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Page No. 1 CASE HISTORY FOR CASE NO.: MSI-97-0204
ROSE MANOR HOMES/GSI NW
12059 SW 96TH PL Unit: PVT
06/05/98
Action Description Req/ Schd/ find/ Action Notes Disp By Update Upd
Code Sent Done Dome Date Hy
MSTA050 Hold for / / / / 09/03/9'1 Water service on adjoining property - FAIL MS 09/29/97 J•11
needs to be re-routed.
MSTA092 (F) Issue combination permit / / / / 07/08/97 PASS DRA 07/08/97 DST
MSTAo95 Issue plumbing signature form / / / / 07/28/97 RECD SW 07/30/9'1 S•W
MSTA097 Issue electric signature form / / / / 08/01/97 RECD SW 08/01/97 S•W
MSTA705 Footing Inep / / / / 07/09/97 PASS TLP 08/12/97 J•H
MSTA720 Mechanical Inep / / / / 10/28/97 See framing inspection this date. FAfL KS 10/29/97 J-H
MSTA725 Framing Inep / / / / 10/28/97 I•.ramitig ti Mechanical Inspection notes: FAIL KS 10/29/97 J-H
1. Provide king stud at each side of
glulam at garage.
2. Truss clips missed.
3. Add stud at splice top plate bedroom.
4. Firestop mechanical chase at upper
level adjacent to bathroom.
5. Provide eave baffles at vaulted
ceiling above stairs.
6. Add stud adjacent to rectangular duct
at utility room.
7. Add ledger under rafters at front
entry cover noteched and birdblocks.
9. Connect exhaust duct at garage.
9. Positive connection trimmers to
garage header.
10. B-vent at furnace touching
insulation needs clearance.
11. Collar tion at stick cut rafters.
DO NO'r RMMOVE CARD UNTIL APPROVED CALL
FOR REINSPECTION.
MSTA745 Gyp Board In P-___ / / / / 11/21/97 PASS KS 11/23/9'1 J•H
MSTA960 (F Iasue Cert. of occupancy / / / / 05/15/98 06/05/98 rr
� M.9TB005 Application race ve -- / / 05/29/97 RBCD JD 06/12/97 PON
y
AL4TB008 Permit created / / / / 06/12/97 PASS B 06/12/97 BON
_i
MST0010 Check for prcl. restrict. / / / / 06/12/97 Check conditions of approval for MEMO B 06/12/97 BON
-. 9UB94-0007 before issuing permit.
i
� .
06/12/97 PASS B 06/12/97 BON
MSTB012 Plans routed to Plans Examiner / / / /
MSTH026 Bldg/mech plana apprd by CPE / / / / 06/18/97 APPP PDP 06/18/97 RDP
06/12/97 BON
MSTB027 Electrical plans apprd by EPS / / / / / /
06/12/97 BON
MOTS029 Plumbing plane apprd by PPE / / / / / /
MSTB030 Reviewed plans routed to DSTS / / / / 06/19/97 RDP 06/18/97 RDP
PASS B 06/20/97 BON
MSTB032 DST Plan Review Completed / / / / 06/20/97
Page No. 2 CASE HISTORY FOR CASE NO.: MST97 0204
ROSE MANOR HOMES/GSI NW
12059 SW 96TH PL Unit: PVT
06/05/90
Action Description Req/ schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
MSTB055 Hold Release / / / / 09/29/97 Per conversation with Mike White, engrg, PASS HAP 09/29/97 J-H
the water line was moved and the
complainant in natinfied. somehow his
action suggested that the builder fill
the trench. Mike wan satisfied ,,ith the
appearance of piping and fill. Releas±d
by review.
MSTB700 Erosion Control / / / / / / 06/12/97 BON
MSTB70S Footing Inap / / / / 07/11/97 PASS TLP 07/21/97 J•H
MST11706 Foundation Inap / / ; / 07/18/97 Approved as noted: 1. Install anchor PASS KS 08/21/97 J•H
bolt size & spacing as shown. 2. Center
foundation vent at real.- wall.
