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2332 SW fJollow Lane
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O� �'���D MASTER PERMIT
CITY
PERMIT#: MS72001-00107
DEVELOPMENT SERVICES DATE ISSUED: 03/20/2001
13125 SWr Hall Blvd.. Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 1233 SW HOLLOVJ LN PARCEL: 2S103CB-07400
SUBDIVISION: QUAIL HOLLOW- E.'ST ZONING: R-4.5
BLOCK: LOT:023 JURISDICTION: TIG
REMARKS: Construction of rev/ single family residence. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS _REQUIRED SETBACKS REUUIRED
CLASS OF WORK: NEW HEIGHT: 7e FIRST: 1.496 of BASEMENT: a' LEFT 11 SMOKE DETECTORS:
TYr:OFUSE: SF FtOORLOAD: 40 SECOND: 1.552 of GARAGE: 460 at FROIIT, ,0 PARKINGFOACE.S:
TYPE OF CONST. EN DWELLING UNITS: 1 FINBSMENT: of RIGHT I I
VALUE: $273.657 00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 1050 00 of REAR: ;'4
PLUMBING
SINKS,. I WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS
LAVAT'RIES 4 DISHWASHERS, 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN P!,AINS 1 CATCH BASINS.
TUBBHOWERS. 3 GARBAGE nISV: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: I GREASE TRAPS•.
OTHER FIXTURES:
MECHANICAL _
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYER: I ,
GAS FURN>-100K: 1 UNIT HEATERS: HOODS: I OTHER UNITS: I
MAX INP: btu- FLOOR FURNANCES: VENTS: i WUODSTOVES: GAS OUTLETS: I
_ ELECTRICAL _
RESIDEN TIAL U''!'T SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH Cl.CUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LEAS: 1 0 - 200 amp: 0 200 amp: WISVC OR FOR: 1 PUMP6RRIGATION: PER INSPECTION
EA A.,YL 0008r. 201 -400 amp: 201 400 amp: let'VIOSVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR.
LIMITED ENtRGY: 40, - 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT.
MANU'fMISVCIFDR: 601 • 1000 amp: 601+ampo-1000v: MINOR LABEL:
1000.amplvoll
PLAN REVIEW SECTION
Reconnect only: 34 RES UNITE: SVCIFDR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC.
ELECTRICAL-RESTRICTED ENERGY
_ A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSC.'�PEARRIG: PROTECTIVE SIGNL.
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS,
Owner: Contractor: TOTAL FEES: $ 4,613.88
DON MORISSETTf HOMES DON MORIS�c1'E HOMES This permit is subject to the regulatiol g contained in the
4230 GALEWOOD ST#100 4230 GALE%JOOD,:TRE ET Tigard Municipal Code,State Specialty Codes and
TAKE OSWEGO,OR 97035 SUITE 100 all other applicable laws. All work
will be done in
LAKE OSWEGO,OR 97035 accordance with approved plana. 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 Nc"1-9tion Center. Those rules are set
Reg 0: LIC 35533 forth in OAR 952-ov. J010 through 952-001.0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
'TIRED INSPECTIONS
Erosion Control Insp 8' Post/Beam Mechanica MechLnical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Oil Exterior Sheathing Ins{ Rain drain Insp Final inspection
Footing Insp Crawl Drain/Backwater Electrical Serv!ce Low Voltage Water Line Insp Building Final
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwik Insp
Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Issued By : % �'��__ Permittee Signahrrc�
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD -_SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2C01-00075
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/20/2001
PARCEL: 2S 103CB-07400
SITF ADDRESS; 12332 SW HOLLOW LN
SUBDIVISIO14: QUAIL HOLLOW EAST ZONING: R-4.5
BLOCK: Lar: 023 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELL-ING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks Sewer connection for new SF detached dwelling.
Owner: __--
---- FEES
DON MORISSFTTE F ARES Type By Date �—Amount Receipt
42.30 GALEWOOD ST'#100 — —
LAKE OSWEGO, OR 97035 PRMT CTR 03/20/2001 $2,300.00 27200100000
INSP CTR 03/20/2001 $35.00 27200100000
Phone: 503-387-7538 - T Total $2,335.00
Contractor:
Phone:
Reg M
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 at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-00 10 through OAR 952-001-0080
You may obtal., copies of these rules or direct questions to OUNC by calling (503) 246-1987
r �
Issued b f __ Permittee Signature:
Call (503) 639-4175 by 'i:00 P.M. for an inspection needed the next business day
Building
City of Til received: .�� `i / Permit no.: nratV—d0/o
Address: 13125 SW nau tslvd, I Igard,OR 972 r'uject/appl.no.: — Expire date:
City njTlgard Phone: (503) 639-4171y P
Date issued: B Receipt no.:
Fax: (503) 598-1960 �I ' Case file no.. Payment type:
Land use approval: 1&2 family:Simple Complex: -��
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family New construction U Demolition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm V Other:
Job address: I Bldg.no.: Suite no.:
Lot: , Block: Subdivision: t\�1C1 ( 1 . I Tax map/tax lot/account no.: jqd105C6_ C,7j1p,0
Prject name:
Description and location of work on premises/special conditions:
V011 SlPIL(11�%I'
Mailing address: . 1,,L I &2 famlly dweUing:
City: State:( ZIP: ). Valuation of work........................................ $,X:23,
.
