12272 SW HOLLOW LANE �4
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12272 SW Hollow Lane
CITYOF T'GARD __MASTER PERMIT
PERMIT#: MST2002.00363
DEVELOPMENT SERVICES GATE ISSUED: 8/22/02
1312: SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12272 SW HOLLOW LN PARC•I:L: 2S103CB-07700
SURD!.'.3i0N: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 026 IURISDICTION: TIG
RFMARKS: New S/F detached, Path 1.
BUILDING
REISSUE: �^ STORIES: 2 FLOOR AREAS REQ_IIIRED SF.TRACKS RcQUIRED
CLASS OF WORK: NEW H_IGHT: 24 FIRST: 1.565 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1(315 of GARAGE: 405 at FRONT: 20 PARKING SPACES: 2
TYP_OF CONST: 5N DWELLING UNITS: I FINBSMENT: at RIGHT: 5
OCCUPANCY GRP: R3 BORM: 4 BATH: 1 TOTAL: 3,19009 of VALUE: $306,971.30 BEAR: i5
PLUMBING
,INKS: 1 WATER CLOSETS' 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: i70 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES. 100 SF RAIN DRAIN;: 1 CATCH BASINS:
TUB/SHOWERS. 3 GARBAGE DISK 1 WATER HEATERS: I WATER LINES: 100 t1CKFLW PREVNIP. 1 GREASE TRAPS:
OTHER FIATURES:
_ MECHANICAL
FUEL TYPES FURY<TOOK: BOILICMP<31,113: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN>0132K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURKANCES: VENTS: I WOODSTOVES GAS OUTLETS: I
ELECTRI^AL _
RES;:,Ei,rIAL UNIT SERVICE rCEDER TEMP SRVCI EEDERS BRANCH CIRCUITS MISCELLA„ LOU9 ADD'I.INSPIXTIONS
1000 SF ON LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PIIMPP.•n:^n TION PER INSPECTION:
EA ADD'L 500SF: 6 201 400 amp: 201 400 amp: tat WIO SVCIFDR: OC SIGNIOU i LIN LT: PER HOUR:
LIMITED ENERGY: 401 •600 amp: D1 - 600 amp: EA ADDL OR CIR: SIGNAL/PANEL: IN PLANT:
MANII HMISVCIFDR: 601 - 1000 amp: 61 t+om-9•1000v: MINOR LABEL.
1000♦a,.IplVolt:
PLAN REVIEW SECTION
Reconnect only: -
> o RES UNITS: SVCIFDR>•225 A.: >600 V NOVINAL• CLS AREAISPC OCC.
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENT IAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUT DOOR LNDSC L1:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG. PROTECTIVE SI GNI..
GARAGE OPENER: CLOCK: INSTRUMENTATION MEDICAL: OTHR
HVAC: DATAITELE COMM: NURSF CALLS TOTAI a SYSTEMS
Owner. Contractor: TO”AL FEES: $ 5,538.34
DON MORISSETTE HOMES DON MORISSETTE HOMES This permit Is subject to the regulations contained in the
4230 GALE WOOD ST#100 4230 GALE WOOD STREET Tigard Municipal Code,State of JR. Specialty Codes and
all other applicable laws. All work will be done in
LAKE OSWEGO,OR 97035 SUITE 10U accordance with approved plans. This permit will expired
LAKE OSWEGO,OR 97035 work Is not started within 180 days of issuance,or If the
work is suspended for more thar,180 days. ATTENTION:
Phone: Phone: Oregon law requires ycu t0 followrules adopted by the
Oregon Utility Notification Center. Those rules are set
Ree O: LIC 35533 forth In OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Framing Insp Gas Fireplace Electrical Final
Sewer Inspection Uri erfloor Insulation Plumb Top Out Shear Wall Insp Insulation Insp Mechanical Final
Footing Insp Crawl Drain/Backwater Electrical Service Exterior Shewhing Ins; Rain drain Ir,up Plumb Final
Foundation Insp Footing/Foundation Dr; Electrical Rough In Low Voltage Wa'ar Line Insp Final inspection
Post/Be�m,,WLTd ural PLM/Underfloor Framing Insp Gas Line Insp Appr/Sdwlk Insp
-f -
Issu By: Permittee Signature : _IL _
Call (503) 639-4175 by 7:00 p.rr. for an inspection needed the next business day
CITYOF TIGAR® _SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00240
--- 13125 5W Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/22/02
SITE ADDRESS; 1227.' SW HOLLOW LN PARCEL: 2S103C13-07700
SUBDIVISiOt1: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 026 .JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
C!-ASS OF WORK: NEW DWELLING, UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new S/F
Owner: -----
__ FEES
__
DON MORISSETTE HOMFS Type By Date Amount Receipt
"
4230 GALEWOOD ST#100
LAKE OSWEGO, 01 97035 PRMT CTR 8/22102 $2,300.00 27200200000
INSP CTR 8/22/02 $35.00 27200200000
Phone: 503-387-7538 _ Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
I
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 at the measurement given,the installer
shall prospect 3 feet in all directions from the distance qiven. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a laierei. 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 though OAR 952-001-0080.
