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Page No. 1 CASH HISTORY FOR CASH ND.r M0T96-0393
HD1t.tRD L WHITLOW
13.64 SW MICHELIN CT
02/10/96
Action Description Req/ SOW Hid/ Action Nates Map By Update Upd
code Sent Done Done Date BY
------- ------------------------------ -------- -------- --•------ ---------------------------- - �--- ---- --- -----'--
MSTA005 Application received / / / / 0','/26/96 RRCD JD 06/07/96 BON
MSTA000 Permit Created / / / / 06/07/96 FRND B 09/07/9F BON
META^12 Plans routed to Plane Rxaminar / / / / 06/07/96 PRM B 00/07/96 BON
MSTA026 Plans approved by Plana Ram- / / / / 00/09/96 PASS RT 06/09/96 BT2
MA-w030 Reviewed plans routed to DSTS / / / / / / 00/07/96 BON
K.iTA055 Hold Release / / / / 10/21/97 s nohow this came Is on hold for a stop PAas JH 10/21/57 J•H
work withcwit ■ stop work action -777
M9TA060 (F) Ready to issue / / / / 00/13/96 PASS CJS 06/13/96 CJD
MSTA092 (F) Issue combination permit / / / / 09/14/96 FABS JRD 00/14/96 JD
MSTA097 Issue plumbing signature form / / / / 06/14/96 PASS JSD 06/14/96 JD
MSTA099 Issue eletrtric signature forty / / / / 00/14/96 PASS JSD 00/14/96 JD
M9TA705 Footing Insp / / / / 10/29/96 N-1- maintain three inches clsaran^e A/N RS 10/31/96 KBa
under reinforcing steel
N-2- isolated piers not included this
inspection
M-3- t remove any soft material prior to
placement of concrete
MSTA706 Foundation Inep / / / / 11/04/96 usa 10-20 PASS RE 11/04;96 PS
MSTA710 Poat/Beam Structural / / / / 12/09/96 each/ i plumbing not installed yet- ok FAIL RD 12/09/96 RE
for decking only at F' of headroom
height; add nails irr. hangers w/in
garage; poet bracket not secured yet w/
bolts; straps req'd at se.-oral locations
at plate line off-sets; etude missed at
rear roome against foundation wall;
remove wood debris; drain water from
crawl space; gussat posting udder-floor;
bearinq studs missed at rear wall
supporting triple 2x, glu-iaa, etc.
H
N MSTA710 Post/Beam Structural / / / / 12/11/96 pandins- straps at platen-haame; PASS RB 12/11/96 RB
positive connect beam at poet in garrge;
_ Do NOT DRCR BRFORR PI,t1MBTM t1NDf;R-r./D0R
IM INSPRMONI
u OT'HRR ISSURS OF 12.9 INBPP ,:ON STILL
_j HIT DONE- W+:_ �nOCCR AT FRAMING
MSTA711 Poet/Beam Mechanical / / / / 02/26/97 PASS " 02/26/97 1CAS
MSTA713 Crawl nrain / / / % / / 06/07/96 IYMN
MSTA717 PIM/underfloor / / / / 12/16/96 PASS MS '2/17/96 MRS
Page No. 2 CASE HISTORY FOR CASE NO.: M8T96-0393
EDWARD L WHITLOW
13664 SN MICHELLE CT
02/10/96
Action Pencripticn Req/ Srhd/ End/ Action Notes Dimp By Update UE,d
colo Bent Dme Done Date By
MOTA730 Mechmni C:Al Tnsp / / / / 02/26/97 seal joint of heat duct in garage; FAIL Pa 02/26/97 KAS
cosplete gas piping at fireplace i add
shut-off valver exhaust venting
disconnected; insulate heat duct at
register in master bedromi at location
of upstairs hall closet- nail plate
protect duct.
MBTA720 Mechs�'_4a1 Insp / / / / 02/27/97 Add soffit members at soffit for gyp FAIL EB 02/27/97 RP
nailing; meal heat duct at scall garage
orening; exhaust venting disconnected-
upstairs bathrooms; nail plate protect
duct upstairs closet; seal joint of
fireplace venting stacks.