Phone: - Fax: 7 --mail: No.of bedroomstbaths..........
Owner's representative: Total number of floors.................................
Phone: Fax: E-mail: New dwellingareas ft.
Garage/carport area(sq.ft.) ........................
Nana Y 1, Covered porch area(sq.ft.) ......................... _
-- Deck area(sq.ft.)
Meiling address: (� ....................................... _—
City: I State: Z1P: Other structure area(sq.ft.).........................
Phone: Fax: E-mail: CommereinUindmtrial/multi-family:
Valuation of work........................................ $
Existing bldg.area(sq.ft.) . ....... ......... . . _ --
Business name: -kYY 16
—.- New bldg.area(sq. ft.)..........
Address: 2 -------
City: State: - ZIP: Number of stories ..................I.... ............... �_--
-- Type of construction....................... ........... _.
Phone: Fax: E-mail:
CCB no.: -- Occupancy group(s): Existing:
_ New:
City/metro lic.no.: Notice:All contractors and subcontractors are required to be
1 licensed with the Oregon Construction Contractors Board under
N,ttric L - A provisions of ORS 701 and may be required to be licensed in the
Address: C4 jurisdiction where work is being performed.If the applicant is
Cit State: ZIP: exempt from licensing,the following reason applies:
Contact person: Plan no.:
Phone: Fax: E-mail: —
Name: Contact person: Fees due upon application ........................... $
Address: Date received:
City: State: ZIP: Amount received ......................................... $ _
Phone: Fax: Please refer to fee schedule.
I hereby certify 1 have read and examined this application and d,e Not alt jundfcnong Kvep credit cards.plow call jurisdiction for more frJ wmedon.
attached checklist.A rovisions of laws and ujidinances governing this U visa O MasterCard
work will be comp) wt ,whether cifi ereor n" Credit card number: tart
Authorized si natu% N te: �, ( Name of cardholder ISShow"on credlr card S
Print name:_ cardnolaer signature Amount
Notice:This permit application expires if a permst is not obtained within 180 days after it has been accepted as complete. 4406IJ(doatr:oM)
A One-and Two-Family Dwelling
Building Permit Application Checklist PReferenct vio.:
Cityoj7'igard Associated permits.
Ci
City of Tigard I O Electrical 0 Plumhing 0 Mechanical
Address: 13125 SW Nall Blvd,Tigard,OR 97223 LO Other:
Phone: (503)639-4171
Fax: (501) 598-1960
-OLLOWING ITENIS ARE REQUIRED1 -
1 Land use actions completed.Sce juitsdwu(m criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
7_K_
3 Verification of approved plrtflot. _ _
4 Fire district_ approval required.
5 Sceptic Pystem 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 rile or with application. _
9 Erosion control ❑plan LI permit required.Include drainage-way protection,silt fence design and location of J
catch-basin protection,etc. __
10 3 Complete sets of legible plana.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheat attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
I I Sitelplot plan drawn to scale.The plan most show lot and building setback dimensions;property comer elevations(if
there is mote 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 wellstseptic systems;utility locations;direction indicator,lot
area;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 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,
fireplace construction, thermal insulation,etc. _
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additi.-)ns and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot rt building envelope.
I ull-size sheet addendums showing foundation elevations with cross references arc accentable. —
16 Wall bracing(prescriptive path)and/or lateral analysis plane.Must indicate details and loc-tions;for
non-prescriptive path analysis provide specifications and calculations to engineering stindards.
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'.calculations." V.
19 Beam calculations.Provide two sets of calculations using current cods.design values for all beat. a -id 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 be applic:ablc to th%•project under review.
23 Five(5)site plans are required for Item 1 I above. Site plans must be 8-1"" x l l"or I I" x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above. X _
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. 4w-4e14(&W/COM)
Mechanical Permit Application
Date received: Permitno.: O •1°l�
City of Tigard Projectlappl.no.: Expire date:
CiryofTigard Address; 13125 SW Hall Blvd,Tigard,OR 97223 -�
Date issued: by: t no.:
Phone: (503) 639-4171 Receip
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TVJPE OF PE101IT
U I &2 family dwelling or accessory U Commercial/industrial U Multifamily U Tenant improvement
Xgew construction U Add ititin/al teration/replacement U Other,
joB siTE monwn5N1 1 1
Job address: � 1J t �� ('� , Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax ma tax lot/account no.: profit.Value$ _
Lot: Block: �_ Subdivision: 1 t "See checklist for important application information and
Project name: t jurisdiction's fee schedule for residential Ixrmit fee.