MSTB710 Pont/Ream Structural / / / / 07/25/97 1. Support furnace plenum to adjacent FAIL KS 08/27/97 J•H
beam.
2. Provide 1/2" air space att and of
beams at pockets.
3. Also install felt under beams.
4. Add pont under notched beams at
pocket n.
9. Poet to beam connection (extend
gannets from top of beam, extend down)
post full depth of beam.
MSTB711 Post/Beam Mechanical / / / / 07/25/97 FAIL KS 08/27/97 J•H
MSTB711 Pont/Beam Mechanical / / / / 07/28/97 PASS KS 08/27/97 J•H
MSTB712 Plm/Underfloor / / / / 07/25/97 PASS MS 08/27/97 J•H
MSTB712 Plm/Underfloor 08/27/97 / / 07/28/97 Previously approved by MB PASS RAB 10/01/97 MRS
M.STB713 Crawl Drain / / / / 05/01/98 install crawl drain w/back water vAlve FAIL GS 05/01/98 (IRS
CL MSTB713 Crawl Drain/Backwater valve 05/18/98 / / 051115/98 PASS TLP 05/18/98 J•H
M9TB723 Electrical Service / / / / 10/28/97 PASS BRP 10/29/97 J•H
N MSTH724 Electrical Rough-in / / / / 10/28/97 PASS HRP 10/29/97 J•H
MSTB725 Mechanical 1nep / / / / 10/14/97 Installation not complete, gas line not FAIL KS 10/15/97 J•H
.-. inspected.
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CA
MSTS725 Mechanical Inap / / / / 10/20/97 1. Connect exhaust fano. FAIL KS 10/21/97 J•H
W 2 Secure insulation shield at attic.
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3. Nall around and firentop heat duct at
upper level.
4. Clothes dryer not vented.
S. Support gas piping at crawl space as
described. 6. Mechanical soffits not
built at garage
Page No. 3 CASE HISTORY FOR CASE NO.: M:T97-0204
ROSE MANOR HOMES/0S5 NF'
12059 SW 96TH PL Unit: PVT
06/05/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
code Sent Done Done Date By
MS113725 Mechanical Inep / / / / 10/30/97 PASS KS 11/10/97 J*H
MSTB727 Lw Voltage / / / / 03/06/98 Note: Smoke detector not installed, only PASS SRP 03/09/98 J•H
one recpt. in double .link vanity.
MSTB729 Plumbing Top Out / / / / 10/01/97 PASS MS 10/01/97 MRS
MSTH730 Framing Innp / / / / 1:/07/97 1.. Framing corrections incomplete. PASS KS 11/09/97 J•H
MSTB730 Framing Inap / / / / 11/12/97 1. Provide a7reen at bird blocks above PASS KS 11/14/97 J•H
entry.
2. Complete collar ties at stick cat
raftern.
MSTB740 Gas Line Inap / / 10/3 /97 PASS K3 11/10/97 J•H
MSTB745 Insulation Inep / / / / 07/28/97 Underfloor Insulation approved PASS KS 09/27/97 J•H
MSTB745 Insulation Innp / / / / 11/17/97 PASS KS 11/17/97 J+H
MSTB750 Shear Wall Inap / / / / 09/29/97 APPROVED AS NOTED, PASS KS 09/29/97 J•H
1. Second inspection thi, date made by
RC (no app plana).
2. PM inspection this date by KS. This
inspection includes generic panels.
MSTB750 Shear Wall Inep / / / / 09/29/97 no plana an rite (Ken found them lateri . FAIL RC 09/29/97 J•H
MSTB75S Firewall Inep / / / / 09/06/97 #-1- intt.-ior side of separation wall A/N KS 08/06/97 KBS
upper level.
clean excessive mud at top of wall to
allow tight
fit between joints wall connection
mud/tape
horizontal joint
ted„ MSTB760 Gyp Board Inep / / / / 09/04/97 1. Jnterior side of separation wall at PASS KS 09/08/97 J-H
C.Y upper level.
