13048 SW PRINCETON LANE i
n
Q
13048 SW Princeton Lane
GI r'Y OF TIGARD 24-Hour p
BUILDING Inspection Line: (503)639-4175 MST o
INSPECTION DIVISION Business Line: (503)639-4171
BUP _
Received ._ Date Re uested ' ' AM___ PM -_.- - BUP
Location - l-?D ��-�- �' � Suite MEC _
Contact Person i�'�� _ Ph( _) — 1 3 PLM —
Contractor. _— _ Ph SWR -_
BUILDING I'enanYowner _ ELC _—
Footing ELC ELC
Ftg Drain ACCESS: ELR
Crawl Drain
Slab Inspection Notes: SIT --�—
Post&Beam
Shear Anchors ---- --------
Ext Sheath/Shr-
Int Sheath/Shear ---------------------_.__�-_.
Framing
Insulation
Drywall Nailing ------ __.._-.--__--_ -- --
Fi rewe lI ,
Fire Sprinkler , -- -
Fire Alarm
Susp'd Ceiling
Roof
Other: - -_-_... - --- -- ------ -
Final ---- ----___
PASS PART FAIL - - ---��_--�----�— -- -`-_----- -
PLUMBING
Post&Beam ----- ---..__---------- ---- --
Under Slab ---Rough-In
Water
Water Service - ---- --
Sanitary Sewer
Rain Drains -------
Catch Basin/Manhole
Storm Drain �_.. --- --- --------
Shower Pan
Ott r - -- - -- -- ---
PAS _PART FAIL -- .._ .. _.__. _-.------------.-..—._.---------
- HANICAL
Post& Beam
Rough-In _-__-.-._.. -- —- ------- - ----- ----------
Gas Line
Smoke Dampers --_ ----- ------- -- ---- --------
Final
PASS PART FAIL --- --_ ----_.-_--_ -- -____-- --
ELECTRICAL
Service --- - --- ____--.__�_. .------ ---------------- -------- -
Rough-In ---- ---_,-- —_-_-- ___
UG/Slab
Low Voltage _-
Fire Alarm
Final ❑ Reinspectlon fee of$--.._—�required before next inspection. Pay at City Hall, 13125 SW Hall Blvd,
PASS PART FAIL
SITE _-- ❑ Please call for reinspection RE: ❑ Unable to Inspect.-no access
Fire Supply Line
ADA
Approach/Sidewalk Dab Inspeetw- +• Ext
Other.
Final M DO NOT RbMOVR this inaptodion reeord from the job Mo.
PASS PART FAIL
curY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MSTp 6(?6
INSPECTION DIVISION Business Line: (503) 639-4171 --
BLIP
Received _ Date R sted___ _ Ste__- AM I'M BUP -
Location � � -- - Suite_ - MEC
Contact Person Ph PLM _
Contractor_- roa3E F&CHIC Ph(------) SWR
BUILDING _ Tenant/Owner .. ELC
Footing
Foundation ELC
Ftg Drain Access: ELR ACX
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:_ -
Final
PASS PART FAIL
PLUMBINGi
Post 8 Beam —.— — - - --- - ---
Under Slab
Rough-In
Water Service ---- --
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain -- --
Shower Pan
Other: - - -
Final —
PASS PART FAIL
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers ---
Final
PASS PART_FAIL -- - - - - - - - - - --- -
ELECTRICAL —
Service
Rough-In
UG/Slab
�Voltage
i
PART FAIL �] Reinspection fee of required before next inspection. Pay at City Hall, 13125 5W Hall Blvd.
S TE Please call for reinspection RE:__ ___-- Unable to inspect-no access
Fire Supply Line ��;
ADA l --1'CZ�.l�_.
Approach/Sidewalk pats Inspecta,r �' 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
INSPECTION DIVISION Business Line: (503) 639-4171
BLIP _
Received Date Requested , __ U -_ AM._ PM BUP
Location ---I I �'- ?� ---- ---Suite - MEC ---
Contact Person Ph ( _--- -__) ____- PLM
contractor - ------ _ Ph ( -) - --- SWR
BUILDING Tenant/Owner FLC
Footing E I_C
Foundation Access:
Ftg Drain Et.R
Crawl Drain -- —"– SIT
Slab Inspection Note.--i:
Post&Beam ---- ---
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation -
Drywall Nailing — -
Flrewall �+-- 7–6 —
Fire Sprinkler
Fire Alarm _
Susp'd Ceiling - -- –�
Roof _
Other:
PASS PART FAIL
I_NG — - -
Post&Beam _
Under Slab
Rough-In
Water Service ---- -- --
Sanitary Sewer �',,y��e' Cie-111– p-r"_J v_
Rain Drains ;-
Catch Basin/Manhole
Storm Drain
Shower Pan _ --
Other:_
Final –
PASS PART FAIL
MECHANICAL_ -- – – -----
Post&Beam _
Rough-In —� – -
Gas Line ..
Smoke Dampers3 ---
�.
A59 ART FAILIET -'– - --��–T
CTRICAL --_ - -- -
Service –
Rough-In –
UG/Slab
Low Voltage ---
Fire Alarm
Final EJ Reinspection fee of$ _ equired before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE — ___—_T_ Unable to inspect-no access
Fire Supply Line
ADA Date Inspector
Approach/Sidewalk
Other:
Final --� -� 00 NOT REMOVE this Inspection record from the Jeb site.