City/county: ZIP: 1 1
Description and location of work on premises: 7handlirg
Fee(m) Total
Est.date of completion/inspection: Description Qty. Res.only Res.onlyTenant improvement or change of use:Is existin s ace heated or conditioned?U Yes 0 No nit _ CFM__.g P ng(site p an required)Is existing space insulated?0 Yes 0 No existing HVAC systemEms _
Boiler/compressors
Business name: ; State boiler permit no.:
HP Tons BTU/H
Address: 'rre/smoke ampeNductsmo a etectors
City: State 2IP: eat pump(site plan required)
m
Phone: Fnx: Email: nsrep ace urnac umer /
Including ductwork/vent liner 0 Yes 0 No
C( Instal UrepIace/re locate heaters-suspended,
City1metro lic. no.: N/A wall,or floor mounted
Vent for appliance other than furnace
Name(please print): - efrigertion:
Absorption units BTUfH _
Name: Chillers HP
Addr
Compressors_ HP
_re-59_ V VI.-C L r oamental exhaust an vent tion:
Cit State: ZIP: v Appliance vent
Phone �F.�. E-mai;: Dryerexhaust _
Type U IF/-resiutchen/hazmat
hood fire suppression system -
Name: V Exhaust fan with single duct(bath fans)
Mailing address: ) N,' aust system apart from heating or A
ase piping anddistribution(up to outlets)
City: T State Z.(Pr� 1 ?ype: LPG NG Oil
Phone: 7'72 I-ax. E-mail: I ue piping g— each additional over 3 outlets
r xesvpiping(schematicrequired)
Number of outlets
Name: _ _ ter app ance or equipment:
Address: _ Decorative fireplace
City �__—_ - ` State: nsert type
Woodstove/pellet
Phone: _ Fax. Email.
er:
S Applicant's signal — Date: Ot er,
Name(print): (x'L YI f Mir lit:l/ --
Nor all junsdicuons accept cnxiit cards.pletfe call junuh_umore on for infvmatian. Permit fee.....................s
Notice:This permit application Minifee................S _._--
O Visa 0 MasterCard expires if a permit is not obtained
Credit card number —/ L— within 180 dayseller it has been Plan review(at , %) E ---
ExpiresState surcharge(8%) ....$
Name of cardholder as shown mn credit card s accepted as complete.
TOTAL .......................$ _--
Cardholder tipruwte _�rmount 410.1617(6000/r.'OM)
Plumbing Permit Application
-- Date received: ; Peraut no.:
Cit of Tip�and
y bSewer permit no.. Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- --
City of Tigard Phone: (503)639-4171 Projecr/sppl.no.: Expire date
Fax: (503) 598.1960 Date issued: By: Receipt no..
Land use approval: ___ rasp file no: Payment type:
t
Q I &2 family dwelling or accessory O Commercial/industrial D Multi-familY O Tenant improvement
ew construction ❑Addiuon/alteration/mplace m^nt U Food service U Other.
JOB StTE INFORMATION FEE 1ULIf(for speilall Infonmilon
Job address: ? �, �1/ti �'\ 7 "1 Description O�tv. Fee(ea.) otal
'C
Bldg. re Suite no.: New 1-and 2--family dwellings only:
(,includes 100 it.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block: Subdivision: t SFR(2)bath — -- — ---
Project nam c: •l.- SFR(3)bath --�- -
City/county: ZIP: Each additional baduldtchen
Description and location of work on premises: SiteutWdes:
_ Catch basin/area drain
Esc date of completion/inspection: Drywells/leach line/trench drain
Footing drain(no.lin,ft.)
Manufactured home utilities
Business name -C _ Manholes _ --
Address: Rain drain connector _
City:
State- 'LIP: Sanitary sewer(no.lin. ft.)
Phone: —�' Fax: E-mail: Stone sewer(no.lin.ft.)
CCB no.: M♦ —2 L Plumb.bus.reg.no: — Hater service m: Jin.ft)
Fixture or Item:
City/metro lic. no.: N/A _ �� Absorption valve
Contractor's representative signature _ _ Back flow preventer_ _ _—
Print name: IVBackwater valve
lasins/lavatory
Clothes washer
Name:'1 fl-H 1 �F__ dishwasher _
Address: G '_ Lte
r)A.L4n f—ritain(s)City: StZIP:Phone: Fax: il: Expansion tank
Fixture sewer ca
ANN—
IV
Floor drainstfloor sinks/hub
Name (print): �� t�� � Garbage disposal
ailing address: Nos tit!h
City: State ZIP: 7-,':p• _
Phone: Fa+c: 7-7 E-mail: Interco torlgreasc trap
Owner lnaragadoWresidendal 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 1 own as per OPS Chapter 447. Sink(s),uasin(s),lays(s) _
Owner's si nature: Date: Sump _
Tubslshower/shower pan
Urinal
Name: _ Water closet
Address: Water heater
City: State: ZIP: Other.