MSTA720 Mr:hma.ical Insp / / / / 03/03/97 seal firepl;:ce venting at joints p1m RB 07/03/97 RB
MBTA720 Mechanical Inap / / / / 03/OS/97 seal fireplace venting at joi,ntm PENn RE 01/05/97 FA
reinspect fee to be charged if not
cospleted next inspection.
MSTA720 Mechanical Insp / / / / 03/07/37 PASS RB 03/07/97 RB
MSTA722 Plumb Top Out / / / / 02/24/97 no toot FATT, MS 02/2%/97 MPS
M13TA722 Plumb Top Out / / / / 02/2S/97 PASS MS 02/26/97 MRS
MSTA723 Blectrical. Service / / / / 02/26/97 EXTEND BE CONDUIT TO MIN 16"BRLON PIN DIS CS 02/26/97 CRS
ORD: USR ANTISIBL COMP ON AIAJ CONDUCTORS
IN PANEL; NM 0R IS GM-RAN ORM SCREW IN
PANEL; MOULT': SMR DET IN MSTRHD ON UPPR
GRIL; INSTALL SMK DRT SOME PLACE ON MAIN
IJWHI, Ot1TSTDR OF STAIR ENCLOSURE; PUTO
NEEDED ON WALL ERHIAD SINK BY PTRBPL
Q
a NSTA723 Electrical Service / / / / 02/26/97 as conduit still needs to be 161 min APP AS 02/26/97 CRS
N below grade
MSTA724 Electrical Rough In / / % / 02/26/97 SHE RLRC SERVICE DIS W 02/76/97 ORS
m M4TA724 Electrical Rough In / / / / X1/26/97 APP Go 02/1q/97 RES
W
Page Na 7 CASE HISTORY FOR 1A96 NO. M0T96-019!
RDIIARI) L NHITL
13664 SM MICHILLR r"
02/10/94
Asti<m Des-riptlon Reg/ Schd/ Rnd/ Action Notes Di.ap By Update LW
Cade sent Dan, Done Date By
M.9TA725 Framing Insp ( / / 03/03/9"' me--h issue; shear +_ssue; re-support PHIL RB 01/03/97 RB
notched floor joist at alcovr, of garage;
support stair stringers; replace urtched
floor joist at laundry rune; violated
floor joist in kitchen- square holes
w/in bottom 2" of edge- re-aapport
joist; strap plates wnere marked; 2Fe
floor /ceiling joists (for attic)
over-spanned= allowable 1011" double
joists; ventilate vaulted rafters at
main 4 upstairs; nail plate wiring den
location w/floor joists- holes bored
w/in 2" of bottom edge.
MSTA725 Framing Insp / / / / 03105/4'1 mach issue; notched floor joist at RAIL PP 03/0G/07 PS
laundry greater than d/6. replace or
obtain engineering; strap plates; nail
plate protection; dr wall shear a" need
blocking if gyp to be applied
horizontal.
MSTA725 Framing Inap / / / ( 03/07/97 PASS RB 03/07/97 RB
MSTA726 Shear Nall Insp / / / ( 02/27/97 HD-10A missing at entry; FAIL RB 02/27197 R9
HTT-22 HD1s missing at L.R.
Drywall Ahem- marked
HTT-2' a Hr's missed .t basement
NSTA726 Shear Mall Inap / / / / 02/2e/9' drywall shear; HD's not installed at PAIr, RB n2/2e/97 RB
time of inr;pection.
MSTA726 Shear Nall Insp / / / / 03/03/97 pending- dr/wail shear at all marked PARR RB 03/03/97 RB
locations
0.
ti TA727 Low voltage / / / / / / 09/07/96 BON
LGy� MSTA735 'Ian Line Insp / / / / 02/26/97 0 pressure FAIL RB 02/26/97 KAB
MSTA735 Gan Line Insp / / / / 02/27/97 PASS RP 0?/27/97 RB
al NSTA740 Insulation Insp / / / / 03/12/97 pending- insulate bottom pan of RA in PARS RB 03/12/97 RB
(7 soffit w/in garaq .
tirestop thru penetrations thru out
(marked)
chink windows/doors (marked)
provide vapor barrier at main entry
MSTA745 Gyp Board Insp / / / / / / main floor- marked SHRR 02/37/97 RB
garage rear wall
' •
Page No. 4 CASK HIBTORY FOR (ASR NO.: MST96-0393
EDWARD 1, WHITLOW
13664 3N MTCH1:;d.R CC
02/10/96
Action Description Req/ schd/ Rrtd/ Action Notes Diep By ];Iodate tlpd
code sent Done Done Lite 91•
------- ------------------------------ - ------ -------- ----------------------- ---- --- - --- _-..
