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11425 SW Lala el Glen Cour+
� MASTER PERMIT
CITY OF TIGARD
PERMIT#: MST2001-00420
DEVELOPMENT SERVICES DATE ISSUED: 8/30/01
13125 SW Hall BI, d., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11425 SW LAUREL GLEN CT PARCEL: 2S110AC-02400
SUBDIVISION: LAUREL GLEN ZONING: R-4.5
BLOCK: LOT:007 JURISDICTION: TIG
REMARKS: New SF detached Path 1
BUILDING
HEISSUE. STORIES: FLOOr AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT 20 FIRST: 1 509 of BASEMENT: of LEFT: r SMOKE DETECTORS: Y
TYPE OF USE: Sr FLOOR LOAD. '10 SECOND: 1.899 of GARAGE: r140 of FRONT: PARKING SPACES: 2
TYPE OF CONST: SN DWELLING UNITS: I FINBSMENT: of RIGHT 5
VALUE: S 331 136.80
OCCUPANCY GRP: R3 BDRM4 BATH: 3 TOTAL: 340800 of REAP.: ir:
PLUMBING
RINKS: I WATER CLOSETS: 3 WASHING MACH'. I LAUNDRY TRAYS. I RAIN DRAIN lur, TRAPS:
LAVATORIES: 4 DISHWASHERS: I FLOOR DRAWS: SEWER LINES I.10 SF RAIN DRAINS I CA rCH BASINS:
T UBISHOWERS3 GARBAGE DISP: I WATER HEATEr'S' I WATER LINES'. I00 BCKFLW PREVNTR I GREASE"RAPS'.
OTHER FIXI URES:
MECHANICAL _
FOEL TYPES FURN-TOOK. BOIIJCMP t 3HP: v VENT FANS. CLOTHES DRYLR. I --
GAS FURN>=100K. 1 UNIT HEATERS: HOODS. I OTHER UNITS- 1
MAX INP. btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I
_ ELECTRICAL
RESIDENTIAL'1NIT SERVICE FEFDER_ TEMP SRVCIFEEDERS _BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
ions SF OR LESS: 1 0 200 amp 0 200 amp. WISVC OR FDR: I PLIMPIIRRIGATION. PER INSPECTION
EA ADD'L 500SF: 7 201 400 amp: 201 400 amp. let W'O SVC/FDR: 00 SIGNIOUT LIN LT. PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 - 600 amp. EA ADUL BR CIRC SIGNALIPANEL IN PLANT:
MANU HM/SVC/FDR: 601 1000 amp' 6p1+ampS-1000v. MOTOR LABEL: i
1000.amp/volt
PLAN REVIEW SECTION `
R•.connect only:
>=4 RES UNITS. 9VCIFDR>•125 A600 V NOMINAL CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENER:;Y
�+ A.SF RESIDENTIAL - B.COMMERCIAL
AUDIO R STEREO: VACUUM SYSTEM. AUDIO 6 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOP LNDSC LT:
BURGLAR ALARM. OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION. MEDICAL: OTHR:
HVAC: DATArrELE COMM NURSF CALLS TOTAL SYSTEMS,
TOTAL FEES: $ 8,136.93
Owner: Contractor: This permit is subject to the regulations contained in the
ALPENGLOW HOMES ALPENGLOW HOMES Tigard Municipal Code,State of OR. Specialty Codes and
5620 SW KELLY AVE. 5620 SW KELLY AVE. ail other applicable labs. All work will be done in
PORTLAND,OR 97201 accordance with approved plans. This permit will expire rf
work is not started within 180 days of Issuance,or if the
work Is suspended for more than 180 days. ATTENTION
Phone: Phone; Oregun law requires you to followrules adopted by the
Oregon Utility Notification Center. Those rules are set
Rego: LIC 131x32 fo,th 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.
