12199 SW HOLLOW LANE a
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12199 SW Hollow Lane
\ CITY OF 1'IG�AR.� ---- MASTER PERMIT
PERMIT #: MST'2002.-00024
;IEVELOPMENT SERVICES DATE ISSUED: 1,'30/02
13125 SW Hall Blvd., Tigard, OR 972.23 (503) 639-417"
SITE ADDRESS: 12199 SW HOLLOW LN PARCEL: 2S103CB-05500
SUBDIVISION' OUAiL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT:004 Jb:,ISDICTION: TIG
REMARKS: Construction of new single family detached residence. Path 1
eUILDINI' _
REISSUE: STORIER: 2 FI OOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,010 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: Sr FLOOR LOAD: 40 SECOND: 1.248 of GARAGE: 585 of FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: I FINSSMENT: al RIGHT: 5
VALUE: S 219,492 10
OCCUPANCY GRP: R3 BDRM: 3 BAtH: 3 TOTAL: 2.25800 of REAR: 39
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING,MACH: i LAUNDRY TRAYS: r10JN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOGn DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS:
TUSISHOWERo• 3 GARBA,F DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFt.W PRELNTW 1 GREASE 1RAPS:
OTHER FIXTURES:
MECHANICAL
_
FUEL TYPES FURN<100K: BOILICMP<3HP: VENT FANS: CLOTHES DRYER: I
GAS FURN>•10014: I UNIT HEATERS. HOODS OTHER UNITS: 0
MAX INP'. btu FLOOR FURNANCES: VENTS: I WOOD:I OVES: GAS OUTL_TS: 1
ELECTRICAL —
RLnln'•' .IAL UNI' SERVICE FEEDER TEMP SRVC/F—DE.RS BRANCH CIRCUITS MISCELLANEOUS ADD'L IN3PEC110NS
1000 SF OR LESS: I 0 200 amp: 0 200 amp WISVC OR FOR: I UMPIIRRIGATION: PER INSPECTION:
EA ADD'L 800SF: 4 201 400 amp: 20' 400 amp: lot W/O SVCIFDR: 01, 31GNIOUT LIN LT: PER HOUR:
LIMITEU ENERGY: 405 •600 amp: 401 600 amu: EA ADDL UR CIN: SIGNAUPANEL: IN Pi ANT:
MANU HMISVCIFDR: 601 • 1000 amp: MINOR LABEL:
1000+ampivolt: PLAN REVIEW SECTION _
Reconnect only: 1•4 RE3 UNITS: 9VCIFDR>•226 A.: >600 V NOMINAL: CLS AREAISPr OCC.
ELECTRICAL•RESTRICTED ENERGY
B.COMMERCIAL
A.9F RESIDENTIAL _
w AU'JIO 6 STEREO: VACUUM SYSTE A: AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC Li:
1URGLAR ALARM: OTI4: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIONL:
GARAGE OPENER: CLOCK INSTRUMENTATION: MEDICAL- OTHR:
HVAC- OATA/TELE COMM. NURSE CALLS: TOTAL 8 SYSTEMS:
TOTAL FEES: $ 4,833.74
Owner: Contractor: Th'a permit Is subject to the regulations contained In the
DON MORISSETTE HOME) DON MORISSETTE HOMES regard Municipal Code,State of OR. Specialty Codes and
423U GALEWOOD ST.#100 4230 GALEWOOD STREET all other applicable laws. All work will be done in
LAKE OSWEGO,OR 97035 SUITE 1U0 accordance with approved plans. This permit will expire If
LAKE OSWEGO,OR 97035 work is not started within 180 days of Issuance,or if the
work is suspended for more than 180 days. ATTENTION:
Phune: Phona: Oregon law requires you to follow rules adopted by the
Oregon Utility Notif ration Center. Those rules are set
Reg N: LIC 35531 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 INSPcC1IONS
Errsion Col,rol Insp 8, Post/Beam Mechanics Mechanical Insp Shear Wall Insp Rain drain Insp Plumb Final
Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Inst Water Line Insp Final inspection
Footing Insp Crawl Draln/Backwater Electrical Service Low Vol l;.ge ApprlSdwlk Insp
Foundation Insp Fooling/FoundatlLn Or; Electrical Rough In gas Line t.1sp Flectrical Final
Post/Beam Structural PLMIUnderflonr Framing Insp Insulation Insp Mechanical Final —-
Issued By I` ' ; i' L l�- � Permittee Signature
Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day
CITY OF TIGARD
� _ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES
PERMIT#: SWR2002-00016
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/30/02
SITE ADDF.c:SS; 12199 SW HOLLOW LN PARCEL: 2S103CB-05500
SUBDIVISION: QUAIL HOLLOW- EAST ZONING: R-4.5
_ _BLOCK:_ LOT: 004 —__ _ JURISDICTION: TIG —
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK- NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new single family detached.