OWA749, O1yp Board Inap / / / / 0:4/19/97 not readyl FAIL RB 03/19/97 RD
MSTA745 Gyp Board Insp / / / J 03/21/97 pendinq- resupport b-vent; b-vent PASS RB 03`21/97 RD
clearance regld; nail eeilinv w/in
alcove of garage; add wheat, :.ailing
behind each equipment in garage.
MSTA755 Rain drai.r Insp / / / / 11/13/96 around house ok PASS MS 11/14/96 MRS
MSTA760 Water Line Insp / / / / 02/10/97 PA-99 K9 02/11/97 MRS
MSTA765 Appr/edwlk Insp J / / / 05/06/97 NOT READY DIA PT 05/07/97 RA
MSTA765 Appr/Sdwlk Insp 06/25/97 / / 06/19/97 1. Bring up black ABS pipe into curb. FAIL MH 06/29/97 S-W
2. Maintain 3/4" - 1" lip at driveway
entrance.
MSTAIA5 Appr/Bdwlk Insp 09/05/97 / / 09/02/97 FABS MH 09/05/97 S•W
MSTA765 Appr/Sdwlk Insp / / / / 10/21/97 Final looks okay. FASB MIs 10/23/97 S*W
MSTA770 Misc. Inspection / / / / 01/10/97 encroachment of upper level structure at RNCR RA 01/10/97 R9
waster bath into setback
K9TA790 Rl p trical Final / / / / 06/29/97 Approved pending correction: PASS BRP 09102/97 J•H
1. Flex conduit under cook-top must be
re-routed to prevent physical damage.
MOTR: Most device plates have been
caulked to wall. I can't remove them
without damage to finish.
MSTA795 Mechanical Final / / / / 09/04/97 1. Discharge on vent moat have same site PAIL RC 09/b9/97 J*H
at duct size.
2. AC must have 3-in. clearance from
earth.
a3. Vert must be secured against
displacement.
P1.9TA795 Mechanical Final 10/21/97 / / 10/17/97 PATI, RA t0/21/91 J•11
m MSTA795 Mechanical Final / / / / 10/23/97 PASS RA 10/23/97 RD
MSTA797 Plumb Final / / / / 06/13/97 sewer c,o7 FAIL K9 06/13/97 MRD
main stmt off valve?
MSTA797 Plumb Final / / / / 06/.tJ/9'7 Wote: Sanitary Sower Cleanout 4 Mair. PASS RAA 06/29/97 J*H
Water Shutoff Just Inside crawl Access.
Page No. S CARR HISTORY FOR CAJR NO.: HMPS-0393
RDNARD L NHITW"
13694 AM MICHRLLR CI
02/10/9•
Action Description Req/ A,.hd/ Rnd/ Action Notes Disp By Update Upd
Code Bent: Doue Dane Date By
------- -------------------------- --- -------- -------- -------- ---------------------------------------- ---- --- -------- --_
NOTA799 building Final / / / / 09!04197 1. All wood in contact with earth or FAIL RC 09/09/97 ,1-"
concrete oust be pressure treated.
2. Ground stet slope away from building
for 6-ft. a: 1/4-in. per foot.
3. All siding must have 6-in. clearance
from earth.
4. Miniaunm width of stnirway is 36-in.
6. Handrail suet be continual from
bottom to top of stairs.
7. Fill all holes in garage wall/ceiling
with approved material.
S. Minimum access size to underfloor is
IR-x24"
9. Provide permanent ladder for
underfloor area.
10. Must have each. approval before
building final - DO NOT OCCUPYI
NSTA'-,9'a Building Final 10/21/97 / / 10/17/97 i. USA erostun final required- mm RH 10/21/97 J*M
2. B-vsnt clearance required at garag:•
ceiling. See 3/21/97 notes under gypsum
inspection.
3. Approach i Sidewalk approval
required
!. Pinish grade/elope.