You maYbbtain copies of these rules or direct questions to OUNC by calling(503) 246-1987.
/ �>
Issuied by: � Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business clay
Building Permit Application
City of Tigard
Date received: Permit no.:t kg?;r
---
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
City of Tigard Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment typ l
Land use approval' 1&2 family:Simple Complex:
U I &2 family dwelling or accessory U Commercial/industnal U Multi-family > New construction U Demolition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other.
1011
!ob address: ) V {� Bldg.no.: Suite no.:
Lot: Block !-: Subdi_visio_n; �� Z.t i Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
Name. Y�e f .�. it,
Mailing address: LL' I & 2 family dwelling:
City: 9 7/
_ Stated ZIP: ! Valuation of work........................................ a 3
Phone: Fax: i -mail: No.of bedroorns/baths.................................
Owner's representative: _
P _ ti i V I Total number of floors................................. i`
Phone: Fax: E-mail: New dwelling area(sq. ft.
Garage/carport area(sq.ft. J _
Name: Y 1 Covered porch area(sq. ft.) .........................
Mailing address: 4, Cj,• Deck area(sq.ft.) .......................................
City: St:re: ZIP: Other structure area(sq.ft.)......................... _
commerclal/induatriaUmultl-famil
Phrmr E-mail: y'
t Valuation of work........................................
Business name: t Existing bldg.area(sq.ft.) .......... ...........
Address: New bldg.area(sq. ft.)....................... .....
Z �" Number of stories . .
City: State: ZIP: .. ............... ...
Phone: Fax: E-mail:
Type of construction................. .......
Occupancy group(s): Existing:
CCB no.:
,7�- — New:
Cil,hnevr,tic.no.: Notice:All contractors and suhcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: Y� provisions of ORS 701 and may be required to be licensed in the
Address: �� jurisdiction where work is being performed.If the applicant is
Cit Static: ZIP: exempt from licensing,the following reason applies:
Contact person: Plan no.:
Phone: I:tr: E-mail; — - -
Name: _ Contact person: Fees due upon application ........................... $ _
.Address: Date received:
City: -- -- State: ZIP: Amount received ......................................... S
Ph•ine: _ Fax: E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Na all iurisdictioru wcept credit cards,please call Jurisdictim frw mane infornution
attached checklist.A rovisions of I ws and off��dinances governing Utis U Visa U MasterCard
work will be comp) wl ,-Hhether cified NereA �t.L•t Credit card number
t
'1✓
Authorized SI natu �� r (� .1.�: (, Name of cardholder as shown on credit card Expires
Print name: T Z�Xti-r I t -Lcardbolder sig uium _ —-- Amount
Notice:This permit application expires if a permit is not obtained within 190 days after it has been accepted as complete. 44>-MI3(&Mcom)
One-and Two-Family Dwelling
Building Permit Application Checklist Re�trenceno.:
Cityof7i8ard
Associated permits:
ty an
Ciof Ti d
`J g O Electrical Q Plumbing O Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 O Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
1 Lnnd use actions completed.See jurisdiction critetia for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved platilot. _
4 Fire district _approval required.
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit. _
7 Water district approval. _
8 SOIL4 report.Must carry original applicable stamp and signature on File or with application. _
9 Erosion control ❑plan O 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 conformance 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 tJ
if copyright violations exist. J� _
1 I Site/plot plan drawn to scale.The plan muni show lot and building setback dimensions;property comer elevations(if
there is more than a 44 elevation differential,plat►must show contour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);location of well.i/sepbe systems;utility locadons;direction indicator,lot
area;building coverage area;percentage of cov,:i age;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 sire,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 floor 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, Y
fireplace 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 elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and loca!ions;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
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 long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or provided,(i.e..shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to he applicable to the project under review.
23 Five(5)site pians are required for Item i I above. Site pians 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
28
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. 440-4614(60M/COM1
IF
Mechanical Permit Application
— Date received: Permit no.:
Project/appl.no.: Expire date:
City of Tigard _
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: --
City of Tigard phone: (503) 639-4171Case file no..
