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12348 SW HOLLOW LANE N W A oo f0 G Z O O r fu I, I 12348 SW Hollow Lane w� \ CITY PERMIT `, ITY OF TI ARD PERMIT #: MST2002-00119 DEVELOPMENT SERVICES DAT ISSUED: 2/20/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 333-4171 SITE ADDRESS: 12348 SW HOLLOW LN PARI"EL: 2S103C13-07300 SUBDIVISION: QUAIL_ HOLLOW - EAST ZONING: R-4,5 BLOCK: LOT: 022 JURISDICTION: TIG REMARKS: SF Path 1 BUILDING REISSUE: STORIES: 2 FLOUR AREAS REQUIRED SETBACKS REQUIRED _ CLASS OF WORK: NF.W HEIGHT: 23 1IRST: 1.570 at BASEMENT: of LEFT: 20 SMOKE DETE�WORS. Y TYPE OF USE: OF FLOOR LOAD: 40 SECOND: 1 620 sl GARAGE: 45 at FRONT: 5 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINSSMENT: of RIGHT: 2.1, VALUE: S 300,820 80 OCCUPANCY GRP: R3 BDRM: 4 BATH- 3 TOTAL: 3,190.0. of REAk: 5 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: k,'IN DRAIN: n: TRAPS; LAV.ITORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 OF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 3 GARBAGE DISP: 1 WATeR HEATERS: 1 WATER LINES: 100 13CKFLW PREVNTR: 1 GREASE TRAPS: -�_ MECHANICAL DTHER FixTURES: FUEL YPES FURN<10OK: BOIUCMP<3HP: VENT FANS: 5 CLOTHES URYER 1 GAS FURN>-100K: 1 UNIT HEATERS. HOODS: 1 OTHER UNITS: i MAX INP: btu FLOOR FURNANC'S: VENTS: i WOODSTOVES: GAS OUTLETS: I _ ELECTRICAL RESIDENTIAL.UNIT SERVICE FEEDER �I:Ml-SRVC/FEEDERS - BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 snip. 0 200 amp: WISVC OR FDR: 1 PUMPIIARIGATION: PER INSPECTION: EA ADD'L SOOSF: 6 201 400 amp: 201 •400 amp: 1st WIO SVCIF'H: 00 RIGNIOUT LIN LT: PER HOUR: LIVITED ENERGY: 401 60,amp: 401 600 amp: EA ADDL Bit CIR: SIGNAL/PANEL: IN PLANT: MANU HWSVCIFDR: 601 • 1000 amp: 601+amps•1000v: MINOR LABEL: 1000+amp/volt Reconnect only: PLAN REVIEW SECTION f >-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREA/SPC OC_ ELECTRICAL-REs7RICTED ENERGY A.OF RESIDENTIAL _ S.COMMERCIAL AUDIO r1 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH SOLER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER CLOT A: INSTRUMEMTATION: MEDICAL: OTHR: HVAC: DATWELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contrr, 'or: TOTAL FEES: $ 5,498.37 DON MORISSETTE CUSTOM HOMES DON MORISSETTE HOMES This permit is subject to the reo;ilations contained in the 4230 GALEWOOD STE#100 4230 GAL EWOOD STREET Tigard Municipal Code,State of OR. Specialty Codes a id LAKE OSWEGO,OR 97035 SUITE 100 all other applicable laws. A.work will be done in LAKE OSWEGO,OR 97035 accordance with approved plans. This permit will expire If work Is not started within 180 days of IssuancA,or if the work Is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Req#: 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 d, Post/Beam Mechanica Ftng Drain Bsm't Walls Framing Insp Gas Fireplace Electrical Final Sewer Inspection Underfloor insulation Mechanical Insp Sear Wall Insp Insulation Insp Mechanical Final Footing Insp Crawl Dra!n,uackwater Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final Foundation Irsp Footing/Foundbflon Dr; Electrical Service Low Voltage Water Line Insp Final Inspection Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Appr1Sdwlk Insp Issued By Permittee Signature : y•__ i_�24��.h Call (503) 639-4175 by 7:00 p.m. for an Inspection needed the next business day �\ CITY OF TIGARD SEWER CONNECTION PERMIT CEVELOPME'A JT SERVICES PERMIT#: SWR2002-00091 13125 SW Hall