Phone: Fax: E-mail: Total _
Not oil'unrdtcuoru arce credit card►,pleau tilt junulicuon for mm mfomunon. Minimum fee................$
_ ---
1 p Notice:This permit application plan review(at _ %) S --_
Ovisa ❑Atuler('tvd expires if a Permit is not ob',sined
Credit cud numberl / within ISO days after it hrs been State surcharge(8%) ....$
E><pirer
accepted as complete. TOTAL .......................
Name of cardholder u%M,*n oo credit:ud _
S
Cardholder signature Amount 4rP.r616(~`0M)
Electrical Permit Application
Datereceivet'r: p Permit no.: 1
City of 'Tigard Project/appl no.: Expire date:
Cirya/Tigard Address: 13125 SW Hall 131vd,Tigard,OR 97223 Date issued. By: Receiptro.:
Phone: (503) 639-4171
Case file no.: Payment type:
Fax: (503) 598-1960
Land use approval:
TYPE OF PERIVIff
❑ I &2 family dwelling or accessory U Commercial/industnal U Multi-family O Tenant imprc✓ement
New construction U A cliuon/altcration/replaieme[It U Other: U Partial
JOB SMINFORkIATION.
11111 a i Bldg.no.: Suite no.: tax map/tax lot/ac-ount no.:
Job ad Tess: >� -
L.ot Block: Subdivision:
Project name: Description and location of work on premises: v _
Estimated dale of compietton/inspection: FEE SCHEDULE
Foe INax
Job no: —
_ Description Qty. (ea.) Total no.bop
Business name: C."Evy �.e. L New residential-single ormuki-Tamil;per
Address: 1 ` - divelWgunit.Includes attached garage.
City: State: ZIP: Servlceinclitew
1000 sq.ft or less 4
Phone: aj 1 Fad; E-mall: Foch additional 500 sq.it.or portion thereof _
CCB no.:� Elec. bus.Ile no: (�� — I�mitedenetgy,residendal 2
C: Limited energy,red home
or ml 2
Each manufac�ured horse or m(ditlar dwelling
Service and/or feeder 2
- aureojsM ervisrn electrician(rr Mired) Date - Services or Feeders-isrsullauon, -
Sup elect name iprmt) 1 Ltcenseno allenllonortelocation:
200 amps or less 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps — 2
Mailing address: _ 60!amps to Inco amps 2
City: �7state/� ZIP: ,� Over 1000 amps orv2lts
Phone: - r Fax: - / .-mail: Reconnetonly
Temporary services or feeders-
Owner installation:The installation is being made on property I own ituttaliation,alteration,orrclocation:
which is not intended for sale, lease,rent,or exchange according to 200&nips or less 2
ORS 447,455,479,670,701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps _ 2
Branch cinvtits•oew,al(eration,
or extension per panel:
Name: A. Fee for branch circuits with purch ve of
Address: service or feeder fee,each branch circuit
-- �le: ZIP: B Fee for branch circuits without purchase 2
City of service or feeder fee,first branch circuit: _
Phone: I Fax: E-mail: Each additional branch cimuit.
Mtsc.(Seryice or feeder not Included):
Each pump or irrigation circle 2
7Service over 225 ampsrortmetcial ❑Healthcare facility Each sign or outline lighting 2
over 320 amps-rating of 162 ❑Harantous locationSi nal chcuit(s)or a limited energy panel,weliings ❑Buildinp over 10,000 square feet fouror B 2
over 600 volts nominal more trsidential units to one structure
alteration,or extension*
v Building over three stones ❑Feeders,aM uups or,-.,re *Description..-
❑occupant load over 99 persons ❑Manufactured,uvcturer or RV park Eich additional inspection over the allowable Inn an orf the a-bo�ve-
U Egrss/lightingplan ❑Other _ - _ --- Per inspection 1 I I T ---
Submit--.selc of plant with any of thr above. I Investigation fee
The shove are not applicable to temporary ratuiruction service. Other -
__ Permit fee.....................$ -
Nor all jurisdicuoea accept crethi cards,please call jurisdictiaa 10r mese udavnauon Notice:This permit application Plan review(at _ %) $ _
❑Visa ❑MasterCard expires if a permit is not obtained _
/_ within Igo days after it has been State surcharge(8%) ....$ —
Ctedd card numb — -- Esp,rcsTOTAL
accepted as complete. ....................... -
Num of cardholder at sbown on credit cod $
dee tianatucc Amount 4sr�615(&W/170M)Cardhol
r
DON • MORISSETTE OBE : 1976
9 0 1 1 9 I N C 0 R P 0 R A T I D
,,air
4 2 3 0 G A L E R O O D S T R E E T LOT: 23
LAY6 0S1I8
G0. OREGON 97036 DATE: 2/6/2001
(603) 387 - 7538 PAX (603) 367 •- 76 16
OPTION ELEVATION PROPERTY: QUAL-HOLLOW
CITY: TIGARD
SCALE: 1"=20'
PLAN No.: 17H
V 1af IT1Z.,�SlO�C�..r
�p1 J2 c Zc�. e-L-F.S
�?r ,CP X32 ,a.l,U. �` OLLOui ,
Ws 6m0�
F51DEWALk - -__6101*10� __
Approach
ad .o-b gs end nsy EL.7y,p ---
Concrete 294
o Drlvewa�
26� ? 6
I i e e 460 bq. ft.