Payment type:
Fax: (503) 598-1960 Building permit no.:
Land use approval: —-----
INEW'"jTJ At e
U Multi-family U Tenant improvement
l� Cl Commermal/industnal _ -
(] l &2 family dwelling or accessory 0 Additiun/alteration/replacement U Other:
ANew constructions a°t
t t 70 Mimi
`r Indicate equipment quantities in boxes below. lndtcale the d° .
ar
Joo address: ,� value of all mechanical materials,equipment,labor,overhead,
Bldg.no.: Suite no.: — profit.Value$
Cax map/tax lot/account no.: *See checklist for important application information and
Lor y Block: Subdivision: jurisdiction's fee schedule for residential permit fee.
al t
Project name: t
ZIP:
City/county: t
Description and location of work on premises:,----— Fee(7'
Totat
Description Qty. Rtes.otdy Ree.only
Est.date of completion/inspection: — clot —
Tenant improvement or change of use: Air handling unit _
Is existing space heated or conditioned?O Yes U No condiuoning(site antequtred)
(fetation v existing A system
Is existing space insulated U Yes NO otter compressors
State boiler permit no.: BTUM
t �. _ HP Tons
Business name: irdsmo e amperI/ductsmoke detectors
Address: eat pump(site p an requir
ZIP: T
City: U
State: nsta rep acefumac urner
Phone: Fax: E-mail-_. Including ductwork/vent liner (7 Ye-O No
nsta repJac dte ocateheaters-suspen ed,
CCB no.: C wall,or floor mounted
City/metro tic. no.: NIA s ent or app isnce other than furnace
Name(please print): IN e geration: BTUlH
Absorption units__- HP
Chillers._._.---
Name: `�-� Com ressors -- F1P
onmental c ust an renttlatiun:
Address:
State ZIP: Appliance vent —
City: _ ryer exhaust
Phon• Fax: E-mail: s ype I/res.k)tche azmat
hood fire suppression system
Exhaust fan with single duct(bath fans)
Name: v 1 haus►system apart tom heaun or Al.
�/L �tic n an distr tit on(up to out ets)
Mailing address:! ) ZIP �- p P B—LPG NG Oil
State - Ty
City: e t to eac additiona over vut ets
Phone: - Fac: E-mail'
rocess p p ng(schematic required)
Number of outlets
t er st app ante or equ ptnent:
Name: — Decorative fireplace
Address: _ nsert-type '—
y: _ State: ZIP: stovelpe et stove
Cit
F •mail: er:
Phone:
ate: ter.
Applicant's slgnaru' (. '
[l
Permit fee........ ............$credit cutis,Please tilt jurisdiction ra mtxe m/attnttlon
Notice:This permit application Minimum fe.:................$ -------
Na ill jurisdicuutu accep expires if a permit is not obtained Plan review(at -- `8') S
❑Visa O MasietCanf
�— within 180 days after it has been State surcharge.(8°b) ••••S _-----
Credit can!number Y�, — -- Expues
accepted as complet:. TOTAL .......................$ -------
Ntttne of cudhulder u shows on cRdit card ; 1aa617(6MCOM)
Amount. sipature
,
Plumbing Permit Application
'— - Date received: Permitna.. Ir,-:;, -
City of Tigard Sewer permitno.: Building permit no..-
Address: 13125 SW Hall Blvd,'l'lgard, 0P 97-21f'roiecdappl.no.: Expire date: �-
City ojTigard Phone: (503) 639-4171
Fax: (503) 598-1960 Datu issued. By: Receiptno.:
Land use approval: Case file no.: Payment type:
t
O I &2 family dwelling or accessory O Commercial/industrial O Nlulti-family ❑Tenant improvement
Jew construction ❑Addition/alteration/mplacement ❑Food service Cl Othur:
t . s' t . s a al
Job address: U W Description Qty. Fee(ea.) Total
New 1-and 2-family dwellings only:
Bldg,no.: Suite no.: (Includes 10011.for each utility connection)
Tax map/tau lot/account no.: SFR(1)bath
Lot Block: Subdivision: t SFR(2)hath
Project name: SFR(3)bath
City/county: ZIP: Each additional bad&tchen
Description and location of work on premises: Siteutilities:
Catch basin/area drain
ESL date of completion/inspecbon: Drywells/leach line/trench drain
Footing drain(no.lin. ft.)
Manufactured home utilities
Business name• Lihl(_.-7 Manholes
Address- __ Rain drain connector _-
State ZIP: I Sanitary sewer(no.lin. ft.)
City: —
Phone:L_�,-,5l.- Fax: E-mail: Storm sewer(no.lin.ft.)_ Water service(no. lin.ft.)
CCB no.: Z L Plumb.bus. reg. no: - Fixture or Item:
City/metro lic. no.. N AAbsorption valve
Contractor's representative signature�. ' �- Back flow preventer
Print name: Qt U Backwater valve
Basins/layatcr+ __ _
•• Clothes washer
Name: `' I N� Dishwasher
Address: G 1 : E , Dnnktng fountain(s)
City: State: ZIP' Ejectors/sum
Phone: Fax; E-mail: Expansion tank
Flxture/sewer C1p
Floor drat n_SJtluor sinks/hub
Name (print): -�, LS Garbage disposal
Mailing address Hose bibb
StateZIP:C Ice maker
Phone: - Fax: 7-7kiC E-mail: Interceptor/grease trap
(Owner installationireridendal maintenance on1r: The actual installation Pnmens)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the propetty I own as per ORS Chapter 447. Sinktsl,basimsi. lays(s)
Owner's si nature: Date: `pump
Tubs/shower/shower pan _
Unnal -
Name: _ _ Water closet _
Address: v �N ater heater-
City: State. ZIP: Other
Phone: Fax. E-mail Total
Nlininmurn fee _.............$ _-----
Na all Iunuboieru accept credit cardr,plesu can Nnuficum ra more mformaum Notice:This permit applicaucn
Plan review(at — %) S --.--
O visa ❑hfumerCmd expires if a permit is not obtained State surcharge (8`.'0) ....$
Credit card number pu� within Igo da%s after it has been TOTAL
accepted as complete.