Owner: -- -- FEES _1
DON MORISSETTE HOMES Type By r,dte Amount Receipt
4230 GALEWOOD 5 1. #100 -- --
LAKE OSWEGO, GR 97035 FIRM T CTR 1/30/02 $2,300.00 27200200000
INSP CTR 1/30/02 $35.00 27200200000
Phone: 503-387-7538 Total $2,335.00
Contractor:
Phone.
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations 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
the accuracy of the side sewer laterals. If the sewer is not located ai 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" Perm
Issued by Permittee Signature:
Call (503)639-4175 by 7:00 P.M. for an inspection needed the next business day
i1 k ,
:
'lr"�&
Building Permit Application
City of TigardDate receive�101 ' �� Permit�no.l'/'',�!,/��.�, •. ,
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
—. `
Phone,: (503) 639-4171 Date issued: By: Receipt no
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: 1&2 family:Simple Complex: L/
t� t
❑ I &2 family dwelling or�cco,ory U Cornmerciai/industrial U Multi-family >CNew construction U Demolition
❑Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm ❑Other: ~`
Job address: la IeLq Bldg.no.: Suite no.:
Lot: [dock: Subdivision: �L
��t ,{� Tax map/trot lot/account no.: ^�
Project name: _
Description and Imation of work on premises/special conditions: — --
-
Mailing address J.V I&2 family dwelling:
City: L 77 jStalcl 7.IP: Valuation of work........................................ $_! 4/ 71
Phone: Fax: -"7 mail: No.of bedrooms/baths................................. �jj
Owner's representative: Total number of floors .......
Phone: Fax: F.-mail:
New dwelling area(aq. R.) ......... ..?..�....
0 Iwo Garagelcarport area(sq.ft.)......................... c� C
Name: ij Covered porch area(sq.ft.) ......................... _
Mailing address: ! Deck arca(sq.ft.)........................................ _ —
City: State: ZIP: Other stroctur. area(s< ft.).........................
Phone: Fax: I E-mail: CommereinUindmstrial/mulli-family:
Valuation of work........................................ $
Business name: Existing bldg.area(sq.ft.) .......................... _
Address: -Z — New bldg.area(sq.ft.)................................
' Number of stories
City: State: ZIP: .........
-- Type of construction...........I........................
Phone: Fax: E-mail: Occupancy group(s): Existing:
CCB no.: _
New:
City/metro tic.no.: - –
Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors 3oard under
Name 4 ` VAA provisions of ORS 701 and may be required to be licensed in the
Address: y-� �(, jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing,the following reason applies:
Contact person: _ Plan no.:
Phone: Fax: I E-mail: —
11"M-3 DI Ali
Name: _ Contact person: Fees due upon application ........................... $
Address: Date received:
City: State: ZIP: Amount received ......................................... $
Phone: Fax: I E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Not all jurisdictions accept credit cartls,please call juriadictlon for more Infommlon.
attached checklist. A rovisions of I ws and o dinances governing this 13 Visa ❑MasterCard
work will be compl wt , whether. cifi cls or n Credit cord number: _„
9 ��!lr F.sp:res
Authorized sl atu 1 ate: r j Name of car�lder as shown on credit cad
Print name: $
Cardholder sipature Amount
Notice:This permit application expires if a permit is not obtained within 190 days after it has been accepted as complete.. 4404613(60aCOM)
i
I
One-and l'wo-Family Dwelling
Building Permit Application CheekEst Referenceno.:
Ctrynj"lignnl Associated permits:
City of Tigard ❑Electrical ❑Plumbing ❑Mechanical
Address: 13125 SW hall Blvd,Tigard,OR 97223 ❑Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
t t t
1 Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot.