PASS PART FAIL
J�RD _ MASTER PERMIT
CITY
OF TIGi_
PERMIT#: MST2002-00080
DEVELOPMENT SERVICES DATE ISSUED: 7/30/02
13,125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
SITE ADDRESS: 13048 SW PRINCETON LN PARCEL.: 2S104DA 20500
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT:031 JURISDICTION: TIG
REMARKS: SF rowhouse, Unit 31, Bldg 7, CSB plan. STRUCTURAL FILL, REQUIRES GEO-TECH
INSPECTION AND REPORTS
BUILDING _
REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: 320 of BASEMENT: of LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 744 of GARAGE: 412 at FRONT: PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: 1 FINSSMENT: 732 at RIGHT:
VALUE: E 173.305 80
OCCUPANCY GRP: R3 BORM: 2 BATH: 3 TOTAL 119500 of EAR:
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN, TRAPS:
LAVATORIES: 3 DISHWASHERS: I FLOOR DRAINS: GEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUBISHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS I WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: 1 BOILICMP<3HP: VENT FANS: 4 CLOTHES DRYER: 1
LPG FURN>•100K: UNIT HEATERS: HOODS: I OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVE9: GAS OUTLETS: I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 9F OR LESS: 1 0 200 amp: 1 0 200 amp. WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 800SF: 3 201 400 amu201 400 omp. tot WIG 9VCIFDR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 800 amp: 401 800 amp- EA ADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HM/SVC/FDR: 801 1000 amp. 601*4mp9-1000v: MINOR LABEL:
10004 amplvolt
PLAN REVIEW SECTION
Reconnect oniv:
-4 RES UNITS: SVCIFOR,•228 A.: >'800 V NOMINAL: CLS AREA/SPC OCC.
ELECTRICAL.•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO B STEREO: VACUUM SYSTEM: AUDIO&STEPEO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGI AR ALARM: 0tH: BOILER: HVAC: LANDSCAPEIIRRIG, PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATArl ELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,099.33
This permit Is subject to the regulations contained in the
BROWNSTONE QUAIL HOLLOW LLC BROWNSTONE HOMES,LLC Tigard Municipal Code,State of OR Specialty Codes and
12670 SW 68TH PKWY STE 200 12670 SW 68TH PKWY all other applicable laws. All work will be done in
PORTLAND,OR 97223 PORTLAND,OR 97223 accordance with approved plans. This permit will expire 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 odes are set
Rea 0: I IC I •Ir 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 _
Sewer Inspection Plm/undslb Insp Framing Insp Firewall Insp Electrical Final
Footing Insp Electrical Service Gas Line Insp Gyp Board Insp Plumb Final
Foundation Insp Electrical Rough-in Insulation Insp Rain Drain Insp Mechanical Final
Wtr Proofing Bsm't Wa Mechanical Insp Shear Wall Insp Water line Insp Building Final
Slab Insp Plumbing Top Out Exterior Stleathing Insf Smoke Detector Final Inspection —
Issued By : ��,g. -t��1_i Permi►iee Signature : _
Call (50 3) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD SEWER CONNECTION PERMIT_
DEVELOPMENT SERVICES PERMIT #: SWR2002-00056
DATE ISSUED: 7/30/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104DA-20500
SITE ADDRESS; 13048 SW PRINCETON LN ZONING: R-4.5
SUBDIVISION: QUAIL HOLLOW - SOUTH JURISDICTION: TIG
BLOCK: LOT: 031
TENANT NAME:
FIXTURE. UNITS:
USA NO'
CLASS OF WORK: NEW DWELLING UNITS: 1
TNO. OF BUILDINGS:
TYPE OF USE: SFA
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection T_ _
Owner: FEES _
BROWNSTONE QUAIL HOLLOW LLC rIN
By Date Amount Receipt
12670 SW 68TH PKWY STE 200 T CTR 7/30/02 $2,300.00 27200200000
PORTLAND,OR 97223 CTR 7130/02 $35.00 27200200000
Phone: 503-598-7565 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage A; ency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the installer
shall prospect 3 feet in all directions from the distance given. If not so located, time installer shall purchase a"Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
lsquiPermittee Signature:
by: 12
\\� Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
/ 7
Building Permit Application
City of Tigard
Date received,- y G' Permitno.-h 'ffs• �!C$�
Address: 13125 SW Hall Blvd, '1 i•WE ProJecdappl.no.: .pindate:
CitynfTigard Date issued: Recei tno.:
Phone: (503) 639-4171 y� p
Fax: (503) 598-1960 Case rile no.: Payment type:
Land use approval: r 1&2 family:Simple Complex:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family O New construction LI Demolition
U Addition/alteratiori/replaccment U Tenant improvement U Fire sprinkler/alarm U Other:
JOB SITE INFORMATION
Job address: f� `, L.� /) L (' i j) Bldg. no.: Suite no_:
Lot: f Block: Subdivision: ITax map/tax lot/account nu.:;,`_
Project name: `---
Description and location of work on premises/special conditions:
Name; ,r 0 cl-, t&s 4n EM
Mailing address: LS 1 do 2 family drrellinv:
City: 4 u� Statc:OlQ 'LII':�t Valuation of work.. ..............................