N.*u!carahuldei a iho+n�m crt1Ll c�n1 s
Cardholder utnarure Amownl yapJ61616ApCON1
Electrical Permit Application
Date received: I ermitno.: `
City of Tigard Ploject/appl.no.: !� Expire date:
City of Tigard A dress: 13125 SW Fiall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639-4171
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval:
=�CeNewconstruction
elling or accessory ❑Commercial/industrial ❑Multi Punily 0 Tenant imprc vement
O Addition/alteratlon/repliccment ❑Other. Ll Partial
JOB SM INFORMATION
Job address: V I l,Y \ • Bldg.no.: Suite no.: Tax map/tax lot/account no.:
Lot: a Block: Subdivision: L' 'tit 1N tJ
Project name: I Description and location of work on premises: u_
Estimated date of completion/inspection:
FEE SCHEDULE
Fee Max
Job no:
i)rscription (ea.) Total �,to.bs
Business name: L Vj,L ii New�dr,�.,�ormulti family per
Address: Y dwelling unit.Includes attached grrage-
City: State: I.IP: ser.tce"rcluded
1000 sq.ft.or less __ 4
Phone: 1j i Fax: E mall: iiach additional 500 sq.ft.or portion thereof
CCB no.: _ Elec. bus. lic. no: Unted energy,residential 1 2
C: Urnited energy,non•ntsidential 2
'� -= Each manufactured home or modular dwelling
1 4i attire-,irupervnarn etrdrlefan(required)
Date I-- Service and/or feeder 2
License no a ^� Services or feeders-installation,
Sup elect name i prints 1 I alteration ormlocatiotc
200 amps or less 2
201 amps to 400 amps 2
Name (print) ` r 401 amps to 600 amps 2
Mailing address:,o 601 amps to 1000 amps_ 2
City: s State ZIP: Over 1000 amps or volts _ 2
s I
Phone: - Fay. .-mall: Raonnectanl
Owner installation:"The installation is being made on property I own Temporary serHcesorfeeders;-
which is not intended for sale, lease. rent,or exchange according to installation.alteration,or relocation:200 amps or less 2
ORS 447,455,479,670,701. 201 amps to 400 amps 2
Otkner's signature: Date: 401 to 6t)n ams 2
NMI Branch circuits-new,alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit ?_
City: _ State: ZIP: B Fee for branch circuits without purchase
2
_ of service or feeder fee,first branch circuit:
rlrtrnr.f!- —
Fax: F mall' Fa chaddiuonalbranch circuit
Misc.(Service or feeder not included):
Ea.h pump or irrigation circle —
U Serviceo�vrr 2:'amps etnr•rnercial U Health cucfacihty _ `
❑Service ovri 120 amps-rating of M2 U HaZXjoUa lnCAUon Fach sign or outline lighting --
fanulydwellmgs ❑ Building over 10,1100 square feet four or Signal circuit(s)or a limited energy panel,
T1 1 2
U System over 600,olts notrunal mom residential units in one structure alteration,or extension' _-
❑Building over three stories U Feeder,400 amps or more 'Descri don.
❑Occupant load over 99 persons ❑Manufactured structures or RV pate Each additional Inspection oyer the allocable in any of the above:
❑EgressAightirg plan U Other _ Per inspecuon
Submit_sets of plates with any or the above. Investigation fee -
7he above are not applicable to temporary construction service. Other
Not all junsdictions taps credit cards,please tall jurisdicuoo for more inforrnauon Notice:This permit application Perntit fee.......... ..........
S _
0% sa O MasterCard expires if a permit is not e6tained Plan review(at -__- r!6) S
�L_; within 190 days after it has been State surcharge(896) ..••S
Credit card number - Expires accepted as complete.
TOTAL .......................$
Name of cardholder as sbown on credit cart! s
Cardholder ti-inature Amount 440 4615(60dCOM)
DON • MORISSETTE
H O M 9 3
4 Y 5 0 G % LBW 0 0 D STRBRT SUITS 1 0 0
1, AKR 03A9G0. OREGON 9705
(509) 367 - 7L36 PAX (500) 367 - 7615 OBE : 1979
LOT:: 26
OPTION 1 ELEVATION DATE: N/1/02
PROPERTY: QUAIL-HOLLOW
CITY: TIGARD
SCALE: 1"=20'
122-72 S.UJ I
ala
3,
OAK TREE,
u HERE C
_'0.0. ®,0®� 61
Sldewd(k Approach'.