2 car gar.
FF-E. 295'
9 3,050 eq. Ft.
4 bdrm. 8
3 bath
FF.E291'
17
40-4 a 0 x 0 RL-;%
a pr,
I �
295 -
300
60100' _'-----
C
i
LOT 023
6,000
CITY OF TIGARD
13125 S.W. HALL BLVD.
I IGARD, OR 97223
IMPORTANT PERMIT NOTICE
JARDINE PLUMBING
P O BOX 186
ESTACADA, OR 97023
Plumbing Signature Form
Permit #: MST2001-Cr '07
Date Issued: 03/20/2001
Pwcel: 2,S103C8.0 i 4010
Site Address: 12332 SW HCLLOW LN
Subdivision, QUAiL HOLLOW - EAST
Block. Lot: D23
Jurisdiction: TIG
Zoning: R-4.5
R amarks: Construction of new single family residence. Path 1
Your company h.is 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
UWNFR: PI.-UMBING CONTRACTOR:
DON MORISSETTE HOMES JARDINE PLUMBING
4230 r.;ALEWOOD ST #100 P O BOX 1¢6
I-AKE O:.WEGO, OR 97036 ESTACADA, OR 97023
Phone tl: 503-387-7538 Phone #
Reg #: 1 Ir. 108747
PI M 3-320PB
AN INK SIGNATURE IS RE01"RED ON THIS FORM
X _
Signatur A uthorized Plumber
If you. have any question:, please call (503) 639-4171, ext. # 310
TO 39vd 9NIRWrlld 3NT(]Hvr Z88Z0E9E09T L9'0Z T00Z/TZ/E0
CITY OF TIGARD
13125 S. V. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CITY ELECTRIC + SUPPLY CO
8900 SW BURNHAM F-27
TIGARD, OR 97223
Electrical Signature Form
Permit #: MST2001-00107
Date Issued: 0312012001
Parcel: 2S103CS-07401
Site Address: 12332 SW HOLLOW LN
Subdivision: QUAIL HOLLOW - EAST
Block: Lot: 023
Jurisdiction: TIG
Loring: R-4.5
Remarks: Construction of new single family residence. Path 1
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
DON MORISSETTE HOMES CITY ELECTRIC + SUPPLY CO
4230 GALEWOOD ST #100 8900 SW BURNHAM F-27
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
Phone #: 503-387-7538 Phone #: 641-8012
Req #: SUP 35925
LIC 42422
ELE 26-289C
AN INK SIGNATURE is REQUIRW IS FORM
Si e of Supervising Electrician
If you have any questions, please call (503) 639-4171, eyt. # 310
Plumbing Permit AWication r
• t
Date received:1'/`/ ) Permit no.. -vu
City of Tigard `�� v��` Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tt 23
City ofTigord phone: (503) 639-4171 1Ca�� Ftojecdappl.no.: Expir d te:
Fax: (503) 598-1960 ,�'� U�� .rate issued: B Receiptno.:
Land use approval: Case file no- Payment type:
7U 1 &L family dwelling or accessory J Commcrcial/indUs:riai U Multi-family ❑Tenant improvement
New construction U Addition/aiterttion/n placenwil: U Food service U Chh, r:
l1 1 99 1 i r 1 r
Job address: /'c2 33 `S (U T v ll eru.l t a-A- , _I)escri�ttictn
Qty. Tee(ea.) Total
Nei)I-sand'l-family dascllings only:
Bldg.R0. suite n0.: (includes too ft.for rich utility connection)
Tax map/tax lot/account no; _ i„ Silt(1)bath
Lot: a3 Block: Subdivision: (, 44.4-(A hl� SFR(2)bath
Project name: CA-4--t I Z3 SFR(3)bath
City/count . " a.tc ZIP: Q7;33 3 Each additional bath/kitchen _
Description an ocatlpn of work on premises: Siteutilitles:
Catch basin/area drain -
Est.date of completion/inspection: fig 3L1 Q Drywelis/leach line/trench drain
1 f Footing drain(no.lin.ft.) _
Manufactured home utilities
Business name: Camra E L,eir s,cC tp 6 Xn G Manholes
Address: q ([) �Ce/� IQD _ Rain drain connector
City: ( )I j :klYI G State:Cii�� ZTIP:yT( Sanitary sewer(no.fin.ft.)