L!Ivd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/20/02 SITE ADDRESS; 12348 SW HOL LOW LN PARCEL: 2S103CB-07300 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5 BLOCK: LOT: 022 _ JURISDICTION: TIG TENANT NAME: U-JA NO: FIXTURE UNITS: CLASS OF WORK. NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL i YPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection Owner: FEES DON MORISSETTE CUSTOM HOMES Type B Date Amount. Receipt 4210 GALEWOOD STE #100 _ LAKE OSWEGO OR 97035 PRMT CTR 2120/02 $2,300.00 27200200000 INSP CTR 2/20/02 $35.00 27200200000 Phone: 503-387-7538 Total $2,335.00 Contractor: Phone: Reg #: '+ Required Inspections This Applicant agrees to co,.iply 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 fee! 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 (503.1639-4115 by 7:00 P.M. for an inspection needed the next business day Building Permit Application City Of Tigard nate received: ,2 �� �r Permit no.: y -n C Address: 13125 SW hall Blvd,Tigard,OR 97223 P*oject/appl.no.: Expire date: a Phone: (503) 6394171 / " We issued: By: Receipt no.: Fax: (503) 598-1960 1 rr. Case file no.: Payment type: Land use approval: 1&2 family:Simple Complex: U I &2 family dwelling or accessory U Commerciai/i-.dustrial Q Multi-family New constn.cticm U;T.—. moltrum t U Addition/alteratioti/replacement U Tenant imprc cement ❑Fire sprinkler/alarm U Other: Job address: C Bldg.no.:I-ot: Block: Subdivision: ,� t �' Tax tnap/tax lot/account no.: /p � .O;/_q o6 Project name: Description and location of work on premiscs/special conditions: Name: 1f r Mailing address: tv Q S4 II &2 family dwelling: City: a State ZIP: J Vaivation of work........................................ $ 00 6��. Y G Phone: Fax: 7 -7 :mail: No.of bedrooms/baths................................. Owner's representative: Total number of floors................ ................. Phone: Fax: E-mail: New dwelling area(sq,ft.) . Garage/carport area(sq.ft.) ....................... Name: i Covered porch area(sq.ft.) ......................... 31 3 Mailing address: co Deck area(sq.ft.)........................................ City: State: ZIF: Other structure area(sq ft.)......................... Phone: F1x; E-mail: Commercial/indtntrial/multl-family: Valuation of work..................................... Business name: -� Existing bldg.area(sq.ft.) .........c. .....Z _ Address: — New bldg.area(sq. ft.) ..................... ........ Number of stories City: _. ......................... ....... .... ..-- Y' State: ZIP: Phone: -- Type of construction....................... Fax: E-mail: . CCB no.: —� Occupancy group(s): Existing: City/metro lic,no.: �— New: _ Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: ti V Y W provisions of ORS 701 and may be required to he licensed in the Address: �(, J `— jurisdiction where work is being performed. If the applicant is Citz: State: ZIP: exempt from licensing,the following reason applies: Contact person: Plato no.: — Phone: I E-mail: -- _ Name: Contact person: Fees due upon application ........................... S_ Address: Date received: State: ZIP: Amount received ......................................... E Phone: Fax: E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all juds&uow.tiro croait cards,ptew call jmUdktion for more inrormatlon attached checklist.A Aprovisions of I�w'sca nd ofinances governing this l]Viaa U MasterCard work will be con 1 wr ,whetherifi aTa or no Credit card numberAuthorized si