30 -
1 30
0 -
& WIDE
Driveway -p�E
3 0
J 9
paw
-
U T(�•
e 409
u 2 car gar. "
0) '7'4•
2•
Riled b(o-begs n, ,�
and hay
i
3,190 sq. Ft.
4 bdrm.
2 1/2 ba th o
FF.E 304.5'
3 �
302 i IO'xio.. Q
i 'CONIC. l4
304
`-1 -------- 1
ul
306 1
306 sr�.mm' 306 (2,111U.a
LOT 626
500 eq. Pt.
CITYOF T I G A R® PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00377
1.3125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/20/02
SITE ADDRESS: 12272 SW HOLLuvV LN PARCEL: 2S1U,r,5-07700
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 026 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAING: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURESLAUNDRY TRAYS: SF RAIN DRAINS:
SINKS URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS. SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Back flow preventer
Owner: __ FEES _
DON MORISSETTE HOMES Type By Date Amount Recelpt
4230 GALEWOOD ST#100 PRMT CTR 9/20/02 $36.25 27200200000
LAKE OSWEGO, OR 97035 5PCT CTR 9/20/02 $2,90 27200200000
Total $39.15
Phone 1: 503-387-7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070
REQUIRED INSPECTIONS
Phone 1: (382-6076 RP/Backflow Preventer
Reg #: LIC 6136
FILM 11558
This permit is iss,- id 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 accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for mc:e
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 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: _ , _ _ Permittee Signature: '
Call (503)639-4175 by 7:00 r'.M. for an inspection needed the next busfneis day
Plumbing Permit Application
Datcmceived: Permit fA41OD,3+
City of Tigard ,... Sewcr permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,�R 97223
CiryofTigard Phone: (503) 639-4171 SCF' PtojecUappl.no.: Expire date:
Fax: (503)"598-1960 J AaiQissued: By: Receiptno.:
c"i Ur
?ay
Land use approval: ment type:
t '
r*ANew
2 family dwelling or accessory D uomrnercial/industrial 0 Multi-family D Tenant improvement
construction 7 Addition/alteration/replacement ❑F,)r)d service D Other:
4 : I I i r
Job address: ` l I L �'11 C k_+u
Description , Fee(ea.) Total
JobBldg. dee Suite no.: New 1-and 2-family dwellings only:
(Includes 100 fl.for each utWty connection)
'fax map/tax lot/account no.: -� SFR(1)bath
Lot: 7 C IB!—.k: Subdivision: 11A (V.) SFR(2)bath
Pruject name: _ t� SFR(3)beth
City/county: ZIP: Each additional bath/kitchen
Desc ' tion and location o work n premises: Site utilities:
- Catch basin/area drain
Est.date of wm letion/inspection: ! ( D wellsAtaeh L trench drrun
Footingdrain(no.lin.ft.)
Manufactured home utilities
puainess name: Ftp&r-ZLS S L.L1tf)L a4G Manholes
Address:a9 VY S-Ly Kj'. _ Rain drain connector
City: j l) StateG �P: '70 U Sanitary sewer(no.lin.ft.)
Phone:lo$�-l0o'7 NIA Fax $ -qr7 E-mail: Storm sewer(no.lin.ft.)
Plumb.bus.reg.no: Water service no.lin.ft.)
CCB no,: (o/3� t _ Fixture or Item:
City/metro lic.no.: 003J-"7 Absorption valve
Contractor's representative signature:+ t-v Back flow reventer 7 5$
V —
:L Print name: j l er S R,`r��"-� Dam - Backwater valve _
� - t Basins/lavato —
Cbthes washer
Name: kn 'slrwasher
rill
ddress: Qq5 � kA Dri 'n fountains)
ity � Vi 1 G State:O(� ZIP: 0 $ectorslsum
c.lc:0ga-loo?(o Fax:iota--915"7 E-mail: Expansion t.w-
Fixture/sewer cap
Floor drains/floor sinks/hub
Name(print): Garbage dis oral
Mailing address: 43U altw 00c1 S7* Hose bibb _
City: LP-12, State: R. �'q Ice maker _
Phone: Fax. I E-mail: IRerse todgrease trap
Owner installation/tesidential maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Si (s),basin(s), ays(s`
Owner's signature: — _ Date: Sum
Tubs/shower/showcr pan
_urinal
Name: ate:closet
Address: Water heater
City: State: ZIP: Other.
Phone: Faz: E-mail:
7_10--fill-Minimum fee................$ ____� —
Not :'{oridicdoos accept credit cards,plena call;u udiction for more inform:-doa Notice:This permit applic-ation Plan rev'!w(at _ %) $
u visa O MasterCard expires if a permit is not obtained State surcharge(8%) ....$
Credit cud oam'xr: — -- — Ea within 180 days after it has been TOTAL .......................$
accepted as complete.