C'0-7)_�� _$(r�l L� REQUIRED INSPECTIONS
Erosion Control Insp 8, PosUBeam Merhanica Mechanical Insp Sheer Wall'nsp Insulation Insp Mechanical Fina,
Sewer Inspection Underfloor insulaticn Plumb Top Out Exler-or Sheathing Inst Rain drain insp Plumb Final
Footing In3p Crawl Drain/Backwater Electrical Service Low'/oltage Water Line Insp Final inspection
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwik Insp
Post/Beim Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Issued 8y : ¢ �� d�. /z—� Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business ',y
_ SEWER CONNECTION PERMIT
CITY O F" TI GARD
DEVELOPMENT SERVICES PERMIT#: S30/01 00217
I L" L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/30/01
SITE ADDRESS; 11425 SW LAUREL GLEN CT PARCEL: 2S110AC-02400
SUBDIVISION: LAUREL GLEN ZONING: R-4.5
_Y BLOCK: LOT: 007 _ JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS Or WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF residence.
Owner: FEES
ALPENGLOW HOMES Type By Date Amount Receipt
562.0 SW KELLY AVE. —
PORTLAND, OR 97201 PRMT CTR 8/30/01 $2,300.00 27200100000
INSP CTR 8/30/01 $35.00 27200100000
"hone: Total $2,335.00
Contractor:
Phone:
Reg#:
__— Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. Tha total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer iaterals. If the sewer is not located at the measurernert given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purl ase a "Tap and Side Sewer" Perm
Issued bj; � �1 _._.. Permittee Signature: ��
Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next business day
71rxr" ?- ?3--&
Sl,()K 0-oo ( -aU.117
Building Permit Application
"Datereceived: I/ — Permit no.lr'j
City of Tigard ' ICJ -
Address: 13125 SW Nall Ivd,Tigrtrd,OR 97223 Projectlappl.no.: xpiredate:
G
('irynf'I'igurd phone: (503) 639-4171 Datcissucd: By: Receiptno._
Fax: (503) 598-1960 Case filr,no.: Payment type:
Land use approval: _ 1&2 family:Simple Complex:
U I &2 family dwelling;or accessory U('rnnmcrcial/industrial U Multi-family Ola New construction U Demolition
U Add ition/afteration/re placement U'fcuant improvement i f nc Sprinkler/alarm U()(her:
JOH SITE INVORMATION
Job address: I 2S SvV Laurel Glfrn Ct. Bldg.no.: Suite no.:
Bit k: Subdivision: LayrC/ _ � 1'ax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: cam) �y YC
------ -
(Floodplain,septic capacity,solar,etc.)
Name: oa„,ld
Mailing address: q1jL9 Alw, #1 Nod I At 2 fandly dwelling:
City: Poetlunee S ate: _ ZIP: 87210 Valuation of work................................ ...... -331, /3
Phone: 72'i ii-1,T 7(o Fax: E-mail: No.of bedrooms/baths.....Y./...;.A.............
Owner's representative: Total number of floors... ...A.......•............... = __
Phone: Fax: J1 .n•... New dwelling area(sq. ft.) ....39.0.8...........
Oarage/carpoti area ,sq.ft.)....9`'�.Q.............. ?Z,3 7.1 _
Name: j en I, W f/oflu-5 lr►i k ��Strr.r,1. Covered porch area(sq.fL),..... C! '
Malting ad rrss. Sv''U 5w e( ✓r _
Ih�ck arca(sq. ft.). D
City: n State:OK ZII': 7 2Df Other structure area(u1 ft i . .....CA............. ---
Phone: -245-772v Fax: 2a s-774s E-mail:
ommerciallhrdustrialhnulr{-family:
Valuation of work........................................ $ I
Existing bldg.area(sq.ft.) ........................ _-- -
Business name: New bldg.area(sq.ft.).......... .
Address: w Number of stories
City: Ck ntj t I State: DA I ZIP: Type of construction...........
Phone: Z -77;kV Fax: 24S•77bS E-mail: Occupancy group(s): Existing: _
CCB no.: 131 q 3-� _- New:
City/metro lic.no.: Notice: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
�N,ame: �}�j C(k-`jam provisions of ORS 701 and may be required to he licensed in the
Address. jurisdiction where work is being performed. If the applicant is
City:
State: ZIP: exempt from licensing,the following reason applies:
Contact Ix rson: Plan
Phonc: Fax: ' mail
10111 mllw�
Name: T It'onta t person: Fees due upon application ...........I............... $
Address: - — Date received: _
City: State: ZIP: Amount received .........................................$
Phone: �it:ax.* E-mail: Please refer to fee schedule.