S. Ccnfi.m B-vent size through roof.
MSTA799 Buildinq Final / / / / 10/23/97 PASS RB 10/23/97 RD
MSTA799 Building Final / / / / 10/22/97 items 2, 3 6 S approved from inspection FAIL RC 10/30/97 J•H
on 10-20-97 and iters 1 i 4 not
approved.
KITA960 (F') Issue Cert. of Occupancy / / / / 10/23/97 mailed 2-10-93 jr 02/10/90 S-N
M,TA970 Case Fir.aled / / / / 10/23/97 PKSS RB 10/23/97 RH
M3TB709 Rroeijn Control / / / / 10/22/97 PARS USA 10/23/97 RB
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)5394171
CERTIFICATE OF
OCCUPANCY
PERMIT M. . . . . . . a MST96-039.:,
DATE ISFUEDt 10/23/97
PARCEL.a 2na 104CA-0`POO
SITE ADDRESS. . . : 13634 SW MICHELLE CT
SUBDIVISION. . . . a HILLSHIRE ZONINOaR--7 PD
BLOCK. . . . . . . . . . a LOT. . . . . . . . . . . . . oO52 JURISDICTION:TIG
CLASS OF WORK. a NEW
TYPE_ OF USE. . . a SF
TYPE OF CONSTR:'SN
OCCUPANCY GRP. :R3
OCCUPANCY LOADe2
1?emarks a Path I
Owners _._._.._.._._._-..__.__-_..___._.______�___......,._..�
EDWARD L WHITLOW
16646 SW AMY LN
BEAVERTON Oft 9: 007
Phone Me 591-5380
Contractor: --- _ _ _..._.. ..._..__.._.____ _.._ ._ .__....._._._
HEYDON HOMES
EDWARD L WHITLOW
16646 SW AMY LN
BEAVERTON OR 97007
Phone M: 591-5380
Reg 11. . : 000865
This Certificate grants occupancy of the above referenced building or, portion
i thereof and r_onfirm% that the building has been inspected for compliance with
+;he State of Oregon Specialty Codes for thei-".' N'
occAmancy, and LISP tAnder
�"-hic:h the �^1ferenc^ed permit was isaueo.
r� NU I LD I N13 INSPECTOR B-L IFF I C I Al.
F^
J_
m POST IN CONSPICUOUS PLACE
�a
�a
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Linc: 639.4175 Business Phone: 639.4171
Date Requested (2- 319 _ A.M. _ P.M. MET: �3
� c -
(oxs3
lion: BUP:._._
i errant: _ — Suite: / Bldg- _
(h m!r-. Phone WC:
Phone: 5 ( s`�� PLM:
Contractor.— —
_ --_--
ELR:
SIT:
BUILDING BLDG(con't) PLT'MBING MECHANICAL L--- ELECTRICAL SITE _
Site Post/Beam Pr.st/Beam Post/Beam Covr.T/Servlce Sewer/Storm
Footing Roof IJndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top(Nd Oas Line Rough-in UG Sprinkler
roundation Insulation Sewer Hood/Duct Recomwct Vault
Bsmt Damp Drywall Storm Furnace Temp Service Misc.