N
N
�- MSTS760 Gyp Board Inap / / / / 11/20/97 1. Nail shear walls at both aides of FAIL KS 11/20/97 J'H
H
.- common wall at garage.
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2. Nail eepara'ion walls with 1 7/9-inch
Cil
nails at 7-inch OC.
L!)
U: A. Separation walla need to extend to
_j
under side of roof sheathing.
4. Firetape all vertical and horizontal
joints and spot nail.
MSTS775 Rain Drain Inap / / / / 07/24/97 PASS M3 OB/26/97 J*H
MSTB775 Rain Drain Inep / / / / 07/28/97 Rain drains still need CO's per M3 FAIL RAB 08/27/9' J•H
Page 4 CASE HISTORY FOR CASE NO.: MST97-0.v4
ROSE MANOR HOMES/GSI NW
12059 SW 96TH PL Unit:
b6/OS/98
Action Description Req/ Schd/ End/ Action Notes Diap By Update Upd
Code Sent Done Done Date By
MSTB780 Water Line Inap / / / / 08/26/97 Pressure reducing valve at meter. PASS WA 08/28/97 J•H
MSTB785 Appr/Sdwlk Inap / / / / / / PVT N/A 05/14/98 JT
MSTB796 Electrical Final / / / / 03/06/98 PASS BRP 03/09/98 J•H
MSTB797 Plumb Final / / / / 03/17/98 1.. Seal front hose bib at siding; flush FAIL TN 03/29/98 J-H
rear hose bibb with aiding, secure and
seal.
2. Provide approved storm sewer cleanout
fitting with threaded plug.
3. Provide cleanout kitchen sink.
4. Secure vertical piping water heater
safety valve drain.
5. Seal Shower valve flange at wall.
Need record to show newer inspection.
MST13797 Plumb Final / / % / 03/24/98 Approved as nr.ted: PASS TN 03/26/38 J"H
1. Beal rear hose bibb at siding - nee
report 031798.
MST8798 Mechanical Final / / / / 03/24/98 1, Support gas piping at. horizontal PASS ES 01/26/98 J-H
ne^tion adjacent to wate heatet.
MnTB799 Building Final / / / / o5/Oi/98 house/garage steps PAIL rs 05/01/98 GE3
remove underfl debris
crawl drain?
newer inspections
MM799 Buildinj Final 05/18/98 / / 05/15/98 crawl drain installed okay. Approved PASS TLP 05/18/98 J•H
per previous inspection; correcti,mn
completed.
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CITY GF TIGARD
DEVELOPMENT SERVICES
'SW Half Blvd., Tigard,OR 97223 (503)639-4171
CERTIFICATE. OF
OCCUPANCY
PERMIT #1. . . . . . . : mq.*r97-0004
PATE ISSUEUt 05115i98
F,APC;EL t 2S102BA--0.3700
SITE ADDRESS. . . t 12059 SW 146TH PL d#PYT
SUBDIVISION. . . . t DUBLIN PARK ZONING:R--25 PI)
13LOLK. . . . . . . . . . t LOT. . . . . . . . . . . . . :007 JURISDICTION:TIG
CLASS OF WORK. t Nr'W
'TYPE OF USE:. . . t SFA
TYPE OF CONGTR:5N
OCCUPANM GRP. 03
OCCUPANCY L OPD: ?