Nam of older u s6owa on credit card s
C older danarura Amount 440-4616(MICOMt
PLUMBING PERMIT FEES:
l!V�oweI`(JS7U�_rl , =s au ,y ryes
:,.,. 5ry� -- � :� i `L• a w� �" a nrar
FJ}CT; _ n .� _ �•, e es I+t> >hl g. I Ire IEe i (9
Sink 15.60 l evJe
Lavatory16.60
- One-S1)bath _ $249.20
Tub or Tub/Shower Comb. 16.60 Two bath $350.00
aho>v,erOnly 16.60 Three 3 bath $399.00
"ur_r.., Closet 16.60 _ -- - SUBTOTAL rr '_ "--•,''`.�',:`i`y^ -�._
Urinal 16.60 8%STATE SURCHARGE `i1• "' _
Dishwasher J 16.60 PLAN REVIEW 29%,OF SUBTOTAL
TOTAL
Garbage Disposal 16.60
Laundry Tray - 16.60
Washing Machine16.60
FIoOrDrain/Floor Sink 2' 16.60 f PLEASE COMPLETE:
47--__ 16.60
Water healer Oon
cversirn O like kind 16.60 (tore Typ g osed/
Gas piping requires a separate mechanical __-
onnit. f+� a. _i a er�;'S^
MFG Horne New Water Service 45.40 Sink
MFG Homo-New San/Storm Sewer 46AD Lavatory
_ _ ---- - Tub or Tub/Shower
Hose_ Bibs 16.60 Combination
Roof Drains - - 16.60 Shower Onl
Drinking Fountain -16.60 Water Closet_
-- 16.sr, Urinal _
Other Fixtures(Specify) _ Dishwasher
- GarSa a Dis osal
--- r - - Lat.ndryRoom Tra -
-
Washinq Machine
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3" -
Sewer-each additional 100' 46.40 4"
Water Service•1st 100' 55.00 Water Heater
46 40 Other Fixtures
Nater Service-each additional 200'
Storm&Rain Drain-lot 100' 55.00 _
Storm&Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 _ -----
Residential Backflow Prevention Device` _ 27.55
Catch Basin y 16.60
Inspection of Existing Plumbing or Specially 72.50
_Requested Inspections per/hr _ COMMENTS REGARDING ABOVE:
Rain Drain,single famlly dwelling 65.25
Grease Traps - 16.60 ---- --
QUANTITY TOTAL
Isometric or riser diagram Is required if -.
Quantity Total Is 99
'SUBTOTAL
- 8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required onlyIf(Ixtureqty,total is>0 _
TOTAL
'Minimum permit fee Is$72.50+s%state surcharge,except Residential Backflow
Prevention Dov�e.which is$36 25•s%state surcharge.
"All Now Commercial Buildings require plans with isometric or riser diagram and
plan review
I:\dsts\forms'plrn-fees.doc 10/10/00
CITY OF T I G A R l PLUMBING PERMIT__
DEVELOPMENT SERVICES PERMIT #: PLM2002-00367
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/13/02
PARCEL: 2S103CB-07'700
SITE ADDRESS: 12272 SW HOLLOW LN
SUBDIVISION: QUAIL HOLLOW- EAST ZONING: R-4.5
SLOG-K: LOT: 026 ------- JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE NOME SPACES:
rYPE OF USE: SF WASHING MACH: BACKFLOW FREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS. TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE. ft
DISHWASHERS: RAIN DRAIN: °t
Remarks: Installation of backflow preventer.
FEE_S_ _
Owner:
Type By Date Y Amount Receipt
DON MORISSETTE HOMES PRMT CTR 9/13/02 $36.25 27200200000-
4 230
72002000004230 GALEWOOD ST#100 5PCT CTR 9/13/02 $2.90 27200200000
LAKE OSWEGO, OR 97035
Total $39.15
Phone 1: 503-387-7538
Contractor: _
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: 682-6076 Final Inspection
Reg #: LIC G 136)
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 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 by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
YOU may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: ./ ,Y( 1 ( ,/J '!� ) Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Perniit Appl icatioii
Datereceived: �j (✓ Permitno.; l t =< 1
City of Tigard Sswerpermit no.: Building permitno.:
Address: 13125 SW Hall 131vd►, ,W"I 97223
CiryofTigard Phone: (503) 639.4171 Ptoject/appl.no.: Expire date:
Fax: (503)598-1960 Dateissusd: By: ,t I Receiptno.:
Land use approval: („1 L Casefileno.: Paymenttype: .
U 1 &2 family dwelling or accessory ❑Commercial/industrial O Multi-family 0 Tenant improvement
,New construction O Addition/altemtion/replarement ❑Food service 1]Other:
tt #m iNFaRmAxioNt
Job address: >, LNew
i)c;crlptiou Fee(ea.) Total
Bldg.no.: _ Suitt uo._ -- - d 2-fandly dwellings only.