natu 1te: 1 ` IX — ane or cardholder is shown on c t card Print name: S Cudbolder signature — Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4617 ctyaoCoMi One- and Two-Iiamily Dwelling Building Permit Application Checklist Ret ere nce.iu.. Associated permits. CityujTigard ( lt of rl and y � O Electrical O Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other _ Phone: (503) 639-4171 Fax: (501) 598-1960 ARE -011 PLAN RFYIIFW. I Land rue action.,completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.H(x)d plain._~( m 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 Solls report. Must carry original applicable stamp and signature on file or with application. _ 9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 J. Complete sets or legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes.Lateral design details aatd connections must be 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 t/ if copyright violations exist._ J� 1 i Site/plot plan drawn to satle.'fhe plan must show lot and building setback dimensions;property comer elevations(if there is more than a O4 elevation differential,plan must show contour lines at 24l,inten•als);location of easements and driveway;footprint of structure(including decks);location of wellshwptic 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,rtxif 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, v fireplace construction, themral 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 locations;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 walla.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 he stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review.JURI , ` r` 23 Five(5)site plans are required for Item I I above. Site plans must be h 1/2" x 1 I"or 11"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 �1I 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(&WCOM) Mechanical Permit Application Date received: Permit no.: City of Tigard Project/appl.no.: Expire date: Cityaf Tigard Address' 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: r By: Rrceipt no.: Phone: (503) 639-4171 Payment type: Fax: (503) 598-1960 Case file no.: YP _ Building permit no.: Land use approval: — i O 172family dwelling or accessory O Commercial/industrial 0 Multi-family O Tenant improvement juction 0 Addition/:dtcration/replacement O Other; 1 ! t WC1111 hi 121 TM M11A F, Job address: ;l C v `i 'tV�' Lice` Indicate equipment quantities in boxes below. Indicate the dollar Suite no.: value of all mechanical materials,equipment,labor,overhead. Bldg.no.: profit.Value S Tax map/lax lot/account no.: fit; Block; Subdivision: (, r yV' 'See checklist for important application information and jurisdiction's fee schedule for residential permit free Project name: -- b x t City/county: ZIP: _ s a i t b s tal' t Description and location of work on premises: - Fee(ca.) Total tM­criplian . Res.onl Resod Est.date of completionlinspection: _ _ VAC: Tenant improvement or change of use: Air handling unit CFM Is existing space heated or conditioned?0 Yes U No Air con it ng(site an required) Is existing space insulated?0 Yes 0 No Alteration of existing A system Bailer compressors State boiler permit no.: Business name: HP Tons BTU/H Address: r irdsmo ce dampen uct smoa etectors City: L State- ZIP: eat pump(site plan requir• ) _-- InstalUreplacefurnace/bur aer Phone: Fax: E-mail: Including ductwork/vent liner O Yes O No CCB no.: f= nsta rep