Phone Fax:/dS,1-%7 E-r.iail: Sturm sewer(no.lin.ft.)
CCB no.: / Plumb.bus.reg.no: Nater service(no.lin.ft.)
r or Item:
City/metro lic.no.: ;j� Absorption t
Absorption valve
Contractor's representative signature: Back flow preventer
Print name. / -t Date U Backwater valve _
1 Basins/lavatory _
Name: ( �• r 12 t Clothes washer
S .•
Dishwa.; er
Address: y� CUl f1 C�r1 7 Drinkingfountain(s)
City: I 1)1,1 krn U L le, State:C ZIP. C176'7() Ejectors/sump _ -
Phone: I I Fax:k&)-c -7 E-mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub _
Name(print):,�C`r�1 /y)[Y[ SSC't�• _ Garbage disposal _
Mailing address: 3U StU �t crnt'L s— Ilose bibb _
City: State:C'f`. ZIP. 703 Ice maker
Phone: Pax: I 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 th,. property I own as per ORS Chapter 447. Sin (s),basin(s),lays(s)
Owner's sl nature: Date: Sum
Tub shower/shower an
Urinal _..
Name: _ _`______ Watercloset _
Address: Water eater
City: State: LIP. Other:
Phone: Fax: E-mail: Tota —
.
Not all judsdicllons accept credit card+,r!zwe call jurisdiction for more information. Notice:This pemlit application Minimum fee........... ....5
O visa Cl MasterCard expires if a permit is not obtained Plan review(at — %) S
/
Credit cud number / within 180 days after it has been State surcharge(8%)....$
_ — Expires .�!• -�
►June or eudholder u-awn on arc it card s
accepted as complete. TOTAL .......................$
cudhol r signature Amount 4404616(6.+00/C0>!
V
PLUMBING PERMIT FEES:
PRICEY .-TOTAL'".
No 1 grid 24amily dwellings_only.: r
FIXTURES (IndividualL'. 'QTY.' mea AMOUNT (includes all plufnblrig fix`tliresln PRICE �'TTAL
Sink 16.60 �` thF dwelling and the flr5t100 ft. QTY (ea) `. =AMOUNT
16 60 for each utilif connection w
Lavatory One(aLath $249.20
Tub or Tub/Shower Comb. 16.60 Two bath $350.00 -
Shower Onty 16.60 hre�3)bath
$399.00
T _
Water Closet 16.60 - �___-- - -- SUBTOTAL ---- _
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
- TOTAL
Gbage Disposal 16.60
ar ��_ ----- -_"-
Laundry Tray 16.60 -
Washing Machine 16.60
Floor Drain/Floor Sink 2- 16'60 PLEASE COMPLETE:
3^ 16.60
4- 16.60 -
Quantity b Work Performed
Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced : Removed/
Gas piping requires a separate mechanical _ "Ca ec'
ormit. --- Sink
h1FG Home New Water Service 46.40 - -
46.40 Lavatory -_
MFG Home New San/Storm Sewer T tib or Tub/'Shower
1 loss Bibs J 16.60 Carnbinalion
Roof air 16.60 Shower Only
--- 16.60 Wa;,r Closet
Drinking Fountain _ Urinal
Other Fixtures(Specify) 16.60 Dishwasher
m Garbage Disposal
Laundry Room Tray-
-WatLiq Machine
__- Floor Drain/Sink: 2" -
Sewer•1st 100 55.00 - _ 3"
Sewer-each additional 100'
55.)0 -- Water Heater
Water Servij1_1- st 100' Gther Fixtures
Water Seryac
ice-eh additional 200' - 46.40 _ (SpecJPy) --
Storm 8 Rain Drain-1st 100' 65.00 -
Storm&-Rain Drain---ea-ch addittoral 100' 46.40 -
Comm2rcial Back Flow Prevention Device 46.40 _
Residential Backflow Prevention Device' 27.55 ---
Catch Dasln - 16.60 -
Inspection of Existing Plumbing or Specially 72.50 .;OMMENTS REGAPDING ABOVE:
Re uesteJ Inspections --
Rain Drain,single family dwelling 65.25 -
Grease
Trap-, 16.60
QUANTITY TOTAL �n n CC
Isomeiric or riser diagram Is required If / U?I. ss 'r z J J --
Duanlity Total Is >e - -- -.