Remarks t SFA - Rath i
Owners
ROSE MANOP HOMES/GSI NW
CUNTRACTORS
10620 SW LUCAS
TUAL.PT I N OR 97062
r�'hcrne #ic •a rc?-81.s:�
Cont rant or t
POEW MANOR HUME�3 INC
10620 SW LUCAS OR
TUALAI IN OR 97062
Phone #^ 452-8133
Rey #1. , t 109668
This Certificate yri:nts orcr.tiiannr_y of` the above refer-enc-ted building or portion
thereof and c onfirmr; thAt the buildiny hau been =.nspected for- compli,Ance with
the State of Ot-egorr Specialty Code; for the grump, occr_ip�nr-y, and use under
which the 10,1'4) erlr _ ernit was iswr.�ed.
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BUV_DING 1146PECTOR _ Li INsFlrCT SZJFERVIr3CJk
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FAUST IN CONSPICUOUS PLACE
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CITY OF TI'GARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171 C
Date Requested: �1y/V A.M. _ P.M. MST: , / 7—G1 )L'
• Locatiop.—�Z 6) BUP:
Tenant:— Suite:rr Bldg. — MFC:
Contracwr: Phone: C1�— -� — PLM:
Cie':_ Phone: LLC:
ELR:
SIT:
BUILDING (rnn' PLUMBING MECHANICAL ELECTRICAL SITE
Site Pos r Post/Beam Post/Buun COVQ-/Service Sewer/Stone
Footing Roof UndFl/Slab Rough-In Cei'ing Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vault
Bsmt Darnp I)1ywl,:: Storm Finace Temp Service MISC.
Masctuy Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire S' Crawi/Found Ih I leat Pmnp l,ow Volt
Approved Approved Approved Approved
Appr/Sdwlk 4,;RPr7,'1y1,1 Not Approved Nol Approved Not Approved Not Approve. —
FINAL FINAL FINAL FINIAL
-�ZI, Iver� �.e ����i���.�•�. EST/s�.���or�F�°7ldiy s'
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O Callfor rein. cti fl Reinspection fee of Sneluuiircd before next inspection O linable to inspect
Inspector - - Date: / /_ Page of
1
CITY CF TIGARD MASTER F•IERMiT
®E�''=�OPMENT SERVICES DATEPIERMISSUED: 07/08/977-02:'04
13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171
F,ARCEL_: `S 10cAA—rr.-3'70
SITE ADDRESS. . . : 12059 SW 96TH F'I_ #F,V T-
SUBD I V I S I ON. . . . :DFJBL I N FDA RK Z ON I Nr: R-25 F'D
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :007 JURISDICTION: TIG
Remarks: SFA - Path 1
---------- BUILDING ------------------------ ____--- -----------------
REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED------------
CLASS Or WORK.:NEW HE16HT........: 21 FIRFT....: 782 sf GARAGE.....: 464 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SFA FLOOR LOAD....: 50 SECOND...: 704 sf FRONT.........: 20 PARKING SPACES: 2
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 2 TOTAL------: 1486 sf VALUE.-$: 107617 REAR..........: 20
----------------- ----------------------------- PLUMBING ----------------------------------------------------------
SINKS.........: 1 WATER CLOSETS.: 2 WASHING MACH..: 1 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 100 TRWE.........: 0
LAVATORIES....: 4 DISHWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 100 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: c GARBAGE DISP..: 1 WATER HEATERS.: 1 WATER LINE ft: 100 BCKFI-W PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
- ---------------------- MECHANICAt- ----------------------------------------—-------------------
FUEL TYPES----------- FURN l 108K ..: 0 BUIL/CMP ( 3HP: 0 VENT FANS.....: 2 CLOTHES DRYERS: 1
GAS FURN >=100K ..: 1 1,1NIT HEATERS..: 0 FLOODS.........: 0 OTHER UNITS...: 1
MAX INP.: 175080 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES..... 0 GAS OUTLETS...: 1
----------------------- -------------------------------------- ELECTRICAL - ----------------_------------------------------------