I hereby certify 1 have read and examined this application and the Not all jurisdictions wcep credit cant::•please call jurisdiction fat name infMms inn.
attached checklist. All provisions of laws and ordinances governing this UVisa U Mastercard
work will be complied with,whether s cifted herein or not. ole cab^^mom
r Rp.re.
Date: r7/ _ Name d urdhnlder u.hnwn^n credit card
Authorized signature S
Print name: E.i k aJ t�►9[ Caidbulder.i`nuure i— - Amoura
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. u04613('000OM)
One- and Two-Family Dwelling
Building Permit Application Checklist licicienceno.: --
--- -- — — — Associated permits:
city,,fTig-Q , cit of Tigard y � U Elr:ctrical U Plumbing U Mechanical
Address; 13125 SW Hall Blvd,'Tigard,OR 97213 UOther-
Phone: (503)
ther•Phone: (503) 639-4171
f;ax: (503) 599-1960
REQUIREDi
M
Land use actions completed.See jurisdiction criteria fon concu,rent reviews. "7
2 Zoning.Flood plain,solar balance points,seismic soak designation,historic district,ei�
3 Verification of approved platllot.
4 Fire district.- approval required. _
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit. —_
7 Water district■pl,roval,
8 Soils 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 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state
huilding codes. lateral design details and conmoctions must he incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot he completed
if copyright violations exist.
I I Sue/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is mon-than a 4-It.elevation differential,plan must Show contour lines at 2-11.iuterrals);laxat'(_n of easements and
driveway;footprint of structure(including decks);location of well:'•optic systems;utility fixations;direction indicator;lot
area;building coverage area-,percentage ol'coverage;impervious area,existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor halts,any hold-downs and reinforcing pads,connection details,vent
siz.c and fixation.
13 Floor plans.Show all dimensions,room identification,window sire,location of'smoke detectors,water heater.
furnace.ventilation fans,plumbing fixtures,balconies and decks )U inches above grade,etc.
14 Cross section(s)and details.Show all frarning-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 wa,l and roof sheathing,roofing,rool'slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
i 5 Elevation views.Provide elevations for new construction;minitnum of two elevations for additions and remodels.
Exterior elevations must trflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-sine sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and fixations;for
non rescriptivc path analysis provide specilicauons and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all Iloors/rxof assemblies,indicating member sizing,spacing,and hearing
fixations.Show attic ventilation.
19 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any hear/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 7gineer or
architect licensed in Oregon and shall be shown to he applicable io the project under reslc�s.