•SUBTOTAL ;2 S
_8%STATE SURCHARGE - -
----
•'PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty.total is`9
TOTAL
Minimum permit fee is'y .state surcharge,except Residential Backflow
Prevention Device,which Is$3 25/« %state surcharge
"All Now Commercial Buildings require plans with Isometric or riser diagram and
plan review.
i:ld*-\l`ormslplm-feeS.doc 10/10/00
CITY OF TIGARD PLUMBING PERMIT
p
DEVELOPMENT SERVICES �rtMlT#: PLM2001 00223
DATE ISSUED: 06/04/2001
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639 4171
PARCEL: 2S 103CB-07400
SITE ADDRESS: 12332 SW HOLLOW LN
SUBDIVISION: QUAIL HOLLOW - EAST JURISDICTION:
: TIG
BLOCK: LOT: 023 JURISDI(_TION: TIG
' CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
WATER HEATERS: CATCH BASINS:
STORIES:
_ FIXTURES__- LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: R.".IN DRAIN: ft
Remarks: Installation of back flow deverter device. --
(�
Owner: I Type By Date Amount Receipt _
DON MOR113SETTE HOMES PRMT CTR 06/04/2001 $36 25 27200100000
4230 GALEWOOD ST#100 5PCT CTR 06/04/2001 $2.90 27200100000
LAKE OSWEGO, OR 97035 I 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 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 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 9520001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued B Permitter Signature:
Call (5031 slQ-1.175 by 7:00 P,M. for an inspection needed the next business day
FY OF TIGARD BUILDING INSPECTION DIVISION MST
lour Inspection L.ae: 639-4175 Business Line: 639-4171 - -
_
Date Requested �_--
_ �� AMPM BUP_. BLD _
Location 33 `✓ Suite MEC _
Contact Person -- — —_ Ph if Z GG 7L OLIN 'Y, -z, Z-,3
Contractor Ph _eZ�Z SWR
ELC
BUILDING Tenant/Owner --
Retaining Wall ELR
Footing Access:
Foundation FPS
Fty Drain SGN
Crawl Drain Inspection Notes:
Slab -- --- — --------- -- -- --- SIT
Post&Beam
Ext Sheath/Shear —__—
Int Sheath/Shear
Framing - _ —_...--- -- ---- ----- —
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler ----------- ------------- -- --
Fire Alarm
SuSp'd Ceiling --
Roof
Misc: ------ — -- ----- -- -
Final -�--
PASS PART FAIL -----_._..._._------_----- --_-----
L
Post & BeaL641 ( ---- - -- ---- — - --
Under Slab
1 op OutWater Sery
Sanitary Sewer —
Rain Dr ins
Fin
SS JPART FAIL —
WCHAMCAL
[lost& Beam ------ - ---- --- -------
Rough
----Rough In
Gas Line ------- ---- - ----
- - -- - -- _----
Smoke Dampers
Final - --------- -- --- —_ —
PASS PART FAIL
ELECTRICAL — ---- -- ---_----------- —
Service ----- —- ..— — -- --- _— ---- ------
Rough In
UG/Slab
Low Voltage
Fire Alarm --- -----— -- - — ------— ---- ---
Final
PASS PART FAIL- --_- -__-__--- ------- -----------_-
SITE
Backfill/Grading — -- --�---- ----- ------
Sanitary Sewer
Storm Drain I )Reinspection fee of$ —_ required before next inspection Pay at C'!y Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ] Please call for reinspection RE:—__ —__ I ]Unable to inspect no access
ADA
atc
rAPFroach/Sidewalk nate InspectorExt
Othcr
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CIT Y OF TIGARD BUILDING INSPECTION DIVISION MST 7
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested _ _AM PM _ RLD
Location 12 3-?2 110 Ac LAY, — Suite � MEC _
Contact Person 9!L1 _ Ph -W -6 YS,? PLM
Contractor Ph _ SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR _
Footing Access:
Foundation FPS
Fig Drain SGN
Crawl Drain Inspection Notes: -- -
Slab _ ---- -... --------- ---------------- SIT _
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -_—_-- h a'-- �1 „n �Or�t'G✓l __ ____
Firewall
Fire Sprinkler
---------Fire Alarm
Alarm - �-
7usp'd Ceiling
`'oof
Misc: - -- - - -------- ----
AS PART FAIL
PLUMBING
Post R Liearti __—
tinder Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL_
MECHANICAL_
Pnst& Beam -- -- -- --
Rough In
Gas line - -
Smoke Dampers
Final - - - -
PASS PART FAIL
ELECTRICAL - -- --
Service
Rough In
UG/Slab
Low voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading - - -�-- -- -- — —}--
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE _- _ [ ] Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date . -/_ Inspectors ,Ext 'Z
Final -
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 _
8UP _
—Data Requested_//// G AM PM BLD _
Location-/ Z .3„3 5 w 14��� �•� /11 _ Suite MEC
Contact Person — _.! _ PhPLM
Contractor — — — Ph —_ SWR —._--_----
Tenant/Owner ELC
Retaining Wall ELR ----
F ooting Access:
Foundation FPS
Fig Drain SGN
Crawl Drain Inspection Notes: - —
Slab ---- ----- ---- - -- --- SIT
Post& Beam —
Fxt Sheath/Shear
Int Sheath/Shear
Framing - /i0�'1, ��rC Ti, c.r, f na Gt�i��o� rd G r✓� /3tn
Insulation / T�
Drywall Nailing 7T j`19 * O -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -.----- /'>>'c�Ar� , �r,� �. .,� // A��'r d� c✓—
L�
Roof
PASS PART CFAIL Jj ��' - r•+ or��c `� - —
PLUMBING
Post 6 Beam -
Under Slab i
Top Out ------__--------- -� �.