--RESIDENTIAL UNIT--- ---SER,.CE/FEEDER----- --TEMP SRVC/FEEDERS-- ---BRPNCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1000 SF OR LESS: 1 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 3 201 - 400 amp..: 0 201 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT....... 0
MANF IMI/5VC/FDR: 0 601 - 1008 amp.: 0 601+amps-1008 v: 0 MINOR LABEL -10: 0
1000+ amp/volt.: 0 ---------------------------------- PLAN REVIEW SECTION ------ --------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 680 V NOMINAL: CLS AREA/SPC OCC:
-----------------•--------------------------------- ELECTRICAL - RESTRICTED ENERGY ---—---—----------------------------—----------_.--
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL----------------------------_.-------------------------_--------- ---
AUDIO b STEREO.: VACUUM SYSTEM..: PUDIO 6 STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: OTH: :: BOILER.........: HVAC...........: l_AN%CAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: X CLOCK..........: INSTnl1FENTATION: MEDICAL........: OiHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL N SYSTEMS: 0
rner: --------------------------------------Contractor: -------- ----------------------- TOTAL FEES:$ 4036.@G
ROSE MANOR HU ES/GSI NW ROSE MANOR HOMES INC This permit is subject to the regulations contained in the
CONTRACTORS 10620 SW LUCAS DR Tigard Municipal Code, State of Ore. Specialty Codes and all
10620 SW LUCAS TUPi-ATIN OR 97062 other applicable laws. All work will be done in accordance
TUALATIN OR 9706 with approved plans. This permit will expire if work is
Phone L1: 452-6133 Phone t: 452-0133 not started within 180 days of issuance, or if the work is
Reg U..: 109060 suspended for more than 180 days. ATTENTION: Oregon law
in
--------------------—_---------------------------------- requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-8810 through OAR 952-001-8800. You may obtain copies of these rules or
J direct questions to OUNC by calling (503)246-1987.
~ --------- -----_.-------------—--------------------- REQUIRED INSPECTIONS ---------------------------—-----—---------------------
�,; Erosion Control Post/Beam Mechan Electrical Servi Framing Insp Firewall Insp Electrical Final
Grading Inspecti Ply/Underfloor Electrical Rough Gas Line Insp Gyp Board Insp Plumb Final
Footing Insp Crawl Drain Mechanical Insp Gas Fireplace Water Line Insp Mechanical Final
Foundation Insp Slab Insp Low Voltage Insulation Insp Water Service In Building Final
Post/Beam St A++
Plumbing Top Out Shear Wall Insp Appr/Sdw4 Insp
Iss1_redRy permittee Signatl.rt•e:+-++++-F++++++++ �+•++4 .+++�++++-4•+++1++++++� ++++++++11-+4+.++++f-+++++-4 1 h F I
Call 639-4175 by 6:00 p. m. for- an inspection needed the next brtsiness day
CITY CSF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT
PERMIT #. . . . . . . : SWR97-0:.:'01
DATE ISSUED: 07/08/97
PARCEL: 2S 1.O2BA-0-3700
SITE ADDRESS. . . : 1:=:059 SW 96TH PL #PVT
SUED I V I S I ON. . . . :DUEL I.N PARK. ZONING: R-25 PD
BLOCK. . . . . . . . . . LOI . . . . . . . . . . . . . :OO7 JURISDICTION: TIG
TENANT NAME. . . . . : 1OSE MANOR HOMES
USA NO. . . . . . . . . . '-i�—IJRE UNITS. . . . 0
CLASS OF WORK :NEW DWELL I NG UN I TS. . : 1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 0
INSTAL_I_. TYPE. . . . :BUSWR IMPE.RV SURFACE: 0 sF
Remarks : SFA — Path 1
Owner: - -- -_—__. .__________________________---__._---_______— ___.__ FEES
ROSE MnNQR H(IMFS/GSI NW type imol_rnt by date r,ecpt
CONTRACTORS PRM-r $ 2200. 00 DRA 07/08/97 97-2:96889
1O62O SW LUCAS DR INSP $ 35. 00 DRA 07/08/97 97-296889
TUALATIN OR 97062
Phone #:
Contt-actor,r _-------------------------------
OWNER
------------------------------------------------
Phone #. 4 22:35. 00 TOTAL
Rey #. . :
REOUIRED INSPECTIONS ----_.___-
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days from _^.•_^_ _ ___ �_.__.