ace/relocate testers-suspender, City/metro lic. no.:N/A t_ ''��--- wall,or floor mounted C Vent forappliance other than furnace Name(please print): C e elation: Absorption units— BTU/H ChillersHP — Name: = •_A1 [�-. Compressors � HP Addres r: w Gam_ r _ virommen exhaust an rent at on: City: _ State: 7_IP: Appliance vent _ Phone: Fax: F-mail: ere aust s,Type U lUres. lchc azmat hood fire suppression system Name: Yl _ I ' Exhaust fan with sin le duct(bath fans) aust sysb•m—aaart om eaun or A Mailing address: ) N+ ue pp pp ng anti distribution up to out ets) City: L T State, ZIP Type: LPG NG_ Oil Phony. 7 Fax: E-mail: ue i ing each ad itiona over out ets roetesspip ng(schematicrequired) Number of outlets Name; Other listed■pp ance or equ pment: Address -- Decorative fireplace __��------ State: ZIP: nsert-type City: stovdpelletstove Phone: F1x: _ --mail: Other: 5 Applicant's sJgnatu' Uate: Wler: _ Permit fee.....................$ Not all junsdicuons accept credit cards,please call jurisdiction far mac nfonnatim Notice:This permit application Minimum fee................ (]visit L)MasterCard expires if a permit is not obtained plan review(at _ %) $ __----- Credit card number ___—____------ — E '- within Igo days after it has been State sutrharge(8%) ...S accepted as complete. TOTAL, Name of cardholder 4{Mown on credit cr S -1 S 440-4617(600WOM) cardholder siputure Amount 7; .i�a:stc Plumbing Permit Application Datereceived: Permit no.:111S ty. Cit of Tigard City b Sewer permit no.: Building permit no.: Address: 13125 SW Nall B vd,Tigard.OR 9722' -- Cid of Tigard Phone: (503) 639-4171 Project/appl.no.: Expire date- _ Fax: (503) 598-1960 Date issued: By Reccipt no.: _ Land use approval: Case file no.: Payment type: t O I &2 family dwelling or accessory O CommerciaUindustnal ❑ Multi-family O'•enant improvement ew construction 0 Addition/alteration/replacement ❑Food service ❑Other. t Tl I 7111MMt 1 Job address: Lt q7 �' �. \j f1 . Description Qty. E"(ea•) Total New t-and 2•family dwellings only: Bldg.no.: 5uiteMo.: _ (includes loo R.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Block: Subdivision: SFR(2)bath _ Project name: SFR(3) -- City/county: ZIP: Each additional bath/kitchen Description and location of work on premises: Site utilities: Catch basin/area drain Est.date of completion/inspection: DrywellsJleach tine/n, "t ftI) drain Footing drain(no.lin. . . Manufactured home utilities Business name __ onholes Address: Rain drain connector City; State ZIP: Sanitary sewer(no.lin. ft.) ff;Z2 fix Phone: 1' Fax: E-mail! Storm sewer(no. lin.ft) _- Water service(no.tin.ft.) CCB no.: Ll Z Plumb.bZreg- — Fixture or Item: City/metro lic. no.:N/A Absorption valve Contmctor'e representative signature Back clow preventet — Print name: V Backwater valve Basins/lavatory Clothes washer Name: Dishwasher Address: Dnnkrn fountains) City: State: ZIP_ Ejectorsisump Phone: Fax E-mail: E+t ansion tank Fimure/sewer cap c Floor drains/floor sinksmub _ Name (print): `— _ h Garbage disposal — Mailing address: _1 C Nose bibb City: 1 State ZIP: Ice maker Phone: - Fax: "]--M E-mail: Interceptor/grease trap _ Owner fnsta(ladonlFesidendal maintenance only: The actual installation Pnmens) 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: Sump Tubs shower/shower an Unnal Name: Water:loset Address. Water heater Cit} State: ZIP: Other. Flione:— —� Fax: Email: lolal Minimum fee............ Nd all junuLcuac oru cep credit cud%,plesu call lun"cuon fa mote mfonruaon Notice:This pe mit application _ Plan review(at _ �) $ S ------ ❑Visa ❑MasterCard expires if a permit is not obtained State surcharge(8%) .•••$ _--Credit card cud number within 180 day s after it has leen Expire% .TOTAL accepted as complete. """""""""..• Name u(cardholder u Chown onemin cant —� s �Cudholdet nVaiutt Amount _ 440-4616(605COM) Electrical Permit Application Date received:AL City Of Iigard Project/appl.no.: _ Expirerlate: City ofTit;ard Address: 13125 SW Ball Blvd,Tigard,OR 97223 Date issued: By: Receipt no,: Phone: (503) 639.4171 - - Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: t U 14 2 family dwelling or accessory O Commercial/industrial J Multi-famit.y ❑Tenant improveme+ r New construction 0 Additiotvalterauon/replacement ❑Other. __. I]Portia OORMO Jots address: 1. 1 V Bldg.no.: Suite no.: Tait map/tax lot/account no.: L.ot Block: Subdivision: )�, t l Pmjcct name: I Description and location of work on premises: Estimated date of completionffnspection: SCHEDULE Job no: Fcc Max Business name: 1—r— '� Description qty. (ra) 7btal ne.Insp New residential-single or multi-Curdy per Address: ) dwelling unit Includes attached garage. CityState: ZIP: Serviceincluded: Phone: 1 fax: I E-mail: 1000 sq.ft.or less 4 r Foch additional 500 sq.ft or portion thereof CCB no.: Elec. bus. lie. no: Limited energy,rmidential 2 _C°/� � --� Limited energy,non-residential 2 Each manufactured home or modular dwelling {� arure ojSupervising eleelrlelaan p rslred) Service and/or feeder 2 Services or fteders—Installation, Sup elect name(print) 1 rise no alteration or relocation: 200 amps or less 2 201 amps to 400 amps 2 Name(print): 401 amps to 600 amps _ 2 Mailing address: _1d _ 601 amps to 1000 amps 2 City: s State ZIP: Over lot)d amps or volts 2 Phone: - ' Fax: -�] mall: Reconnect only I Owner installation:The installation is being made on property I own Temporary services or feeders- which is not intended for sale, lease,rent,or exchange according to btstallation,alteration,orrelocadon: 200 amps or less 2 ORS 447,455,479,670,701. 201 amps to 400 amps 2 Owner's si nature: Date: 401 to 600 ams 2 Bench circuits-new,alterallon, or extension per panel: Name: _ _ _ A- Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: State: ZIP: B Fee for branch circuits without purchase 2 — -- of service or fader fee,first branch circuit: Phone: X. Email: Each additional branch circuit: PLAN REVIEW(Please check all that apply) Misc.(Service or feeder not Included): ❑Service over 22.5 arips-commercial U Health-cave facility Fick pump or imitation circle 2 0 Service over 320 amps-rating of 1&2 0 Hazardous location Each sign or outline lighting 2 familydwellings O Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel. 0 System over 600 volts nontinal more rr,%idential units in one structure alteration,or extension, 2 O Budding over am stones 0 Feeders,400 amps or more 'Description O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspe:lion over the allowable in airy of the above: O Egrus/ligh"ngplan O Other Per inspection r Submit__sets of plans witb any of the above. Investigation fee The above are not applicable to temporary constriction service. Other v Na all lurixl+cuons accept credit cards,please WI jurisdiction for m«e infonruunn Notice:This permit application Permi:fee.....................