC unit.
OWNER: Hit-TON, HARRY PHONE #: 503-62GA543
CONTRACTOR: TRI COUNTY TEMP CONTROL INC PHONE #: W3.567-2220
Inspection Request Schoduled For: Date: 9/27120D5 Pour T:mw
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 016646-01 603.6f;7-2220 N
Corrections/Comments/Instrucl?ons:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL —� V ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
PM 1
Inspector: _ N ® Date: q �� _ Phone #: (503) 719-
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Heli Blvd., Ilgard,OR 97223 (503)539.4171 PERMIT ##. . . . . . . : PLM97-0200DATE ISSUED: M. /20/97
PARCEL: 2SIllDC-13600
SITE ADDRESS. . . : 15865 SW OAK MEADOW LN
SUBDIVISION. . . . : SUMMERFIELD N0. 11 ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :632 JURISDICTION: TIG
—
CLASS OF WORK. . :AL1' GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
SIORIES. . . . . . . . : 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) . . . s 0
WATER CLOSETS. : 0 WATER LINE (ft) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft) . . . : 0
Remarks: Instailling a water heater
Owner: ------------------------------------------------------ FEES ------- ---- ____
LOUISE GRETCHELL type amount by date recpt
15865 SW OAK MEADOW LN PRMT $ 25. 00 B 05/19/97 97-294720
TIGARD OR 97224 SPCT $ 1. 25 B 05/1.9/97 97-294728
Phone #:
Contractor----------------------------------
GEORGE MORLAN PLUMBING
5529 SE FOSTER RD
PORTLAND OR 97206 ----------------------------------__---__..
Ph o rt e #: 771-1145 26. 25 TOTAL
Req #. . : 000027
------- REQUIRED INSPECTIONS --------
This permit is issued subject to the regulations contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable lass. All work will be done in accnrdance with
approved plans. This permit will expire if work is not started _
a within 198 days of issuance, or if work is suspended for more
than 180 days.
to -
m Pprmittep Signature : AIA "Ac ^�p
W T s a u e d By : 6, mv
J
Call for inspection — 639-4175
ZITY OF TIGARD Plumbing Application need ev
-fk
13125 SW FALL BLVD. Commercial and Residential Dime Reed -
T'IGAKD, OR 972231 l / l ' Daft to P F-
i 5031 6394171 U Date to
Print or T Pei a���nJff
Type Related SM a _
Incomplete or illegible applications will not be accepted Cared_,,,
Nance of oevelaPn+.nNProler, FIX[llRfra;
Job Lam
9.00
Address Sbeet Address ae guft Lavalory 9.00
Tub of T 9.00
Ell"10
snow.►ordy 9.00
Name wow L'o 0.00
ow"W r 9.00
Owner +ho Aiwen o
.55
NM uO muftne
/y -7, 9.00
9.00
Now 9.00
4 9.00
Occupant mailiro Acioreaa S,' ft - waur I�aaM, o
Latmdty rsy 9.
00
Ph" ON
9.00
Nanlm Mar Formam
» lfY/ ( , 9.00
9.00
Contractor �Ad*en saw 9
l7.rr 1
(LI-11
(Prior to avuence 9.00
apprcant moat ; M 7Z 3 - g j 0.00
provide all 9.00
73�c Dowd (q-47
eonasaars
kens. 9.00 I
-tat 100' ;2U.00
.04
-aeon add lionei 107
far COT CIA eus4haa9 9th or rtte 9 Exp DM2 .00
database). vvmm -1x1100' .,E
Nerrhe MW Sarvloa-each addwerW
Architect Storm a Rain Oram a jar iW 2100
or h0 Addraea 510nn i Rain Orsin.a" v"IM 25.00
Engineer Gty�sum ZIP P�ft Atobra)NMI Uw 23.00
Gamna - Fjeft ejp� tai' arMIE 25.00
PokMon Gama _
"wba work Now O Addition O Aftroon O Repair O Residanral PrehrarhrOrhiM Davfoa' 13.00
be done: ResidarMlal O Non rssWerwl) O Any Trap or Waw t Net le a
Mclibcl
onal desipran of work 900
C' oCf;r/Y �(, �CI&�4'C Catdhesrin 9.00
f0. t t✓G r4r•� `l�Gh�a✓' I"o�/p S r"v,an� ,yl a.7 Gt 11i/ AI IMP.of 6dsting PkanbMho
. 40.00
pwft
J�V1
.:cntlng tMe of Spec 'ry Regtwted^"M-` "� 40.00
Duddwq or DrrParry - /s(�.f �0✓�rJX RainPoft
Droim sk"fan**A&q 50.00
'r000sed use of � ��
=� guidingvp.'aPerb- �LCii.R:�1�. Al 9.00
CD GUAkffff Mir k..,
0 Are you capping, moving or npi "any fb%m? res p No p leans).or rimer k regar"r T"le i ,
(if yes see back of forth) UeTO r
hereby acknowledge that I have read this appreation,)hat the informatton t -�Y'
, en is correct I am rtz
the owner or auMtond ageru of ft owner.and 6%3URCHARCE
rythat r.`-
hat Glans submitted ars in carrlpWhrtce with O. State Lahvs. "t, N
Signature of OwttedA Do% PLAN REVIEW 25%OF SUBTOTAL
:.mart Person Name Phone et. z
is M• strdh9l�•ss�pt Resid.nlal eatltnt+vr
1:\plmapp doc 121% (dst)
'LEASE COMPLETE AS APPIQERIAIE TO PROJFCy:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or tub/Shower Combination
Shower Only
Water Closet
Dishwasher T
Garbage Disposal
Washing Machine
Floor Drain 2" \
3" r _�
wn
17
Water Heater Y
Laund Room Tray
Urinal
Other Fixtures Speci ) \
OMMENTS REGARDING IMOVE:
a —
ir -
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour in.pection Linc. 6394175 Business Phone: 639-4171
Date Requested- ��� I — A.M. P.M. MS1: �—
Location:—ta _
AUP:
Tenant: r Suite: Bldg: MEC:
contractor: --t �— _M� _ --y- PLM: !l QW-
Owner: 7 ILL Phone: 7--- ELC:— —
�_ ELR:
SIT:
BUILDING BLDG:(con't) PLUMBING-1/ — MECHANICAL ELEC71UCA:L SITE
Site Post/Beatn caro Post/Ilcam Cowx/Service Sewer/Stornt
Footing Roof UndF1/Slab Rough-In Uiling Water Line
Slab Framing Top Out '' Gas Line Rough-In lJ0 Sprinkler
Foundation Insulation Sewer �l/Hood/Duct Recontact Vault
Bsmt Damp Drywall Sunt Furnace Temp Service Misc.
Masonry Ceiling Rain Drain A/C' UG Slab
Shear/Shea h Fire,SpkIt/Alm Crawl/Found Dr Heat nunp Low Volt
Approved ppro. Approved 1pprmved Approved
LApMpr/'Sdwlk Not Approved ved NM Approved Not Approved Not Approved
FINAL FINAL FINAL FINAI. FINAL
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Q Call fin rein ti O Reinspection fee of s aired before next inspection 0 Unable to inspect
Inspector: of