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee tI-e accuracy of the T _
side sewer laterals. If the scwer 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 require=_ you to follow ruses adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR _
952-Nl-0BI8 through OAR 952-MI--OW. You may obtain copies of
these rales or direct questions to OUNC by calling (503!246-1497.
Issued �r1 .. Permittee Signature:
_
Q)
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+++++4•+++++f•t+++++++++++++++ti-+-1•+++++++++#+.+-}•+++++...I. -++++t....++++++++++++•++ h+
Call 639-4175 by 6:00 p. m. far an inspection neaded the next bi_rsiness day
t ++++++++++++++•++++++++++++++++++•f+++++++++++++++++++++++++++++++++++++++++++++-t
Pian Check
.TY OF TIGARD Residential Building Permit Application Recd By
'125-Sw HALL BLVD. New Construction Additions or Alterations Date Recd C'l
3ARQ OR 97223 Single Family Det:,�;ned or Attached (Duplex) Date to P E +.o 12 -
503-639-4171 Date to DST L 4-Q7 p'
- 503-684-7297 Permit SOU, `DZo 5(1)f17-
Print or Type Called x7141
Incomplete or illegible applications will not be accepted
r Name of Protect (— 1 Name
Job 3L rU /�,Pl� C' /)-�,
Address Site ddressL �7 / Architect Mailing Address /� ,I�
e --=--/ C tyis�ate /t Zip Phone"
v�A' �.J.L tuet1iW75� £':Zr4n'�� C. `I.-ZZS- -'
Owner Mailing Address ama�
/Stale Zip Phone Engineer Marling Address vt�
—, z� )IP �'"':2t�i /S�-&res �_ i���
Nam .C aystate Phone
General Describe work New Additi n O Alteration O Repair O
Contractor Mailing Address to be done
Additional Description of Work:
Cityrstate Zip Phone
y� r1 i l,j (k `i 7cla 'K ).S-,/J
Oregon Const, Cont. Board L c.M Exp. Date _
Irtach Copy of /67��, 9- //_ V 1� 7 C7
Current COT Business Tax or Metro a Exp. Date PROJECT
Licenses VALUATION
Name
Mechanical (�-- NEW CONS TRUCTIOW ONLY:
Sub- Mailing Address Sq. Ft. House: Sq. Ft. Garage
Contractor /)S Aa)
�Z/J1r�,J Corner Lot YES NO Flag Lot YES NO
�..0tate Zip Phone
ra 1 � ;�_ ��,a (check one) r! (check one)
r7�tsf _
O regon;,oust. Cont.Board L c 0 Exp. Date Restricted Audio/Stereo Burglar
xrtach Copy of ;'C: J( Energy L t System Alarm
Current .;OT Business Tax or Metro a Exp. Date Installation I Garage Door HVAC
L.censes Opener Systems
Na e � G
� /f� (check all that Other
Plumbing qtr h►____IJr_�rc' f tc�r3L apply)
Sub- Mailing Address Will the electrical subcontractor wire for all YEAS NO
Contractor + /� "Z" _jcV)lJ=L r restricted energy nstallanons) '
::,tyiS;ate Zip Phone I Has the Subdivislen Plat recorded? NIA YES NO
Icy �
Jregon ri r Cant Board Lica i Exp Date C Reissue Jr-MS-4, I Solar Ccmphance
Attach Copy of Zm�;b I L
Current Piumbin L:c a — (Calculation Attached)
9 Exp.,)ate I heart
Licenses I � I y acknowledge that I have read this applir„ahon, that the
.