$ 0 Visa O MasterCard expires if a permit is not obtained Plan review(at — %) S Credit card numb" / / within 180 days after it has been State surcharge(896)....S fapires accepted as complete. TOTAL .......................S Name of cardholderr at mown on credit card S Cardholdet signature Amount 4444615(6WOCOM) DON - MORISSETTE 9 0 1A V 8 1 N C O R P 0 R A T 3 D 411 3 0 0 A L IT 0 0 0 BY 2 13 T 8 U I T 1 1 0 0 L A l 1 0 6W 9 0 0. 0 R 1 0 0 N 0 7 0 3 6 (303) 367 - 7630 FAX (303) 387 - 7616 OBE . 1975 LAT: 22 DATE: 2/8/02 PROPERTY: QUAIL-HOLLO't OPTION I ELEVATION CITY: TIGARD SCALE: 1"=20' ULAN No.: 170 t',' I It �`�tD'3C i'r1234,13 Sm HOLL Qt4�aa- OW LN. OAK TREE, N € U WHERE d O > ++ APPROPRIATE M N 0. 8 wi !D P-wer, COPi of r Zea F, filled blo-bege And hey 2 ~ I A05 eq. ft. 2 car ger. rJ 3,190 ecl• ft. ; 4 bdrm. 2 1/2 bath ' Q FF.E293.5' �� 1 = cone � Paur ' I � r� 291 94 692 294 LOT +212 500 eq. ft. CITYOF TI GARD _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2002-00' 06 13125 SW Hall Blvd., Tigard, OR 97223 (50:1) 639-4171 DATE ISSUED: 3129/02 PARCEL: 2S103C13-07300 SITE ADDRESS: 12348 SW HOLLOW LN SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4 5 BLOCK: LOT: 022 JURISDICTION: TIG____—_ ` CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: ft P.amarks: Installation of backflow preventer. _ FEES Owner: Type By Date Amount Receipt DON MORISSETTE CUSTOM HOMES PRMT CTR 3/29102 $36,25 27200200000 4230 GALEWOOD STE #100 5PCT CTR 3/29/02 $2.90 27200200000 LAKE OSWEGO, OR 97035 — — Total $:19.15 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 PLN1 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 Dales or direct questions to OUNC by calling (503, 246-1987. Issued By: - L {�.CC Pern-titice Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day PaumbingPermit Application City of Tigard Daterecelved: / ,,y ,•`,,� Permit no.: t Address: 13125 SW Hall Blvd,T� kou Sewer permit no.: Building permit no.: Ciry Tigard phone: (503) 639-4171 .,., Project/appl.no,: Expire date: Fax: (503)598-1960 Datcissued: R y:�•G Receiptno,: Lana use approval: +; Case file no.: Payment type: O 1 &2 family dwelling or accessnry ;;&;ffune'rciaUind tstrial O Multi-famUy ❑Tenant improvement ',New construction O Addition/alteration/replacement ❑Food service D Other, JOR'SliftEWORMATION Job addrss: ,� Description Qty. Fee(ea.) Total Bldg.no.: Suite no.: New I-and 2-fanrlly dwellings only: Tex maprtax lot/account no.: (includes 100 ft.foreach utility connection) ' SFR(1)bath Lot: c13 Block: Subdivi t ((z(� / clic: _ SFR(2)bath Project name:Ce.l rt-( / -O//,�tJ _ SFR(3)bath -1 City/county: l u to - u-'ac7 h. I ZIP: C D_ Each additional bath/kitchen Descittion and focati of _work on premises: _ SllteutWtles: �}r'.4c-0mk) o fWIC Catch basin/area drain Est.date of completion/inspection: /:' l;' ;> Drywe 1�ach line/trench drain Footing drain(no.lin.ft.) Manufacturrd home utilities Business name: .12' --7MJ S /)(Mccam, Z nC� Manholes Address:a9 f%C S W ain drain connector City: j f, Staleb ZIP: `70 d Sanitary sewer(no.lin.ft.) - Phone:foga-loo7rp alh Fax; -qg17E-mail: Storm sewer(no.lin,ft.) CCB no.: (e/3(p Plumb.bus.reg.,to: Water service(no.lin.ft.) City/metro lic.no.: r.)03,- 7 Fixture or Item: Contractor's represet,cative signature; Absorption valve L Back flow reventer 7 .S Print name: $ lhr7 zr Date: 3 [ Backwater valve Milt M Basins/lavatory_ Name: Elltnspa•t'n-tK? Clothes washer AddSSW KLn MAA M _Dishwasher City: W 11 94MW►11 C, State:Oft I ZIP: O Drinking fountain(s) -- —__FE_ectors/sum