Masonry Ceiling Ra [rain A/C IJO Slab
Shear/Sheath Fire Spklr/Alm Crswl/Found Dr Heat Pump Low Volt
v Approved pprov Approved Apprrved
Appr/Sdwlk mwoved Not Approved ved Not Approved Not Approved
FINAL FINAL FINAL
�Sati�s \M S4
U
O Call for reinspection O Reinspection fee of S_ required before next in.4pection O Unable to inspect
-7 ,y /��
Inspector: -- Date: l Gr' 1 Page of—
CITY OF TIGARD PERMIT *HERMIT. . : MST960393
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/14/96
•13126 SW Hall Blvd.Tigard,Oregon 9722:06199 (5011639-4171
PARCELi rS104CA-05200
SITE ADDRESS. . . : 13684 SW MICHELLE CT
SUBDIVISION. . . . : HILLSHIRE 7.ONINGt R-7 FAD
BL.UC'�. . . . . . . . . . . LOT. . . . . . . . . . . . . :050'
Remarks: Path I
------------------------------------------------------------- BUILDING -------------_�—_-------------
REISSUE: STORIES........ 2 FLOOR AREAS-------- BASEIENT...: 0 sf RUOUIRED SETBACKS---- REQUIRED------
CLASS OF WORK.INEW HEIGHT........: 31 FIRST..... 151E of GARAGE.....: 927 sf L.EFT..........s 5 SMOKE DETECIRS: Y
TYPE OF USE...:SF FLOOR LOAD..... a1 SECOND...: 954 0 FRONT.........t 21 PARKING SPACES: l
TYPE OF CONST.:5N LINELLING UNITS. 1 FINBSMENT: 8 it RIGHT.......... 9
OCCUPANCY GRP.:R3 BOM: 3 BATH: 3 TOTAL-----.-: 2456 sf VALUE..1: 17451 REAR..........: 40
-------_ -------------------- --------- __ ------------ 11-UMB'N6 -----__—_------- ---------_ __ --------________SINKS......... 2 WATER CLOSETS.: 3 WASHING MACH..- I LAUNDRY TRAYS,t 1 RAIN DRAIN ft: 0 TRAPS.........: 8
LAVATORIES..... 4 DIS M011ER5...: I FLOOR DRAINS..: / SEWER LINE ft: 1 SF RAIN DRAINS: 1 CATCH BASIL..: 1
TUB/SHOWERS.... 3 GARBAGE D1SP..: 1 WATER HEATERS.: 1 WATER LINE ft: 111 BCKFLW PREVNTR: I GREASE TRAPS..: 1
OTHER FIXTURESt 0
-------------------------- MECHAN;CAL ----------��_._�FUEL TYPES TYPES--------- FURN ( 118K ..: 0 BOIL/CMP ( 3HPs / VENT FANS...... 4 CLOTHES DRYERSt 1
/GAS; / / FURN )=IOW ..: 1 LIMIT HEATERS..: o HOODS.......... 1 OTHER UNITS...: 1
MAX IIP.: 1 BTU FLOOR FURNACES: 0 VENTS.........: B WOODSTOVES....: 1 GAS OUTLETS...I 1
--------------—----------------------•------------------------ ELECTRICAL ------------__--_-- -- --------__-----------------
---RESIDENTIAL UNIT--- --SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS-- ----MiSCELLANEOUG---- --AUD'L INSPECTIONS--
1008 SF OR LESS: 1 0 • 200 amp..: 8 0 - M. amp..: 0 W/SVC OR FOR..: 1 PUT-/IRRIGATION: 1 PER INSPECTION: 0
EA ADD'L 5815F.: 5 211 - 400 amp..: 0 e01 - 400 amp..: 0 lit W/0 SVC/FOR: 0 SIGN/OUT LIN LT: 1 PER HOUR..... ,: 0
LIMITED ENERGY.: 0 401 600 amp..: 0 401 - 600 amp..: a EA ADDL BR CIR: 0 SIGNAL/PANEL...: 1 IN PLANT......: 0
MANF HM/SVC/FDA: 0 501 1110 amp.: 0 611+a2ps-1111 vs / MINIR LABEL -11: 0
1080+ amp/volt.: 0 —_--_ - ------------------------- PLAN REVIEW SECTION ---------------------------------
Reconnect only.: 0 )z1 RES QUITS..: SVC/FDR)-225 A.t 1 MO V NOMINALt CLS AREA/SPC OCC:
-------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ------------------------A. SF RESIDENTIAL_._ B. CUIEACIAL------ --- --------------- ------- ------------------------- --- -----
AUDIO i STEREO.: VACUUM SYSTE" .: AUDIO I STEREn.: FIRE ALARM...... INTERCOM/PAGING: OU1:9OR LNDSC LT:
BURGLAR ALARM..: OTH: :: X BOILER.........: HVAC...........: LANDSCAPE/I RRIG: PROTECTIVE SIGNI.s
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION- MEDICAL......... OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL t SYSTEMS: 0
Owner: -----------------------------------Contractor: -------------- --- ------ TOTAL FEES:$ 4688.21
EDWARD WHITLOW HEYDON HOMES
16646 SW ANY LN EDWARD L WHITLOW
16646 SW ANY LN
BEAVERTON OR 97007 BEAVERTON OR 91007
Rhone N: 591-5380 Phone R: 591-5388
Reg L.: 886904
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will he done in accordance with approved plans. This permit will expire if work is nrt started within lee
days of issuance, or if work is suspended for more than 110 days.