00 ft.for each Wilily cotutection)
Tat map/tax lot/account no.: t 4 ,t I 1 bath
L M: 1 Block: Subdivision: LC: � bathProject name: ( II l ) ( bath
City/county: I ZIP: Each additional bath/kitchen
Description and location of work on premises:. Sheutilitles:
A{,L.)1� _ Catch basin/area drain
Ftit.date.of completion/i pf.,ction: i a n eU�1�eh If tr°nch drain
Footing drain(no.lin.ft.)
PLUMBING Cd*TRXCYOR
Manufactured home utilities
)Business name: P�hrZ4 S L L" 4C r
_— .-- -.ted- ���` _ Manholes •
Address: -9,?9S S:W ft /l.rf7Rain drain connector
City:w j j SMui It 6 i StateG M: 9-70 7 b Sanitary sewer(no.lin.ft.)
Phone:(og�'•-w7(o all Fax: g -qg,7 E-mail:• Storm sewer(no.U.ft.)
Plumb.bus.reg.no: Water service no.lin.ft.)
CCB no.: (a 3 Fixture or Item:
Ci /metro lic.no.: G 03z-,l Absorption valve
Contractor's representative signature: I v Back flow reventer 7 S
Print name: S Rt'!-trt� Darr: (l Backwater valve
Basins/lavatory,
Name: 0kn �q.rrL"c.k.3 Clothes washer _
,� gq5 � k� AA Dishwasher
Address: Drinkin :ountain(3)
City: �'3t 1eStatc:OQ 7,IP: O E'ectors/sum_p
Phone:fpl;a log?(o FaK'(og3-C?1;'r7 Email: Ex ansion tank
s Fixture./sewer C±P
Name(print): r3 fL^O)d-SSC�— Hem t:�_ FIoK'r drains/floor sinks/huh
Garua a disposal
Mailing address:L4a D lt) dl-P-W_Ood Hose bibb
City: La- t Q State: R, ZIP:g70.3 Tcem
Phone: Fax: I E-mail: Interceptor/grease trap
Owner installadon/residential maintenance only: The ectual installation Primers)
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. Sink(s),basin(s),lays(s)
Owner's signature: Date: Sum _
Tubs/shower/shower pan _
Urinal
Name: _ — Water c oset
,KddrTss I Water heater
City: V� State: ZIP: Other.
Phone: I Fax: E-mail: I Total
Not ell Ior{adlcdoe.rcapt etedit ear&,plan alt jurisdiction ror more Inrom adna Minimum fee................s 3k, '2
Notice:This permit application Plan review(at_ %) $
O Visa O MuterCard expires if a permit is not obtained 170
Croda cud number. ----�--f— within 189 days after it has been Stair:surcharge(896) ....S g
exptr., /
accepted as complete. TOTAL .......................5
Nurse o cudhotder u shown oo r edit cud $
Cudholder dgnaturo Amount MO4616 r6CQ/COM)
PLUMBING PERMIT FEES:
w: '-.ter+ y- :`• r „'- .s, r p 'CE.�~,v! All ( a�I 1� I0 „z'�-
`� ea 'iia I' 3ii r e r I
X1 A
Sink 16.60
Lavatory 16.60
_ One 1 bath _ $249.20
Tub or Tub/Shower Comb. 16.60 Two 2 bath _ $350.00
Shower Only 16.60 _ Three 3 bath _ $399.00 yi
Water Closet 16.bOI
SUBTOTAL
Urinal 18,60 8%STATE SURCHARGE r ,'.•1
Dishwasher 16.60 PLAN REVIEW 23%OF SUBTOTAL
TOTA
16.60 L r-
Garbage Disposal _
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" _ 16.60 PLEASE COMPLETE:
4" 16.60 _
Water Heater O conversion 0 like kind 16.60 ; w e ..e
Gas piping requires a separate niochanical urs 7y
ennit. -- -- -- -
MFG Home New Water Service 46,40 Sink
MFG Home New San/Storm Sewer 46.40 Lavato
Tub or Tub/Shower
Hose Bibs 18.60
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 1B 80 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Wishina Machine
Floor Drain/Sink: 2"
Sewer-let 100' 55 00 3" J
Sewer-each additional 100' 48 ' 4"
Water Service-lot 100' 65.1 Water Heater �...
Water Service-each additional 200' 48.4u• Other Fixtures
S ecl _
Stony,6 Rain Drain-1st 100' 55.00
Storm 6 Rain Drain-each additional 100' 48.40 --
Commercial Back Flow Prevention Device 46.40 r -
Residential Backflow Prevention Device 27.55T�-
Catch Basin 16.60 y
Inspection of Existing Plumbing or Specially 72.50
-Requested Inspections ii COMMENTS REGARDING,ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.80 _
QUANTITY TOTAL
Isometric or rIzAr diagram is required If
uant Total is >9 -i
•SUBTOTAL
8-A STATE SURCHARGE C
"PLAN REVIEW 25%OF SUBTOTAL
Required only If flxturo total Is>D
TOTAL + • = $3�,/S
Minimum permit fee Is 572.50•8%slate surcharge,except Residential Backflow
Prevention Device,which Is$88.25•8%state surcharge.