Phone:(AA•L-091b I Fax:(ogd-9'7 E-mail: I Expansion tank Fixture/sewer cam_ ' - -- Name(print):LSM fY16 _sv_f-fc, h f flry+W Floor drain fIvor sinks/hub - Mailing addre'as: ,4.3D W slew Wd S7- Garbage dis sal y Hvac Lr1Ll, _ City: La.a p . State: R, Z11'12034 Ice maker Phone: Fax: E-mat,. terse for ase trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me of 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) t Owner's si nature: Date: Sum Mel Tub&'shower/shower pan Unna; Name: 'ater closet Address: _ stet heater City: State: ZIP: Other. Phone: _Fax: E-mail: Total _ Na all Jnrt�lcdow accept aedit fs,please call jurlxacdo�for more Irtformadon. Minimum fee................$ r R' Notice:This permit application O Visa O MasterCud expires if a permit is not obtained Pian review(at _ °�, $ _ C,edit card number: ____ within 190 days after it his been State,surcharge(8%) ....$ � Nam Naof cardholder u shown on credit;and -- accepted as complete. TOTAL .......................$ i Cardholder stgnatura Amount 4.10.4616(6MC©M) PLUMBING PERMIT FEES: AL 16.60 Lavatory 16.60 One(1)bath _ $249.20 _ $350.00 Tub or Tub/Shower Comb. 16.60 Two 2 bath Shower Only '- 16.60 Three 3 bath $399.00 _ Water Closet 10.60 SUBTOTAL 'l+ 18ST ,80 8% ATE SURCHAR Urinal 18,80 PLAN REVIEW 25'/6 OF SUBTOTAL. 's •... :":a'6� Dishwasher _ TOTAL Garbage Disposal 16.60 Laundry Trey 16'60 Washing Machine 18.60 Floor Drain/Floor Sink 2° - 16.6 PLEASE COMPLETE: 3" - r 16.60 4.. 16.60 -_,.___� W,o�tK°PEr- Ottd Wslon O like kind 16,60 O conver ; 0 ater Heater 1, d Gas piping requires a separate mechanical ,Ly;' 'A w• em11t. 46.40 Sink MFG Home NOW Water Service Lavato MFG Home New San/Storm Sewer 46.40 Tub ar I ublShower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only 16.60 Water Closet Drinking Fountain Urinal Other Fixtures(Specify) 16.60 Dishwasher Garba a Dis osal Laundry Room Tray -- Washin Machine Floor Draln/Sink; 2" Sewer-lot 100' 55.00 3" Sewer-each additional 100' 46.40 4" 5500 Water Heater . - Water Service-1sl 100' Other Fixtures Water Service-each additional 200' 46.40 S eci -- Storm 3 Rain Drain-1st 100' 55.00 - Storm 6 Rain Drain-each additional 100'- 45.40 -- Commercial Back Flow Prevention Device 46.40 - "- _ Residential Backflow .55 Prevention Device' 18 2-7 - '60 Catch Basin 16 - - _- Inspectinn of Exleting Plumbing or Specially 72.50 Re nested Inspections erRtr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 85.25 --- no QUANTITY TOTAL Isometric or riser diagram is required If ---- Quarift Total is >9 _ "SUBTOTAL 8%STATE SURCHARGE 4 y0 "PLAN REVIEW 25%OF SUBTOTAL Req TOTAL J I r S *Minimum permit fee is$72.50*a%state surcharge,except Residential Backflow Prevention Device,which Is$36.23 4 a state surcharge "NII New Commercial Bulldings require plans with isometric or riser diagram and plan review. I:\dsts'forms\plm-fees.doc 10/10/00 CITY OF TIGARD 24-Hour E.'IILDING Inspection Line: (503)639-4175 MST I'NSPECTION DIVISION Business Line: (503)639-4171 BUI' � Received ^___ __.Date Requested___ J _ AM --PM BUP Location � �' ''c — �-U Suite -- MEC -- Contact Person __ —_ — Ph( ) PLM Contractor Ph( ) SWR BUILDING Tenant/Owner _ _ ELC Footing ELC - --- - Foundation Access: ELR r r Ftg Drain -R-�-�--- Crawl Drain SIT Slab Inspection Notes: Post&Beam —_ -- -- Shear Anchors Ext Sheath/Shear .