4 Fire district_ approval required.
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit. _
7 Water district approval.
8 Soils report.Must carry original applicable stamp and signature on file or with application. _
9 Erosion control ❑plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc. _
10 3 Complete sets of legible plans.Must be drawn to scale,showing confnmance to applicable local and state
building codes.lateral design details and connections must he incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist. K
I 1 Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);location of wells/septic sy.,tetm;utility locations;direction indicator,lot
arca;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location.
13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater.
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing such as flour beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show
details of all wall and roof Sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
Lre lace construction, thermal insulation,etc.
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevation-,with zross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to en ineerin standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation. _
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet lung and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design detalls.
21 Energy Code compliance. Identify the prescriptive path or provide calculations.A gas-piping schematic is required V
for four or more appliances. _
22 Engineer's calculations.When required or provided.(i.e.,shear wall,roof truss, ..all be stamped by an engineer or
architect licensed in Oregon and shall be shown to lw applicable to the project under review.
23 Five(5)site plans are required for Item I I abwive. Site plans must be 8-1/2" x I I"or I I" x 17
24 Two(2)sets each are required for Items 16, 19,20& 22 above.
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or mirrored building plans will be accepted.
27
18 _
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 4444614 AWCOM)
Mechanical Permit Application
Datemceived: Permit no.:
City of Tigard Project/appl.no.: Expire date:
Cir;ofTigord Address: 13125 SW Hall Blvd.Tigard,OR 97223
Fhone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no. Payment type:
Lancs use approval: _ _ _ Building permit no.:
TYPE OF PER141T
O 1 &2 family dwelling or accessory 0 Commercial/industrial U Multi-family U'tenant improvement
>(New construction U Addition/alteration/r--placement U Other:
Il SITE INFORNIATION1 1SCHEDULE
1 , Indicate equipment quantities to boxes below.Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$ _
Lot: J—j Block: Subdivision: 1 r 5 *See checklist for important application information and
Project name: iur7sdiction's fee schedule for re^idential permit .fee.
City/county: ZIP: - - - 111 ft ) x al t
Description and location of work on premises: F ) r x t t
—-- _ Frc(ra.l Tolal
Est.date of completion/inspection: — Dexri on Uty. Ites.only Rn,only
A
Tenant improvement or change of use: AC`
Is existing space heated or conditioned?0 Yes U No Air handling unit --CFM--
Air conditioning tatte`plan-regwre�7j
Is existing space insulated?U Yes U Noluxation o e,usti g HVAC system
Boiler/co pressors
Business name: State boi!er permit no.:
HP Tons BTU/H
Address: ire/slno c dampers/duct_smoke detectors
City: State T_IP: eat ump(siteTrequir )
Phone: Fail: Email: nsm rep a:e mac urner__
---- Including ductwork/vent liner U Yes 0 No
CCB no.: _ Instal rep ace/re ocat heaters-.,-spen e , _
City/metro tic. no.: NIA wall,or floor mounted
Name(please print): Ventfora lianceu cr than furnace
Refrigeration:
Absorption units _ BTU/Il
Name: E91— ,�rl, , Chillers HP
Address: , fr Cl I Compressors HP
onenta a must an rent on:
at
City: State: ZIP: APPlia,tcevent
Phone: Fax F-mail: erex aust
oods.Type res,kitche 7Fazmat
hood fire suppression system
Nance. (jam t ' Exhaust fan with single duct(bath fans)
Mailing address: ' aust system apart fromeaun or
City: State ZIP ) Fuelpiping anddistribution(up to out els)
_--- Type: LPG NO oil
Phare: 7 Fay E-mail: Fuelpipin each additionalover4outets
Process piping(schematic required)
Name Number of outlets
_ ,rerll'— appliance or equipment:
Address: Decorative fireplace
State: ZIP: Insert-type
a - stove/pe et stove
Phone: fax: •mail
her.
—
AppllcantO's sfRnatu' Date: ter.
Name(print): ' • 1" _
Na VI jurlsdlctlons aceep audit cards,pknse c Junsdxuon for rnae iNormwan Permit fru.....................S
Notice:This permit application Minimum fee................$
U Visa U MasterCard expires it a permit is not obtained
Cmdir card number within 18(1 days after it has been Plan review(at _ 016) $
t+ State surcharge(8%) ....$
Nam of cudhorder as shown on cadit card — s accepted as complete.