information given is correct. that I am the owner or authorized
COT 3usiress Tax ar Metro a ExpDate, agent of the owre,r. and that plans submitted are in compliance
- -
Name 1 1 with Oregon Stated S`
C.0 Signature of n Prat i' Date
Elec.ricalt{t2�cS ;,fc t S - ' � S
Sut- M1taiiir.g.ldaress ry ,
/ D,5l0, be-6 w �j Contact P on N � s Phone# Y,
Contractor �/ a c� t if'C c� ,"ASn'3 -"I- %JJ
I rt-State nZ'p ons FOR OFFICE VSE LY:
V;/Y> ir�J platn: Map(TLO.
Cre�on Const ant Board L c AI Exo Date ' ,On Z(/ 7. 7
`tach Copy of L j7 - 5etha s: Z n9:
CE $018x:
_ce see ep:ycal L,c i i ^xp. Date
f "�� I�V Engineenng Appr vat: I P!anDin Approval: I TIF
CVBusiness Tax or Metro a Exv .Care I l �h
7 �'Z 3i.lsfa p.doc(dsl) 1197 V1 r
EILM tj Account Descri 1 n
iZL2_ Am n Ami. Pd. I r
MST Permit (BUILD)
Plumb. Permit (PLUMB)
v'o
Mlech. Permit (MECH)
ELC/ELR Permit (ELPRMT)
State Tax (TAX) � 13
Bldg.-
Plumb:
r, .
Nlech: f
ELC/ELR:
Plan Check
MST: (BUPPLN) 2 A¢
Plumb. (PLMPLN)
Mech: (MECPLN)
CDC Review t,��/ � 4Z/Lo ��-
(LANDUS) �tu _ _, VAI zg
Sewer Connection, (SWUSA) a'0
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC
Residential TIF (TIF-R) 1570 • �� 7v�—
Mass Transit TIF (TIF-MT) /.;I'
Water Quality (WQUAL) ° - &n'-
Water Quantity (WQUANT) A/?.) /dv
Erosion Control Permit (ERPRMT) —
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Fire Life Safety (FLS)
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ROSE MANOR HOMES. LTD.
1PH 1 a52-8133
CITY OF TIGARG
.7 S DUBLIN PARK
LOT 7 12059 5 W 96TH PLACE
o3 rCO LOT 6 - 12037 S W 96TH PLACE
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GRAVEL DRIVEWAY ENTRANCE
7PER EROSION CONTROL
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ALAN MkSCM DESIGN ASSOCIATES PC
IS 40 LIABLE FOR TI( ACCWACt OF TIt / /I
TOPOGPAMr KOAMAr" fT IS 14 SOLE
NEVONSEiE f'.OF 1w SLIDE" 10 YFAst
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1305 NW 19TH AVENUE, PORTLAND, OREGON 97209 1503) 2259161 S C A L E t ' 2 0 ' - 0 `
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171
Date Requested: —7— — A.M. y� P.M. MST:
I�z Z--J20--v
r,ocation: BU.
Tenant: Suite: Bldg: MEC: —
-ontractor• Phone j-C1(0 I PLM:
Owner:_ Phone: ELC:
ELR:
_ SIT:
BUILDING BLDG(con°t) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Bcam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFUSlab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Linc Rough-In i 1G Sprinkler
Foundation Insulation ,e�e,wet Hood/Duct Reconnect Vault
Bsmt Damp Drywall �,- Furnace Temp Service MISC.
Masonry Ceiling C Rauf Drain A/C I KI Slab
Shear/Sheath Fire Spklr/Alm Crawffound Ir I Leat Pump Low Voll _
Approved Dyed Approved Approved Approved --
Appr/Sdwlk Nol Approved proved Not Approved Not Approved Not Approrcd
FINAL FINAL FINAL FINAL FINAL
Lo
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C7 Call for reinspection O Reinspection fee of S _required before next
inspection C3 Unable to inspect
Inspector: /% Date: 1- �l/ Pager of