Phone - Fax: E-►nail: No.of bedrooms/baths................................. _
Owner's representative: Total number of floors................................. _
Phone: 8 l ax:6 I: m•,il New dwelling area(sq.ft.) ..........................
APPLWANir Garage/carport area(sq. ft.).........................
Name: L- � Covered porch area(sq.it.) .........................
Mailing address: r !�. - _ Deck area(sq.ft.) ........................................
City: c„, State: ZII. 4 - Other structure area(sq.ft.).........................
Phone: Fax: E-mail. CommerciaUFndustrlal/multi-family:
�tjtjel Valuation of work.... .
Existing bldg.area(sq.ft ) . ........................
Business name: r ,. t ft.)
Address: S�' New bldg.area(sq.r � ............................... .---.
Cit Statro ZI Number of stories........................................
y' �- !' `� Type of construction _
Phone• -' Fax:b�•p_� _'-mail Occupancy group(s): Existing:
CCB no.: New: _
City/metro lic.no.: Notice:All contractors and subcontractors are required to be
r licensed with the Oregon Construction Contractors Board under
Name: LCA _ provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed. If the applicant is
Address: j /r AvC =5c, . l� exempt from licensing,the following reason applies:
City: � State ZIP:
Contact person: Flan no.: --
Phone: - I E-mail: —
Name: , Contact person: Fees due upon application ........................... $
Address: 6 9 69 S t ) r c C4- Date received:
City: _talc: ZIP: 3 Amount received ......................................... S_—
Phone: Fax: E-mail: Please refer to fee schedule. _
I hereby certify I have mad and examined this application and the Na.n jurisdiction rap credit cards,pteaw cWi jurisdiction rut mare infamaticn
attached checklist.All provisions of laws and ordinances governing this U visa U Mutercard
work will be complied ,whethe e i ed heroin or not. Credit cud number
Cap
Authorized si m: We- 4t� Name or catdbo der as sbawn of credit cud
S
Print name: Cardboider s`Hato,. Amami
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440.613(60WOM)
Plumbing Permit Application
Wterncei ed: Permit no.: P
City of
i TigardSewer permit no.: - Building permit no
Address: 13125 SW Hall Blvd,Tigard,OR 97223 F'uojecUappl.no.' Expire date
CityoJ77gard Phone: (503)639-4171 -'-'�
Fax: (503)598-1960 1 Date issued: By:_ Receipt no.:
Case file no.: Paymen,type:
Land use approl•va - --
O 1 &2 family dwelling or accessory U Comelom" IT'Stnal U Multi-family U Tcnant imprTement
❑New construcdon U Addition/aiteration/replacement U Food service U ntJicr- _ -- -
t ' t , .
Uescri tion Qt Fee(ea.) Total
Job address: 3C'�ct'ss'_,4l�J �{e .- �•� New 1-and 2-fandly dwellings only:
Bldg.no.: Suite no.: _ (includes 100 f1.(or each utility connection)
Tax map/tax lotiaccount no.: — SFR(1)bath
Lot: Bla:► --Subdivision: SFR(2)bath
Project name:
City/county: r Or: Each additional bath/kitchen
Site adlities:
Description and location of work on premises: Catch basin/area drain _
--- - --- D wells/leach lin tren11 ch drain
E t.date of comple.tion/inspecticrn Footin j drain(no.lin.ft.)
coNiriAcTOR Manufactured home utilities
Rncin�cc namr• Manholes
Wolcott Plumbing _Rain drain connector
PO Box 2007 Sanitary sewer(no.lin.ft.)
Storm sewer(no.lin.ft.)
Gresham OR 97030-0594 Water service(no.lin.ft.)
503-667-1791 Fixture or item:
CCB:23847 PM #
L :2G-208PB Abso tion valve
(;ontracWr s t+epreaeatative aignatut+e: - Back flow reventer
Backwater valve
Print name:
easins/lavatory -
Clothes washer
Name: _-_ -- Dishwasher
Address: Dn'rtking fountain(s)
City: State: ZIP: E'tctors/sump _
Phone: Fax: E-tnail: Expansion tank
961110 K� RixturcIsewcr crap
Name(print). Floor drains/floor sinks/hub _
- t3arba�disposal
Mailing address: Hose Bibb
State: 71P: lcc maker
Phony: Fax: E-mail: _ Interceptor/grease trap —
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the propt:rty I own as per ORS Chapter 447. Si (s),basin(s),lays(s) —
Owner's signature:-___ kll _- - Date: Sump —
111� Tubs/shower/shower an
Urinal -
Na7Wairr
- Water closet _ -
AdeaterCi — State:= Other.PlFax: :mail: Total
_ Mitilmum tee................$
ae&l putt,plere emu i,rtrm -ray m:e Y►ansrban Notice:This it plication
No.0 .one,* �' tt' Plan review(at � 'b) $ --..