Cardholder siplarum Amount 4/64611(6gM-'oM)
Plumbing Permit Application
_—� Date recurved: Permit no.:
City of Tigard Sewer permit no.: Building permit no..
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Pro)ecdappl.no.: Expimdate:
CiryojTigt:re Phone: (503) 639-4171 --
Fax. (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case Cele no.. Payment type:
—
11 7=1717M -
=&2 dwelling or accessory O Commercial/industrial O Multi-family O Tenant improvement
ction ❑Addition/alterarion/replacernent Cl Food service C1 Ocher
111tikill Valet 111INUFAIM 31 711
Description 10ty. Fee(-.) I Total
Job address: I,- t�ICy t� New 1-and 2-family dwellingsonly:
Bldg. no.: Suite no.: (includes loo ft.for each utility connection)
'T'ax map/tax lot/account no.: SFR(1)bath
UL Block: Subdivision ( t SFR(2)bath
Project name: (.� SFR(3)bath _
City/county: ZIP: Eat n"rldiuonal ba schen
Description and location of work on premises: SiteutWties:
Catch basin/area drain
Urywelis/leach line/t, rich drain
Est date of completion/inspection: Footing drain(no.lin. ft.)
Manufactured home uti!lties
Business name: L Manholes
connector
Address: � ata drain
Sanitary sewer(no.lin. ft.)
City: � 5tate• "LIP: �' —
E-mail: Storm sewer(no.lin.ft)
Phone: I �" Fax: Water service(no.lin.ft.)
CCB no: Plumb.bus.reg, no: Fixture or item:
City/metro lic. no.: NIA Absorption valve
Contractor's representative signature , Bak
Print name: I U e-/ I Backwater valve
Basins/lavatory _
Clothes',flasher
Dishwasher
Address: ( �� Dnnkine fountain(s)
City! State: ZIP: E)ectorsisump
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap
Floor drains/floor stnks/hub
Name(print): L_ Garhage disposal
Mailing address: , Hose bIbh _
City,. 125tate ZIP:C Ice ma4:cr
Phone: - Far: 7-7H E-mail: Interceptor/grease trap
Owner insro/!adonlresldenda/maintenance only: The actual installation Pnmensi
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on the propem 1 own as per ORS Chapter 447. Sink(s), baslmsl,lays(s)
Sump
Owner's signature: _ Date:
TUtlS'ShOWC[/5hgwef pan
Unnal —
Name: _ ____
Water closet
Address: Water heater
City -- State: ZIP: Usher.
Phone. Fax: E-mail: Total
Nlinimurn fee... ............$ _
Nc all lun"cuom=cep credit cards.Aleve call luny bcuon fat mwe mfomunon Notice. Tills pernia application Plan review(at __ %)
O Visa O MulerCardexpires if a permit is not obtained State surcharge(8g6)
--
within 180 da%s af)er it has been
' ' ....S
Credit exd number -
accepted as complete TOTAL .... .................$ ---
Name u(cxd)wl,kr u rhown wt cram:ant s
A.lt)_a616 160WOMl
Amount
L"ardhnldet tttnJtute_^__ - ._-
Electrical Permit Application Permit no.:
Date received:
Project/appt.no.; Expire date:
City of Tigard _ 13y. Recnpt no :
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued:
City ojTigard Phone: (503) 639-4171 Case file no.: Payment tyl>r:
Fax: (503) 598-1960
Land use approval: - --
NINE"IbIllwDjull 11
O Multi-family O Tenant improvement
74ew
amily dwelling or accessory O Commercial/industrial U Partial
nstruction O Addition/alt.eration/replacemr-it U Other.