--- Int Sheath/Shear Framing -- -- —_-- Insulation Drywall Nailing --- ----------— -- — - -- Firewall Fire Sprinkler -- - - Fire Alarm Susp'd Coiling Rcof Other: Final PASS PART FAIL PLUMBING - --- - Post& Beam Under Slab - -- - - - --_..- - Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan OthaL PART FAIL_ ANIC_AL Post& Beam Rough-l.i Gas Line Smoke Dampers — --- ---- Final PASS PART _FAIL -- ELECTRICAL Service Rough-In _ -— UG/Slab Low Voltage _— Fire Alarm Final L J Reinspection fee of$___ __required before next Inspection. Pay at City Hall, 13125 SW Hail Blvd. PASS PART FAIL 'SITE [� Please call for reinspection RE: Unable to inspect-no acces Fire Supply Line �1 ADA Date 1 �__1�.__—_ inspector Approach/Sidewalk Other:.--_ Final -� DO NOT REMOVII this InsPoetIOn roeord hoM the Job alto. PASS PART FAIL N O � 7 r, a O � � G 7 N O N O s � n e � 3 F � C C is CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-� /5 MST Z�'U 1 GL's// 9 INSPECTION DIVISION Business Line; (503)639-4,i71 BUP Received Date Requested— �__-. _- AM -___-_ _ PM --_-_ BLIP Location Z -3 yS--- ( `�� Suite _ _ MEC Contact Person -P ; - Ph( ) `222 q ?3:;? PLM Contractor - - -— --- ----- - Ph( ) _ SWr. - BUILDING Tenant/Owner ELC - Footing ELC Foundation Access: Fig Drain ELF! - - -- - -- Crawl Diain - Slab Inspection Notes SIT Post&Beam - -- Shear Anchors Fxt Sheath/Shear Int Sheath/Shear Framing -- -- Insulation Drywall Nailing - -- _— -- Firewall (� wl� j— �� - �M t;( J( C t e -7 Fire Sprinkler --�- Fhe Alarm I _ 3 fil Susp'd Ceiling - Roof - — Other: in SS RT FAIL os &Beam Under Slab -- - - Rough-in Water Service - - - Sanitary Sawer _ Rain Drains - --- -` Catch Basin/Manhole _ Storm Drain - -- Shower Pan _ Other: --- --- - ---- - — — na --- SS�PART FAIL ME_GHANICAL - - -- - ''ost It.Beam Rough-in - Gas Line Smoke Dampers Final PA$S.___ RT FAIL EJECIERCAL Service Rough-In - UG/Slab Low Voltage ------ ---- - - - --- Fire Alarm — Frnat Reinspection fee of$______ __-_ required before next inspection. Fay at,',ity Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE _ n Ple?ca caii for reinspection HE:-____---_—.-_— Ur,ahlP!o inspect-no access Fire Supply Line ADADate Inspector --- _ - Ext _ Approach/Sidewalk Other. Final DO NOT REMOVE this Inspection record from the job site. t PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection. Line: (503) 639-4175 INSPECTION DIVISION Business Line: (503)639-4171 BUP Received I_ Date Requested _-- L �_ AM -_ --- PM BUP Location [ �- U _..? _L'�- - -% -_.-Suite ___-_.____ MEC Contact Person — ..1...!..4AAa.V_C1 Ph( ) ?s` 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 _ 09 - - - - - Insulation -- Drywall Nailing --T - Firewall Fire Sprinkler -- ---- — Fire Alarm Susp'd Ceiling -- ------ -- - Roof Other: Final PASS_ PART FAIL PLUMBING - - Post& Beam Under Slab - - Rough-In Water Service Sanitary Sewer Rain Drains --- -- Catch Basin/Manhole Storm Drain - Shower Pan Other: Final PASS PART FAIL � -----_.---...__----- - - - ---- ---- MECHANICAL __- Post& Beam- Rough-In - ---- ."--- ------ - Gas Line Smoke Dampers - - - - - Final PASS PART FAIL -------_.----_ _---_-- _ ----. _- ELECTRICAL Service --- - ---�--- _---- Rough-In UQ/Slab Low Voltage Fire Alarm FAn.- Reinspection fee of -_____-required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S PART _ Please call for reinspection RE: LJ Unable to inspect- no access Fire Supply Line Q ADA Approach/Sidewalk �-C'_1 `b - Inspectpe -W-A-1 �' _ Fact - Other:_ __ i Final DO NOT REMOVE this Inspection record froth the Job site. PASS PART FAIL