Oval OMutacard expires if a pemtit is not obtained surcharge
��tn t RO days after it has boon SEG t e(896)....$ ------
C",card nanim �.__-- TOTAL
None of aanRr+ldc a+�I�orvo
= scoerted as complete. Moue(fi)
--- CarGrto die A�erw
MechanicalPermit Application
Daiereceived: Permit no.:/
City of Tigard lhojetx/appl.no.: Expiredate: -
Ci o !•i and Address: 13125 SW Hall Blvd,Tigard,OR 97223 --- —�
ry I I'lione: (503) 639-4171 Dau issued: _ By: Receipt no
Fax: (503)598-1960 Cam.file no.: Payment type:
Land use approval: Building pe"ni'no.:
TVPE OF PIERNI IT
U 1 &2 family dwelling or accessory U('onimercial/industriil U Multi-family U'I enant improvement
U New construction U Add i(ion/al terat iort/rcpIacenient U Other.
tot INFORMATION,
Job address:130qg 5 CK r �c c-A�l Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: _ Sulte no value of all mcchanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: — profit.Value$
Lot Block—Subdivision: 'See checklist for important application information and
Prvjut name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: I r
Description and location of work on premises: r e a r
Fec(m.) Total
Est.date of completion/inspection: _ Desailwion (rp. Res.only Res.ouly
Tenant improvement or change of use: Air handling unit __—ChM
Is existing space heated or conditioned?U Yes O No Air conditioning site plan required)
Is existing space insulated?U Yes U No �tionofexisting HVAC system
MECHANIC I AL CONTRACTOR Tiodeer compressors
SIAic boiler permit no.:
HP _er_Tons BTU/H
Four Seasons Beating&A/C Service Inc 1-tre/smoke dampers/duct smoKe detectors
PO Box 66409 eat pump(site p—lanrequ )
Portland OR 97290-6409 -lnstallTrcp acef-i�urnacdburner_._ T
503-775-5919 Including ductwork/vent liner U Yes O No
CCB: 48281 n-�Trc{rlace/reRcate heaters-suspen ,
wall,or floor mounted
Name(please print): Vent forappliance other than furnace
Refrigerstim
t AbsorptionunitaBTU/H
Name: ('pillars. _ lip
Com tres"%_— ___ HP
— — _-- -- _ •bit an veo on:
City; _, State: ZIP: _- Appliance vent _
['hone: Fax: Email: Dryer exhaust
I foods, ypo res.kitcheiNa2RFat
hoaA fire suppression system
Nano..: Exhaust fan with single duct(bath fans)
Mailing address: Exhaust systema ntmg or AC
City: Slater 21P:— — a oo up to outlets
-- --- Type: ---I1'(; _, NO Oil
Phone: pax: Entail: vsT iinrtschaddidonal over 4 ou els
'rocessolping(schematic required)
Name: Numha of outlets
_ l appliance or equipment:
Address: Decorativefireplace _
City: State: ZIP. nsert-type
Phone: Fax: L-mail: tov p>c Ict�tovc^_
tJther.
Applicant's signature: Date: O _
Name (print):
Not all finto Blom kvW aedif earth,pksse call)mitdicdan fa mar inrama8on Permit fit ... ............$ —
Nolicr.:'this permit application Minimum feeee................$ _
U Visa O MutterCard expires if a permit is not obtained
Plan review(al —9G) $
Credit cord number: within ISO days aflex it has been
State sur,harge(896) $
._
NNW of canttwl a ahona on credit cud accepted as complete. —�
$
TOTAL.......................$
---Cordbolder airsalwe - Amsm"- 440-4617(610NUDW)
hlcctrical Permit Application
----- -- Datereceived: Permitn .. TZ,-Ca2- CUU
Project/appl,no.: .—
city of Tigard Expire date:---
Address: 13125 5W Hall Blvd,Tigard,OR 97223 pate issued: — By: Receipt no.:
C,r�of Tigard Phone: (503) 639-4171 (:ase file no.: Payment type:
Fax: (503) 598.1960
Land use approval:
1
O Multi- arnily O Tenant improvement
2 family dwelling or accessory U Commercial/industrial i.-a• P:trtittl
ed-New construction U Additir,n/alteration/replacement 0 Odtc ,
t t
�Jobaddreqs: s` t � Bldg,no.: 5tc no.: Tax map/tax lot/account no.:
ot: Klock: Subdivisioj _ -- --
Project list t: _
r Description and location of work on premises:_
Estimated date of cont let ion/inspection: l
v
tcc Max
Job no: -- — Desert tion QI . (ca Total nu.im r
Business halite: I C__ New vAldenFIA -single or multl-hunlly per
Address: dwelling unit.Includen nuaiched garage.
City: H I L L S B O R O State: O R ZIP: 97123 servicelncloded: 4
IWO srl.ft.or less
Phonc:6 4 8-5'14 4 Fax6 4 S-9 7 2 E-mail: Each additional 500 59,ft ol portion thereof
Elec,bus. lic,no: 34-119C_ Limitedenergy•residenucd 2
CCD no.; 36051 - 2
City/metro lie.no.: 1 3 _
Limited encrS ,lien tcaidentiul
Each manufactured home or modular dwelling ,
--- Service.and/or feeder
sianature of su civising clecuician ,tc rod) 2 f3 7 7 S Servlce4nrferden-In4tnllatlnn,
Sup,elect,name(print)[)A V I D A J E R O M E License alteration or relocation:
2
Zoo amps or less 2
f 201 amps to 400 amps 2
Name(pent) V'c3t✓wo ?/w►--' �i s� - 4tl I amps to 600 amps
Muiliu address: `JET V �-��G --- 601 amps to IOtHI amps 2
City: Slat ZI P: 7 L Over loon amps or volts 1
E-mail: Reconnectonl
Phone: 75�+� Fax: ('emporary 4ervice4 or feeders
Owner installation:'Ihc installation is being made on property f own hntallatlon,alteration,orrelocation:
2
which is not intended for sale,lease,rrm:,or exchange according to 200 limps of less 2
ORS 447,455,479,670,701. 2016 to 400 amps _ 2
Dat " - 401 to 600 am s
Owner's signature- Branch clrculis-new,alteration,
or extension per panel:
A Fee for branch circuits with purchase of 2
service or fader fee,each branch circuit
Address: A Fuc fur branch circuits without purchase
City: - r _Mate: Z1 P: 2
of service or feeder fee,first branch circuit:
Phone: I ax; E tttail: F�chadditirmalhrenchcircuit.