pld no.: Suite no.: Tax map/tax lot/account n :
Job address: c v �- t g — —
IE
Lot: [ Block: Subdivision: '1.1, l
Project name: Description and location of work on premises: __— ---- ---
Estimated date of completiom'inspection: t
Fee hex
Job no: _ Description Qty. (ea.) Total no.lnsp
Business name: � 1 -- New residential-s6,Skorm'skifamilyPer
Address: dwettingwdt.Includes attached gat-+ge•
State: ZIP: Serviceincluded: 4
City: 1000 sq.h.or le
Phone- 1j I/ FE-mail: ss
Fax: Each additionai 500 sq.ft or portion thereof
_ 2
CCB no. Elec.bus.lic. no:a Umitedenergy,residen�lal 2 -
Urnited energy,non-residential
C' f�`� �y-7� F.uh manufactured home or modular dwelling
-- - --- Djter�,� Service and/or fader 2
atureofsu ervain electrician(re mired) „ 01 Services or feedefs-bsstallation,
` T_ :.we,tse alteration or relocation:
Sup elect name(print) no era
2
200 amps or less 2
r- 201 amps to 400 amps 2
Name (print).
�4- t- 2 401 Amps to 600 amps 2
Mailing address: 601 amps to loon Amps 2
Slate ZIP: over 1000 amps or volts I
City: . , Reconnectonly
Phone:• - Fir: -� -mail:
Temponry xrva:es or feeder-
Owner installation:The installation is being made on property I own kwullation alteration,orreloadion: 2
which is not intended for sale, lease,rent,or exchange according to 2o0imp.corless 2
ORS 447,455,479,670,701. 201 amps to 400 amps - —Z
Date- 401 to 600 ams -
Owner'i sl nature: O!r7chcircuits•Bew,alteration,
or e"tension per panel:
A. Fee for branch circuits with purchase of 2
Name' _--- urvice or'ceder fee,each branch circuit —
Address: B Fee for branch circuits without purchase 2
— State: ZIP: of service or feeder fa,first branch circuit:
Ci :
--ty --'�
Phone: E-mail: Each additional branch circuit: ---
Fax:
� Mise.(Berries or feeder not inclulied): 2
Each ump or itri anon circle 2
U Service over 225 amps cnnunerr,al ❑Health-care Fach sign or outline lighting
O Service over 320 amps-rating of 1 de2 O Hazardous location B
Si nal circuits)or a limited energy panel. 2
family dwellings 0Buildingover10.000squarefeetfourat
alteration,or extension,
O System ever 600 vola rrominal more residential units in one structure �--
O Feeders.400 amps or more •Descri tion, ._
O Building over three stories Fach additional iection over the allocable In any of the above:
O occupant load over 99 persons U Manufactured structures or RV park nsp
O oder _ Per inspecuon �—
O Egrrss/IiRhtingplan lnvesugationta
Submit_sets of Plass with any of The above.
The above sire ool applicable to temporary comstructlost�e�wice. other
Permit fee..........-......•..S
11
Na all jurisdictions scop credit cards,please tilt jurisdknon for more information Notice:This permit is Plan review(at _. %) S
expires if a permit is not obtained
O Visa U MasterCard within 180 days atter it has been State surcharge(8r�) ••••S .-------"
Credit card number -- piles— TOTA�� ..•.•.•• s
accepted u complete.
Name---------------
tit cardhol r u shows on c 't caid— $
440.4615(&OCKOM)
Cvdholder signature Amount
DON - MORISSETTE
g ) H = I N C 0 9 P 0 2 A T % D
4 830 a A L 2 V 0 0 D 0T. 9 U I T 2 100
t6 0 3) d 0 7e 7 6 6 6' r i I6 (6 0 S)8 6 7 - 7 6 1 6
OSE : 1957
STANDARD ELEVATION 'r•-� �) /� LOT: 4
�p �1 DATE. 1/23/02
PROPERTY: QUAIL—HOLLOW
CITY: TIGARD
SCALE: 1"=20'
PLAN No.: 132
2M 28e
gm 500 :ae,
s
286
19age y �
r - -
04
i W _
LU
92 P44*nUj
B6 c
e. 2,133 eq. ft.
3 hdrm.
3 bath
39' 3'h F.FE. 293'
s8s eq. ft.
2 car gar.
FF E. 292'
5'.00 23< 2'�
s'PUB.- - �� op� I I 0
291
I
�apraach 81d�w 289 T
50.00•_ f
121HOLLOW
LOT • 4
50" eq. ft.