3 -------------------------------------------------------- REOUiRED INSPECTIONS ------_--_--------------------------------------
— —
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building incl
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Erosion Control
Post/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final _-
Post/Beam Mechan Electrical Servi Fireplace Insp Rain drain Insp Mechanical Final
Crawl Drain Electrical Rough Gas Line Insp Wats Line Insp Plumb Final
1,ei-mitt,ee 5i gnat1_tr•e : -_ Issued
�
c �� — _ -
Call for inspection 639-4175 f
_ I
SEhiER CONNECTYON
CITYTIGARD
PERMIT
C'ERMIT #. . . . , . . : SWR96-0393
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/14/96
•"13125 SW Hall Blvd.Tigard,Oregon 97223.8109 (503)030.4171
PARCEL: 2S I04CA—05200
SITE ADDRESS. . . : 13684 SW MICHELLE CT
SUBDIVISION. . . . : HILLSHIRE ZONING: R-7 PD
BLOCK, . . . . . . . . . . I._01'. . . . . . . . . . . . . :052
--------------------------------------------------------------------------
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . :BUSWR IMRERV SURFACE: 0 sf
Remarks : Path I
Owner: -------------------------------------------------- FEES ____ ------ ----
EDWARD WHITLOW type amount by date recpt
16646 SW AMY LN PRMT $ 2200. 00 JSD 08/14/06 96-282879
INSP $ 35. 0r ' JSD 08/14/96 96-282879
BEAVERTON OR 97007
Phone #: 591-5380
Contractor: --..___.__..._
CONTRACTOR NOT ON FILE
------------------
Phone #: $ 2235. 00 TOTAL
Reg #. . :
—-- --- REQUIRED INSPECTIONS
——--_This Applicant agrees to comply with all the rules and regulations Sewer Inspection _
of the Unified Sewage Agency. The permit expires 188 days from
the date issued. The total amount paid will be forfeiter+ 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.
Permittee Signatl_rre : �
Issued 1 y: -- .sic ci
IC Call for inspection — 639-4175
3
"o )
U
a
L�
Plan Check 0 v 1—'�cc)
CITY OF TIGARD Residential Building Permit Application Recd By c
13125 SW HALL BLVD. New Cor -truction Additions or Alterations Date Recd t�
TIGARD, OR 97223 Single Family Detached or Attached Date to P E.
(503) 639-4171 Date to DST
Print or Type Permit$„a �✓
Incomplete or illegible applications will not be accepted Called
Name of Subdivision Lot# Narne `
Address
Site Address Architect Mailing Address
S��—�Y►\AAt� Zip Phone
I NQS IU
Name ky/State Z
Owner Mailing Address Name
City/State Zip one Engineer Mailing Addros
.ue AQ �Izpo� 5°t!_S.T>9�J CI(y/S ata Zlp Phone
Name F!
(general Describe w
ork new addition O alteration O repair O
kOl to be done:Contractor Mailing Add ess
Lr� Additional Description of Work:
City/Sla a "lip Phone
Oregon Const Cont.Board Lic.# Exp.Date __ 17
Attach copy of _ _ Project Q
Current COT Business ax or Metro# Exp.Date Valuation �Vl+'
Licenses u tel(. ' .�' 1 �' 3 i r�' —
Name NEW CONSTRUCT! N GNLY:
Mechanical rL Sal Sq.Ft. House: Sq.Ft.Garage:
�14 �) 7
Sub- Meiling Address `~
ContractorComer Lot Yes No Flag Lot Yes Pio
ity/State 7_ip P one I.(check one) __X (Che 'k one)
4 75 9 Restricted Audlo/Stereo Burglar
Oregon Const.Cont. Board Lic.# E�p Dat Energy System ilamt
Attach Copy of � O�( I 9�
�-�•— � Installation Garage Door HVAC
Current COT Business Tax or Metro# Exp.Dat
Licenses J p�� � Opener Systems
Name (check all that Other:
Plumbing ar- � �U� �� apply)
M X
Sub- ►icing Address Wil:the electrical subcontractor wire for all Yes No
restricted energy installations? _
Contractors p �,� �� Has the Subdivision Plat recorded? NA Yes No
City/State Zip I Phone �/
(0114- (.►4 Y.