Mise.(9ervlce ar feeder not included): 2
U Health-care facility Each pump or irrigation circle 2
U Service over 225 amps-commercial Each sign or outline lighting
U Service over 320 amps-rating of 1&2 0 tiazardnus location Signal eircuit(s)or n limited energy panel, 2
family dwellings U Building over 10,0110 square feet four lir altcrallon,or extension• _
U system over 600 volts nominal more residential units in one stnicture _ —� —�—r
U Building over three stories 0 Feeders,400 amps or more •Uescri don:
_
C3 occupant load over 99 persons O Manufactured structura4 or RV park Each additional Inspection over the allowable In an�f hor�e_T_
0 Egres Aightingplan G Other _ -- Per Ills pecdon -
subndt sets of plans will,any of the above. _Ell es0g.11
The above are not applicable to 1 emporary construction service.
Other _�-.--
--
Permit fee.......... .......... ----
Notice This permit Application Platt review(at rbc) $
Nm rill jwisdictions accept credit cords,plena anti putatiaiun for more hrfntmnumr expires if a permit is not obtained
U Visa U MasterCard State surcharge(8%) $ .-
ctedu card number _� .--� --
within 1 AO Boys ager It has been TOTAI. ................. -
-- — spires accepted as crmplele. �-�
Dune o car ho t u s awn o—a- creel cwd $ (6
'"— mount t
Cudholder signature ,� ..{�-
I
T�/' OF
T I G /� R D _— MECHAf` � PERMIT
i / '� r+ PERMIT#: MEC2002-00565
DEVELOPMENT SERVICES DATE ISSUED: 12/13/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104DA-20500
S11 E ADDRESS: 13048 SW PRINCETON LN
SUBDIVISION: QUAIL. HOL.LOVV - SOUTH ZONING: R-4.5
BLOCK: LOT: 031 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SFA UNIT HEATERS: VENT FANS:
OCCUPANCY" GRP: R3 VENTS W/O ADPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HA_NDL.IN_G UNITS OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas fireplace and gas piping.
Owner: _ FEEST—_.-__ --
BROWNSTONE QUAIL HOLLOW [-LC Description Date Amount
12670 SW 68TH PKWY STE 200 %11 ('111 Permit I cc 12/12/02 $72.50
PORTLAND, OR 97223 1'IA\ S StatL'l,i12/12/02 $5.80
Total $78.30
Phone: 503-599-7565 --- ------
Contractor:
FOUR SEASONS HEATING & A/C
PO BOX 66409
PORTLAND, OR 97290 REQUIRED INSPECTIONS
Gas Line Insp
Phone. Cit1-775-5919 Mechanicallnsp
Reg M I IC 48283 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State 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. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notificatiun Center. Those rules are set forth in OAR 952-001-00
Issu By: AA Permittee Signature: ktU
Call (503) 6 9-4175 by 7:00 P.M. for inspections needed the next usiness day
Mechanical Permit Application
- --
FNd: 1 receive1 A Dry Permit no.:}f¢d 56,5
city of Tigard Project/appl.no.: FxlZire date:
city of Tigard Address: 13125 SW Hall Blvd,1'i}ani,(112 47223 Date issued: I Receipt no.:
Phone: (503) 639-4171 Payment type:
Fax: (503) 59&1960 Case file no.: Y
I;uildingpermitno.: M�J�-�� - Q(,)Q�
Land use approval: -
TYPE 1
1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Other:
Joh address: i ' i? , y ,.ti lr C.N I (l` ti� Indicate equipment quantities in boxes below. Indicate the dollar
�- -- - value of all mechanical materials,equipment,labor,overhead,
Bldg.no.: f JSuite no.: - -
profit. Value S
Tax map/tax lot/account no.:
Lot: Block: Subdivision: •See checklist for important application information and
Project name: .jurisdictin: ' fee schedule for residential permit fc r
r
City/county: v 7_IP: a r 1 r 3 1
Description and I con of work o Iremiissc�s:_ --
�,�ur1 tt l Y" � c�•---- � _ t c�•(c•:c.I t„rrl
Est.date of completion/inspection: tkwcritArim DIY• Res•unlv es.only
R
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned?U Yes U No Air con iuoning(site p an require )
is existing sr Ice insulated?U Yes U No Alteration of ex sung system
Sol er compressors
State boiler permit no.:
Business ame: LLQ (L` :Y 11P Tons BTU/14
Addre •Ir smo aamper i ct smo a detectors
City: State 7,IP: eat pum r(sue p an reyurre )
nsto rep ace urnac umer U/t
Phone:,50 -537-91W Fax: E-mail: Including ductwork/vent liner O Yes U No
CCB no.: nsta rep ac re ovate caters-suspenc c ,
City/metro tic.no.: p mounted
wall,or floor
-- - - - Vcnt for a lance of er t an fur
Name(please rint): a gent on:
1NTA(`T VERSON Absorption units BTU/H
Chillers _ HP _--
Name: Com ressors_ III'
Address: "]V v ronmenta ex utt and vent at ou:
Cil Stal Appliancevent
t Fax: E-mail: ryerex laUSl _