CITY OF
TIGARD ,_ __PLUMBING PERMIT
PERMIT #: PLM2002-00105
DEVELOPMENT SERVICES DATF ISSUED: 3/29102
13125 SW Hall Elvd., Tigard, OR 972.23 (503) 639-4171 PARCEL: 2S103CB-05500
SITE. 60DRESS: 121434) SVvI HOLLOW LN ZONING: R-4.5
SUBDIVISION: CJUAII_ HOLLOW - EAST JURISDIC i ION: TIG
BLOCK: LOT: 004 --
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME ' PACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
R DRAINS: TRAPS:
FLOOR OCCUPANCY GRP: R3
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URIVALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES-
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE. ft
DISHWASHERS: RAIN DRAIN. ft
Remarks: Installation of backflow preventer. FEES
Owner:
Owner: Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT :,TR 3/29/02 $36.25 27200200000
4230 GALEWOOD ST. #100 5PCT CTR 3/29/02 $2.90 27200200000
LAKE OSWEGO, OR 97035 Total $39.15
Phone 1: 503-387-7538
Contractor: __
PROGRASS LANDSCAPE SERV,CES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: 682-6076 Final Inspection
Reg#: LIC 6136
PLM 11558
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordanoe 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
hrequires
0AR 952-0001-0010 thaough OAR 952Oregon
-0001-008C.
Notification Center. Those rules are set fort
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
� a- 1
Issued By: ���C't.� '" " Permittee Signature: r ) 12
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
s
�^ PlumbingPcrinit Application
Date received: l Permit no.:I i,
Cagy of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Til,:ud.OP 9-1223
lIn :id , Project/appl.no.: Expire data: —
Phone: (503) 639-4171
Fax: (503) 598-1960 �,,: Date issued: By: .V') Recelptno.:
Land use approval: !_ Case file no.: Payment typo:
7�*New'constru
family dwelling or accessary 4-%CQkial/industtial ❑Multi-family U Tenant improvement
ct;,m Addition/alteration/replacement ❑Food service ❑Other:
T ATION FFIE SCIIEDVLE
Des(ri tion I Qty. Fee(ea.) I Total
/ l / )//C� L��
Job address:-1�.� �J'/ �-/.. L L�n�— New 1-And 2-family dwellings only:
Bldg.no.. I Suite no.: (Includes 100 ft.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: �nani
Subdivis' lif dl� SFR(2)bath
Project��j/(tt D SFR(3)bath _
City/county:n q 044 L&AV-, I Z1P.r7jJLEach additional bath/kitchen
Desc tion and,location,of work on premises: SiteutWtles:
ACk fi cnU to, _ Catch basin/arna drain
FDrywellsAeachTine7trench drain
Est.date of completion/inspection: t ?,i_) 1 Footing drain(no.lin.ft.)
111,11 INIBING r
CONTRACTOR Manufactured home utilities
Business name: ProLrAS S [-szl)' SC Man oles _
W Address:a-9 Pq S- S t-v Rain drain connector _
City: 1J;�nIU G Stateb ZIP: `70 b Sanitary sewer(no. tin.ft.) —
D Storm sewer(no.lin.ft.)
_r
Phone: 107 ail Pax: & -9�7 E-mail:
Water service(no.lin.ft.)
CCB no.: (013(.1 j Plumb.bus.reg.no: Fixture or Item:
City/metro lic.no.: 103 '7 Absorption valve
Contractor's representative si6•tature: le-t t_1 Back flowreventer 7 S
Print nturre: S FW'Yz? a Date �U ! �� Backwater valve
Basins/lavatory
Clothes washer
Name: k11Y�A�I. _ _-. tshwasher _
Address:.;L-,l ?q S +Wt —- Drinking fountaitt(s)
City: 1 S1TnW G State:off,, ZIP: U F.'ectors/sum
Phone:(p&a-0017fo Fax:(eta—9V7 E-mail: Ex an,tca tank
Fixturelsewer cap
�C�1� ^*� Floor dmins/floor sinks/hub
tNameprint): Garbe a disposal
g address: Z,3U ,beau rx -1 S7- U Hose bibb
ate n State: J2 ZIR cemaker
Fax: E-mail: Interceptor/grease trap
Owner instailation/resident.al 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 property I own as per ORS Chapter 447. Si (s), asin(s),lays(s)
Owner's signature: _ Date: Sum
TubVshower/shower pan
Urinal
Name: _ __ _ _ Ater closet
Address: _ EE
ater heater
City: tate: ZIP: — Other:
Phone: Fax: E-mail: ora
Minimum fee................$
Not all Jarisdicdoas accept credit cods.please call Jurisdiction for more informadoo. Notice:This permit application Plin review(at _ %n) $
7 Visa O MasterCard expires if a permit is not obtained State surcharge(806) ....$ 70
credit cvd number: __ --- -- i1— within 180 days after it has been
p TOTAL .............. ........$ _ -
accepted as complete.