d
Oregon Const. i.ont.Board Lic.# Exp.Date Reissue of r Soler Compliance
MST `
p� Attach Copy of j5-- 13 -97 (Calculation Attached
Current Plumbing Lic.# Exp.Date I hereby acknowledge that I have read this application,that the
Licenses - ( '5- 131-91 information given is correct,that 1 am the owner or authorized agent of I
COT Business Tax or Metro# Exp.Date the owner. and that plans submitted are in compliance with Oregon f
J D State laws.
m Na e jqo;nta-�t
nt40 ,�)
�►r ge Gats _
W
Electrical n/ame Phone
Sub- ail ng ddress � � � L. '}� 5 I'5U6
Contractor g 1 S FOR OFFICE USE ONLY:
�5 _
City/State Zip Phoner Plat# Map/TL#:
OF559 I r ct r-
Oregon Const.Cont.Board Lic# f xp.0 r p 41 '�� ll/ 1 �
Attach copy of 0427043 � _�I Setbadca ;:one: Solar:
Current Electrical Lic.# Exp Daae
Licenses '" - n 1C C� l- ;G_� lam'
COT Business Tax or Metro d Exp. Date Engineering AP ro%'ai. PI inning Approval: TIF:
lsrtr- _¢".r i +1 1�
t,:Wsts\mstapp.doc .
Permit# jscGQunt D, ;siptiop Amount Amt, Pd. BAL
MST. Per,nit (BUILD)
Plumb. Permit (PLUMB) '
Mech. Permit (NIECH) j v a w_ -1-1 CV
ELC/ELR Permit (ELPRMT)
State Tax (TAX) �,s,_
Bldg: o 3 /
Plumb: 2 /
Mech: j
ELC/ELR: A
Plan Check
MST: UPPLN) / . 33 G��aV /S 3�,,�
Plumb: (PLMPLN)
Mech: (MF_CPLN) _ , 2 a
,
..DC Review ( NOUS)
Pt<a�'41i D,yL: Sewer Connection (S SA)
Sewer Inspection (SWIN
Parks Dev Charge (PKSDC)
Residential TIF (TIF R) j _ _ 5 Zo
Mass Transit F (TIF-MT) L2y _
a _ –
Water Qual' (WQUAL) '
N — --
Water Q ntity (WQUANT) _LG h Jo C)
ao Erosiq Control Permit (ERPRMT)
W
Erosion Planck/USA (ERPLAN) a• — n
Erosion Planck/COT (EROSN) 2v
Fire Life Safety (FLS)
TOTALS: � �_ Y' �r
isldsts\mstapp.doc
Rev.7x98
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Tax Map - 25104 CA •2 s Garage Eley. - 493.0
7.nned - R7 ( Front 20',Side 5', Rear 20') *3 a 8" gravel - 4"concrete
i Hillshire Lot 52 *4 * 4"of 3/4" minus rock
13684 S.W. Michelle Ct. 105 Erosion Control s Silt Fence
Tigard, OR. 97225 *6 =Slape Direction st North
Lit Sq. Footage - 7,493
Heydon Homes Construction
Edward L. Whitlow
Ph. (503) 591 --5380
CITY OF TIGARD
13125 S.W. HALL 61.4D.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PAC WEST PLUMBING
2110 NE CORNELL RD
HILLSBORO OR 97124
Plumbing Signature Form
Permit # • • • • : MST96-0393
Date Issued. : 08/14/96
Parcel . . . . . . : 2S104CA-05200
Site Address : 13684 SW MICHELLE CT
Subdivisi.on. : HILLSHIRE
Block. . . . . . . . Lot : 052
Zoning. . . . . . . R-7 PD
Remarks:
Path I
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: PLUMBING CONTFACTOR:
EDWARD WHITLOW PAC WEST PLUMBING
16646 SW AMY LN 2110 NE CORNELL RD
BEAVERTON OR 97007 HILLSBORO OR 97124
Phone # : 591-5380 Phone # :
Reg # . . : 8190
c�
m
Signature uthorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171, ext. #310
I
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