Water Service - -- - — /'i (���t c'� by %� p a J5
Sanitary Sewer
Rain Drains --
Final
PASS PART FAIL
ICV
Post & B el
m —
Rough In
Gas Line ---- - -------- -- - __-_ -
Smoke Dampers
PASS PART FAIL
Service
Rough In ------._.. - -
UG/Slab _ ----- --- - — ----- --- ---- —-
Low Voltage
Fire Alarm
PASS PART FAIL
SITE
Backfill/Grading --------.-_.._ ------___-- -�.—_ --------- _-_
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection ftF. _ _ _ - [ Unable to inspect no access
ADA
Approach/Sidewalk Date � w Inspector� Ext-��
Other -- -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST1 -6016
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -----�
BUP � V
_Date Requested_ � `* _ _AM_ PM �_- BLD
Location. 3 S! �( tiJ ____ fi�� _ Suite _ _ MEC
Contact Person „— Ph PLM
Contractor Ph SWR
BUILDING Tenant/OwnerELC
Retaining Wall — v ELR _
Footing Access:
Foundation FPS
Ftg Drain - SGN
Crawl Drain !nspection Notes -- ----
Slab SIT
Post&Beam -----
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing ---- -- ------------ ---------------- --
Firewall
Fire Sprinkler -— --- -- - -- ---------_-
Fire Alarm
Susp'd Ceiling — -- --- --- — - -- —
Roof
Misc: - -- --- -
Final
PASS PART FAIL --
PLUMBING Q / _�S -
Post&Beam
Under Slab
Top Out -
Water Service _
Sanitary Sewer -
Rain Drains
Final
PASS PART FAIL
MECHANICAL __--
Post&Beam -- -- —.
Rough In
Gas Line - - -- ---- ---
Smoke Dampers
Final -- --- --
PASS PART FAIL
;r,rvice
Rough In i
1 i�;ISlab
I ow Voltage --
i ire Alarm
F
PAS PART FAIL -- --- ---- --- - --
Bac..kfill/Grading --- --- - - ------ -
Sanitary Sewer
Storm Drain [ ]Reinslicction fee of$ -_ required before next inspection. Pay at City Hall, 131,25 SW Hall Blvd
Catch Basin call fof reins_er tion RF Unable to inspect - no access
Fire Supply Line [ 1 Please P- ' —_ [ 1 P-
ADA
Approach/Sidewalk //
Other Date �- _�__��_L_ ---- Inspector r/�L-l— c�E'_!�_ .�_Ext
Final
PASS PART FAIL_ DO P1OT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST 2sv -v al '7
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
// BUP
—_ —Date Requested 2:2� —_ AM PM _ BLD
I-ocation�2 Z Sw �ti/��w —___— Suite _ MEC _ —
Contact Person _ , Ph L PLM --
Contractor— _ --__ Ph SWR
BUILDING Tenant/OwnerELC
Retaining Wall — ELR
Footing Access: -
Foundation FPS
Ftg Drain 0' 1 SGN ----- -
Crawl Drain Inspection Notes: — -- -----
SlabSIT
Post& Bean') ___-_--- -------------______—_---_ ---- ---_-- - - -
Fxt Sheath/Shear
Int Sheath/Shear
66j-
F raming - ( -'r`—
'� -
Insulation
Drywall Nailing 1_ l.t = � •4-- �� ch - -
Firewall
Fire Sprinkler - �'� � c— gp'c GtNc�-cam _--
Fire Alarm
Susp'd Ceiling --
Roof
Misc: - ------- - - --- -_-�-
f ural
PASS PART FAIL ---- ----- -- ------ — - - - ----
Post 8 Beam _—_----
Under Slab
fop Out
Water Service
Sanitary Sewer —
Rain Drains
PASS , PART FAIL
NLE.GKANICAL - -- -.-�- ---
Post ft Heant --- --- ---- ---
Rough In
GasLine ____.----.___- __. ._____..____.._- ...___.___...
Smoke Dampers
Final --- - --- ---
PASS PART FAIL
ELECTRICAL -- -- ------ - -- ------ ----- ----- ------ ------- -
Service
- - --- -Rough In
In
UG/Slab
Low Voltage
Fire Alarm - - -- - - -
Final
PASS PART FAIL
SITE
Backfill/Grading --- - - --
Sanitary Sewer
Storm Drain ( ] Reinspection fee of$---_- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I ]Please call for reinspection R[: _ ( ]Unable to inspect no access
ADA
Approach/Sidewalk -T � �-0 ���.�
Other Date _ inspector � —Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.