Nun,or cardholder u shown on credit cud $
Cardholder denature Amount 1404616(bR)OICOMt
PLUMBING PERMIT FEES:
V& 4. luj Af
NO
FIXI 16.60
Sink 16.60 $249.20
-LTV;;i:orY - One 1)bath
16.60 TnAabath $350.00
rub or Tub/Shower Comb. ---Tg_60 Three(3)both 5399.00
!!Shower Only
Water Closet 16.60 SUBTOTAL `':.;''';',•
16.60 8%STATE SURCHARGE �'j
Urinal 16.60 _VLA REVIEWTo SUBTOTAL
Dishwasher To L
Garbage-Disposal 16.60
Laundry Troy 116.60
Washing Machine 116,60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60
Gas piping requires a separate mechanical
orrnit. Sink -
MFG Home No. water Service 46.40 Lavatory
MFG Home New San/Storm Sewer 46.40
Tub or Tub/Shower
----------
Hose Bibs 18.60 CombInatlor,
i
Roof DrainsShow
- 1660 Shower
16.60 Water Closet
Drinking Fountain Urinal
Other Fixtures(Spam 16.60 -Dishwasher
Garbage Disposal
-
LaundthRoom Troy
Washing Machine
Floor Drain/Sink: Z-
-Te-w 55.00 3"
Sewer
100' 4"
Se er-each additional 100, 46.40
55.00 Water Heater
Water Service-1st 100' Other Fixtures
Water Service-each additional 200' - 46.40 S ect
Storm&Rain Drain-list 100' 55.00
Storm&main Drain-each additional 1100' 48,40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevsntlon Device' 27.55
---------------
Catch Basin 16.60
Inspection or Existing Plumbing or Specially 72.50
Re ussted Ins actions -parthr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
GreaseTraps16.60
QUANTITY TOTAL
Isometric or riser diagram is re julred if
QuanMy Total Is >9
'SUBTOTAL
V%-STATE SUR,-_,HARGC,
-**PLAN REVIEW 25%OF SUBTOTAL
Re�ulred fixturIgatotal 16>9
TOTAL $
.Minimum permit fee Is S72,50+8%state surcharge,except Residential Bsckffow
Prevention Device,which is$38 25+a%state surcharge
"All Now Commstclsl Buildings require plans with isomeric or riser diagram and
plan review
i:\dsts\forrns\p1rn-fee,;.doc 10/10/00
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crry OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST �- oyut�
INSPECTION DIVISION Business Line: (503)639-4171
BUP - - -
Received Date Requested___-, -- AM_— PM __ BUP _—
Location _—___� r --� - �� Suite-- MEC
Contact Person Ph( ) L=1 PLM —
('oPh(—) SWR
BUILDIN J TenanYOwner -._ _ ___ ELC _—
o ing - - ELC —
Foun ARMn Access:
Fig Drain ELR -
Crawl Draln SIT
Slab Inspection Notes:
Post&Beam
Shear Anchors
Ext Shoath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling — -
Roof i Zeez
d --
rn�l - - -
ASS PART_FAIL
os Beam
Under Slab -_ - ---- - - - _
Rough-in
Water Service -- - -- --
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain — -
Shower Pan
Other:
Final! _
FAIL -
MECHANICAL '
Rough-In -
Gas Line
Smoke Dampers
in
RT FAIL
LECTRIC .
Rough-In - - - - - -
UG/Slab
Low Voltage -- -- -- ---- - —
Fire Alarm
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 S%14 Hall Blvd.
ART FAIL
- - 1 Unable to inspect--no access
LJ Please cell for re spectf n RE:_— -
Fire Supply Line �_ / ���.�
ADA
Date / Inspector Ext
Approach/Sidewalk -
Other:_
Final DO NOT REMOVE this Inspection record from the Job site.
FABS PARK FAIL