Phcmc: ( 1� or, s,Type /res. uc a lazmat
hood fire suppression system
Name: Exhaust fan with single duct(bath fans)
x aust sstem apart from heatingorpW
Mailing address: Fuel p p ng rin alstribut on hip to 4 outlets)
City: Stale: ZIP: Type. I,PG NU. Oil
Phone: I,iI Email: uc / in eac add--fana over 4 outlets
process piping(sc Icmatic required) -
Number of outlets
Name: ter -e�appp a or equ pmeut: I gO r�
Address: Decorative fireplace d
City: State: 'LIP: nsen-t pe_ —
mail: cwast�pe et stove
Phone: ax: Other:
Applicant's signal r ( " L 1—
Name(print): ) ( .rV j —
Permit fee.....................$
Nd an jurisdictimr lecept crahi cards,phare rail jurirdiciim for"rare'"tonnNI Notice:111is permit application Minimum fere................$
U Visa U MasteWard expires if a permit is not obtained Plan review(at _ %) S -
c otitic card numlxr --- - --L / within Igo days atter it has been State surcharge(8%) ....S �'3��,
accepted as complete. TOTAL .............
1�ime of cnrdrolder u r n m c i crd $
Cardholder iiputurc Airroaai 440-4617(NUaR.'oM
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
Description: Price Total
TOTAL VALUATION: f$72
ERMIT FEE: Table 1A Mechanical Code city
(Ea) Amt
$1.00 to$5,000.00 nimum fee 577..`.•0 1) Furnace to 100,000 BTU
14.00
$5,001.00 to$10,000,00 .50 for the first 55,000.00 and includin ducts&vents.52 for each additional$100.00 or 2) Furnace 100,000 BTU+ 1740
ction thereof,to and including inciudin ducts&vents
$10,000-00. 3) Flax Furnace
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 14.00
includin vent
$1,54 for each additional$100.00 or 4) Suspended heater,wall heater
fraction thereof,to and Including 14.00
$25 000.00. or floor mounted heater
5) Vent not included In appliance permit
525,001.00 to$50,000.00
$
379.50 fot the first 525,000.00 and 6.80
$1.45 for each additional$100.00 or 8) Repair units
fraction thereof,to and Including 12.15
$50 000.00. -- Boiler Heat Air
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: or Pump gond
51.20 for each additional$100.00 or For items 7-111 1 footnotes below.
Comp
fraction thereof. -
_ 7)<3HP;absorb unit 14.00
SUBTOTAL:
Minimum Permit Fee$72.50 $ l0 100K BTU
8)3-15 HP;absorb 2560
6%State Surcharge $ unit 100k to 500k BTU
9)15-30 HP;absorb 35.00
25•/.Plan Review Fee(of subtotal) $ unit.5-1 mil BTU
Required for ALL commercial ermils only 10)30 50 HP;absorb 52.20
TOTAL COMMERCIAL PERMIT FETE: $ unit 1-1.75 mil BTU _
11)>50HP;absorb 87.20
-- ---- -�- unit>1.75 mil BTU
_ _ 12)Air handling unit to 10,000 CFMValutU.00
ASSUMED VALUATION_ S P.ER AP_PLIANe E: Total 13)Alr handling unit 10,000 CFM+
Qt Ea Amount 17.20
Desarl tion: 955
Furnace to 100,000 BTU,Including 14)Non-portable evaporate cooler 10 00
ducts&vents 1,170
Furnace>100,000 BTU Including15)Vent fan connected to a single duct 6.80
ducts&vents 955
Floor furnace Includin vent _ 18)Ventilation system not Included in 10.00 _
Suspended heater,wall heater or 955 a Iiance ermit
floor mounted heater 17)Hood served by mechanical exhaust 1000
Vent not Included in appliance 445
- 18)Domestic incinerators 17.40
emelt -_
Re air units 805
Z-3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator 69.95
to 100k BTU___ 1,700 -
3-15 hp;absorb.unit, 20)Other units,including wood stoves 1000
101k to 500k BTU 2,310
15-30 hp;absorb.unit,501k to 1 21)Gas piping one to four outlets 5.40
mll.BTU 3,400
30.50 hp;absorb.unit, 22)More than 4-per outlet(each) 1.00
1-'1.75 mil.BTU 5,725
�b0 hp;absorb.unit, Minimum Permit Fee$72.50 SUBTOTAL:
>1.75 mil.BTU 656
Air handling unit to 10,000 cfnt 8•/.State Surcharge
Air handling unit>10,000 cftn 1'170 $
_Non- rtable evaal�rate cooler 858 TOTAL RESIDENTIAL PERMIT FEE:
Vent fan connected to a sin le duct 446
Vent sy inciuded In 858 -- --
appllance permit _ Other Inspections and Feos: hours)
Hood served by mechanical exhaust 656 1 Inspections outside of normal business hours(minimum charge
Domestic incinerator 1.170 $62 50 per hour
Commercial or industrial incinerator ,590 -_- fically indicated (minimum charge-half hour)
42 inspections for which no fee is sped
$62 50 per hour
Other unit,including wood stoves, 3 Additional plan review required by changes,additions or revisions to plans(mnurnum
Inserts,etC. --- 360 charge-one-half hour)$62 50 per hour
4
Gas piping 1 outlets - 83
Each additional OU►lel - _ ------- --- :State Contractor Boller Certlflcallnn required for units>200k BTU.
- Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
All New Commercial Buildings require 2 sets of plans.
VALUATION:
I:\dsts\forms\mech-fees.doc 02/11/02
ELECTRICAL
/\ CITY OF TIGARD RESTRICTEDE ENERGY RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2002-00270
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/27/02
PARCEL: 2S104DA-20500
SITE ADDRESS: 13048 SW PRINCETON LN
SUBDIVISION: QUAIL HOLLrVJ - SOUTH ZONING: R-4.5
BLOCK: LOT: 031 JURISDICTION: TIC
Proiect Description: All encomp. low voltage.
A.RESIDENTIAL E.COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: L. NDSCAPE/IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
_TOTAL#_OF_SYSTEMS: _
Owner: Y--- � Contractor: —
BROWNSTONE QUAIL. HOLLOW LLC AZIMUTH COMMUNICATIONS INC
12670 SW 68TH PKWY SrE 200 P.U. BOX 509
PORTLAND, OR 97223 W'ILSONVILLE, OR 97070
Phone, 5113-593-7505 Phone: 503-639-0110
Reg #: I I F 36-94C'LE
5111 2312LEA
I.IC' 14;928
_ FEES — Required Inspections --
Description _ Date Amount Low Voltage Inspection
�I I I'IthlI I I{LIZ Permit 11/27/02 $15.00 Elect'I Final
I A.':18"l,State'l'ax 11/27/02 6.0n
Total $81.00
I his Permit is issued subject to the regulations contained in the Tigatd Municipal Code State of OR Specialty Codes
and all other applicable laws All work will be done in accordance with approved plans 1 his permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days 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 952 001-0100 You may obtain copies ` these rule, or direct questions to OUNC at (503)
246-6699
' L Permittee Signature
Issued by I, /, ;i 1 �� —
OWNER IN:TALLATION ONLY
The installation is being made on property I oven which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N _— DATE:___ _
LICENSE NO:
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
�rt�
Electrical Permit Application
Date received: //,. _py Permit no.:r-' _, U U
City of Tigard Prnject/appl.no.: Expire date: --
City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171 Case file nn. Payment type:
Fax: (503) 598-1960
Land use approval:
TYPE OFTERMIT
U I &2 family dwelling or accessory U Commercial/industrial J Multi:family U Tenant improvement
*New construction U Addition/alley lion/n.ltl:rccntrnt U Other: ❑Partial
It
.lob address: d a,/. f C�7Gti. Ll1- lildk. nu.: J Suile no.: 11ax map/tax lot/account no.: —
Lot: Block: Subdivision: f L Sot i Tdr - —
Project name: Qv.At t Srr�t a'N _ Description and location of work on
Estimated date of completion/inspection:
i lium
F,•c mfrs.
Job no: Ihycri lino QIV- (ea.) luial no.imp
Businesename: Z1A9uil+ New residential-aingleornwhi-familvper
Address: '3 dwelling unit.Includes attached garage
Cil l / Slate:(�� ZIP: Q 0 Service Included:
City: w/l5 I L l E" l0(x)sq_ft.or less __ 4
Phone r e -p I/D Fax' (, U+/T Email: _ Each additional 500 sq.ft.or portion thereof
CCB no.: / ,?f' Elec.bus.lic.no: 3G 4yC _r Limited energy,residenllal 2
City/metro lie.no.: (1 s �_
Limited energy,non-residential 2
2 _ Each manufactured Name or modular dwelling
`— ---- -�'�Y Service and/or feeder z
Signature or so rvising elect tan(required) Pate
�r �«� Serrlcesorfeeders-tnstallatlon,
Sup,elect.name(printl � ' ' LIC. [)EC I,iansen°' alteration or relocation:
1111011 200 amps or less 2
201 amps to 400 amps 2
Name(print): �;r , j/I,1`� -
p i L 401 amps to 600 amps
Mailing address: 601 amps to I000 amps 2
State: ZIP: Over 1555 amps or volts 2
City: -- I
Fax: I Illail: Reconnect out _-
Phone: Temporary services or feeders-
Owner installation:The installation is being made on property I own tnvlallation,alteration,orrelocation:
which is not in; nded for sale,lease,rent,or exchange according to 2
2011 amps or less _
ORS 447,455,479,670,701. 201 amps to 400 amps
Date: 401 to 6(x)amps
t)N'11Cr'S til'IIaWCC: _ __-__ -
tlranch circuits-new,alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
service or feeder fee,each branch circuit — _—
Address:
State: ZIP: B. Fee for branch circuits Without purchase `
Cully: -- of service or feeder fee,first branch circuit:
Pbutlt: I n I:Ina I Finch additional branch circuit.