All New Commercial Buildings require plans wfth L^.ornetric or riser diagram and
pian review.
I:\dsts\forms\pim-fees.doc 10110%00
CITY OF TIGARD 24-hour
BUILDING Inspection Line: (503)639-4175
MSl
INSPECTION DIVISION Business Line: (503) 639-4171
BLIP
Received _ _ Date Requested /U'L j c L AM PM !_-__ BUP _ __—
Location w llll5l/dew Ze. ,e Suite MEC
Contact Person Ph( �0 3 ) - o PLM ?-U 0, 7
Contractor -- -- _-__ _ _ _ Ph(—) SWR ---- -.-
BUILDING Tenant/Owner _ _— ELC
Footing
ELC
Foundation
Ft Access:
g Drain ELR
fly G - � �' ----_- --
Crawl Drain _
Slab Inspe ron Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing --- - - - - - _
Insulation
Drywall Nailing - -- - - -- f --
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling --
Roof `
Other: /
Final
PASS PART FAIL
Post&Beam
Under Slab - - -
Rough-In
Water Service
Sanitary Sewer
Rain Drains --- ---
Catch Basin/Manhoie
Storm Drain -�
Shower Pan
Other:
Fine
QS PART FAIL
CHANICAL
Post& Beam
Rough-In - -- —
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In —
UG/Slab
Low Voltage
Fire Alarm
Final [I Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL act-no access ins
SITE [� Please call for reinspection RE: _� ❑ Unable to P
Fire Supply Line
ADA
Apprnach/Sidewalk Date Inap�cl�►r
Other
Firms DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Dour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171 - --- -
BLIP
Received -- _ Date Requested LI AM PM BLIP
--�
Location Suite__ _— _MEC
Contact Person -- - 1 I� t , , Ph( ) PLM _ -
Contractor ---- --- -_-- -_ --_ Ph(—) _ SWR
BUILDING Tenant/Owner -- —--------.-- -_..---. _ -._-- - ELC
Footing ELC -_
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall NailingFirewall
- LJ P /II/N'' ���� �Un ✓ yy
Fire Sprinkler (n -) //1.�� 2 �- W A4-t e.,L - —�
Firo Alarm ----�/
Susp'd Ceiling - '{� _ —
Roof
ot
FAIL
81 _
Post&Beam
Under Slab
Rough-In
Water Service - 7
Sanitary Sewer
Rain Drains - - - -- -
Catch Basin/Manhole `
Storm Drain
Shower Pan
Other: - - _ ----
Final)
_PASS PART FA
MECHANICAL '
Post&Beam
Rough-In
Gas Line 1'
Smoke Dampers -- - — —
ART FAIL --
_
ICAL
Service —
Rough-In
UG/Slab
Low Voltage
Fire 4orm
Final 3 PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd.
Please call for reinspection HE: —__ E] Unable to Inspect-no access
Fire Supply Line
Approach/Sidewalk Date / / l �( (, f n�Pector �� Ext
Other:
Final DO NOT REMOVE titis Inspectlon record from the Job site.
PASS PART FAIL
CITY OF TIGARD 20-Hour
BUILDING Inspection Line: (503)639-4175 MST _ v`�—3 (P INSPECTION DIVISION Business Line: (503) 635-4171
BUP
Received _,_� / __ -- Date Requested 7 — AM-__ PM BLIP
Location / 2' -J.d' T_Suiter MEC
Contact Person ___. Ph( ___) 96 g' �J PLM
Contractor.._._
Ph(---) SWR - - -
BUILDING Tenant/Owner - ---_._-.._-- --- _ - ELC - ---
Footing ELC -
Foundation Access:
Ftg Drain � ? ELF
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.
Fin
ASS PART FAIL
i4JMING --- 14
—.
Post&Beam
Under Slab ----- --
Rough-In
Water Service - - --
Sanitary Sewer
Rain Drains
Catch Basin/Manhole _
Storm Drain
Shower Pan
i
F,t
S PART FAIL
ME H ICAL -- --
Pos & III
eam
Rou In \ — _ -----
Gas ine
Sm Dampers
Fi aIV
AS PART FAIL —
L E C Tft ICAL
Se vic
Ro gh n `���
UG b 1
Low oltage _ _ -
Fire arm
Fin I PART FAIL. Reinspection fee of$ requirad before next inspection. Pay at City Hell, 13125 SW Hall Blvd.
3 _
SITE _ ❑ Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA � �
Approach/Sidewalk Date Inspector Ext
_— -- -- -
Other:
Final QO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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