Misc.(Service or feeder not Included):
,
Eiach pump or irrigation circle `
O Serviceovo 225 angts-connmerctal U ilealth-carefacihty - 2
Each sign or outline lighting
U Service over 320 amps-rating of 1&2 U Ilazardous location Signal circuit(A)or a limited energy Patel,
famllydwciting% U Building over 10,t)(x)square feet low or g 2
t]System aver 600 volts nominal more residential units In one structure alteration,or extension* _
O Building over three stories U Feeders,400 amps or more •I)escn tion•
Occupant load over 99 persons U Manufactured structures or RV park FACII additional Inspection over the allowable ITn any of the alcove:
U Egtess/0ghlingplan U(ether: ._. — Per inspection
submit _eels of plans with any of the above. Investigation fee
t)ther
The above are not applicable to temporary construcllon service. —•—
Permit fee...................... _
Nnt all iuriulicrions accept ctetht came,please call juriutiction Rtr more informalicm Notice'Phis pelmet application plan review(at — Ir) $ --
U Vtsn U MasterCard expires if a permit is not obtained State surcharge(9%) ....$
within 180 days alter it has leen
credit ra,d number: -.-._------------- xpirea - accepted as complete. TOTAL .......................$ -
_ Name of cardholder ar shown on credit card s
- — — ry IMuc,at
aJ r 440 Cardholder signature Amount s
I
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIALONLY
RestrictedEnergy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total I Check Type of Work Involved:
Residential-per unit �1
1000 sq ft.or less — $146 15 4 L 1 Audio and Stereo Systems'
Each additional 500 sq ft or
portion thereof _ $33.40 1 n Burglar Alarm
Limited Energy $7500
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less _ $80.30 _ lr—�
201 amps to 400 amps _ $106.85 — 2 L Vacuum Systems'
401 amps to 600 amps $160.60 _ 2 ❑
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65
Reconnect only $66.65
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system....................,..... . . . $75.00
200 amps or less _ $66.85 :' (SEE OAR 918-260-260)
201 amps In 400 amps $100.30
401 amps to 600 amps $133.15 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits ❑ Boller Controls
New,alteration or extension per panel
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6 65 2 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder lee.
First branch circuit __ $46.85
Each additional branch circuit — $6.65 _ ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 _ . ❑ Intercom and Paging Systems
Each sign or uutline lighting $53.40
Signal circuits)or a limited energy
panel,alteration or extension $7500 _ _ ❑ Landscape Irrigation Control
Minor Labels(10) _ $125.00 __ __
Each additional inspection over ` Y ❑ Medical
the allowable in any of the above
Par inspection _ $62.50 Nurse Cells_ ❑
Per hour $62.50
In Plant $73.75 Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ _ Other
8%State Surcharge $ Number of Systems
25%Plan Review Fee
See Plan Review"section on $ No licenses are required Licenses are required for all other installations
from of application.
Fees:
Total Balance lJue $
- Enter total of above tees $
❑ Trust Account# _ .._ 0%State Surcharge $_
Total Balance Due $
All New Commercial Buildings rnquire 2 sets of plans.
\isle\forms\elc-fees.doc 08/30/01
i
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Form
Permit #: MST2002-00080
Date Issued: 7/30/02
Parcel: 2S104DA-20500
Site Address: 13048 SW PRINCET A LN
Subdivision: QUAIL HOLLOW - SOUTH
Block: Lot' 031
Jurisdiction: TIG
Zoning: R-4.5
Remarks: SF rowhouse, Unit 31, Bldg 7, CSB plan. STRUCTURAL FILL, REQUIRES
GEO-TECH INSPECTION AND REPORTS
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 the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING', CONTRACTOR.
BROWNSTONE QUAIL HOLLOW LLC WOLCOTT PLUMBING CONTRACTOR;
12670 SW 68TH PKWY STE 200 PO BOX 2007
PORTLAND, OR 97223 GRES14AM nR 97010
Phone #: 503-598-7565 Phone #: 667-1781
Reg #: I Ir 23847
P! M 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
sw
Signature o thou _ed Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
LAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAtAAAAAAAAAAA AAAAAAAAI'
STREET TREE CERTIFICATION
Vf
Owner/Ag ent fo Jkl jr-j" t&tay
T (PERMITHOLDER) lot.
(PLEASE PRIN ) �'
No.
Do hereby certify that the following location
�I meets Citi- of Tigard/NXTashington County ►
land use and development standards for street tree installation.
t
ADDRESS: ►
SUBDIVISION: ►
LOT: ►
t ►
�I ►
1 D Poo.
BY: DATE: ►
RECEIVED �: =`L� ..� ,�:_- DATE: _ ►
I
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I �
i
CITY OF TIGARD
Residential Certificate of Occupancy
Permit No.: P67 2902 -
CCO80 Address:
Owner/Contractor:
Date of Final Inspection:
� `� C?� Inspector:
This structure has been found to be in substantial compliance with the provisions of the kale of Oregon One& Two Family Dwelling
S ecialhy Code and is hereby approved for occupancy-