JURISDI1111110NAL
23 Fisc(5)site plans are required for Item 11 above. Site plans must be 9.112" x I I-or I I"x 17".
24 Two(2)sets each are required for Items 16, 19,2O&22 above.
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 adavc'oMi
Electrical Permit Application
Date received: Permit no.:m / - toVi
City Of Tigard Project/appl.no.: Expire date:
City11V�Imf AL
of Tigard Address: 13125 SW Hall Blvd,'I'igard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
ALU-W"Ilia I I
U 1 &2 family dwelling or accessory U Conuncicial/industrial U Multi-innliIV U Tenant improvement
U New construction U Addition/al(eration/replacernent U tither: U Partial
.100 t
Job address: S w L.vre l CO&17C 111 Ipr.: Tax ma /tax lodaccount no.:
Lot: .2-
Block: Subdivision:
Project name: I Description and location of work on premises:
Estimated date of coni lesion/inspection:
Job no: I cc Ma%
Business name: Wtha✓ r�«ff _ Ikycriptiou Qty. (ea.) total no.imp
– 'Neh rrsidenlial cinxle or multi-lamily per
Address: c he, dweningUnit.Inrludesaltachedgaraw
City: rt r State: LIP: Servialncluded:
Phone: Fax: I E-mail: I(M sq.ft.or less 4
CCB no.: Elec.bus. lic.no: Each additional 500 sq.ft.or onion(hereof
Limited energy,residential 2
City/metro Ile,no.: I.iniiiedenergy,nan-residential _ 2
Each manufactured home or modular dwelling
Signature of supervising electrician(required) Dale Service and/or feeder 2
Sup.elect.name(print): -- Licenscno: Service;or freden–Instillation,
alteration or relocation:
200 amps or less 2
Name(print): Q (y A, 9„,s 201 amps to 400 snips _ 2
Mailing address: /f / 401 amps to 600 amps _ 2
601 strips to I OW amps 2
City: ro State: off LIP: 00 72 P Over 10amps or volts _ 2
Phone: Fax: E-mail: Reconnect only - 1
Owner installation:The installation is being made on property I own Temporary urrvlees or feeders
which is not intended for sale,lease,rent,or exchange according to installation,alteration,or relocation:
ORS 447,455,479,67(1,701. 200 amps or less 2
201 amps to 400 snips 2
Owner's sl nature: Date: 40110 tial ams 2
Branch circuits new,alteration,
Name: or extension per panel:
A Fee for branch circuits with purchase of
Addmss: service or feeder fee,each branch circuit ?
City: State: LII' B Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: J Fax: E-mail: I.ach additional branch circuit: _
M isc.(Service or feeder not Included):
U Service over 225 Limps-con•ttercial U Health-care facility I ach pump or irri stion circle 2
v Service over 320 amps-rating of i&2 U Hazardous location Lech sign or outline lighting 2
familydwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
U System over 6(x1 voles nominal store residential units in ow,structure alteration,or extension _
U Building over three stories U Feeders,4(10 amps or more *Description:
U Mcupam load over 99 perrons U Manufactured structures or RV park tach additional Inflection over the allowable in any of the alcove:
U Filressfilghtingpim, U Otter: _ --- Per inspection r —T---�--
Submit—-sets of plans with any of the above. Investigation fee
_IV above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cant,please call jurisdiction for more information Notice:This permit application Permit fee.....................
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %)
Credit card number ._._- -_-. ,��_ within 180 days after it has been State surcharge(8%)....$
spin' accepted as complete. TOTAL .......................$
Name of cardholder u s n cn c turd � —
S
Cardholder slSitature 4444615(6AO/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Restricted Energy Fee......................................_.............. $75.00
N ember of Inspections r permit allowed (FOR ALL SYSTEMS)
Service included: Itents Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq fl.or less n 14'j 15 4 ❑ Audio and Stereo Systems'
Each additional 500 sq ft or
portion thereof $:!3 40 1
-- - -- - ❑ Burglar Alarm
Limited Energy ;75.00
Each Manurd Home or Modular
Dwelling Service or Feeder _-� $90.90-- ❑ Garage Door Opener"
Services or Feeders ❑
Installation,alteration,or relocaUor mHeating,Ventilation and Air Conditioning System'
200 amps or less _ $80.30 _ 7
201 amps to 400 amps i $106.85_ ❑ Vacuum Systems'
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 Other _
Over 1000 amps or volts $454.65 2
Reconnect only $66.85_ 2
Temporary Services or Feedars , v TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installatior alteration,or relocation Fee for each system..................................................... .... $75.00
200 amps nr lase v $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps _ $100.30 l
40'amps to 600 amps $133.75 _ 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. E-J Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel ❑ Boiler Controls
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $h 65 ❑ Data Telecommunication Installation
I))The fee for branch circuits
w►thout punch.,tse of service rr
or feeder fee. Fire Alarm Installation
L_
Firs:branch circuit $46.85 _
Each aeditional branch circuit $6,5 HVAC
Miscellaneous r
(Service of Instrumentation feeder not included) `-�
Each pump or irrigation circle $53 40
Each sign or outline lighting _ $53.40 ❑ Intercom and Paging Systems
Signal circult(s)or a limited energy
panel,alteration or extension _ $75.00 ❑ Landscape Irrigation Control'
Mina Labels(10) $125.00_
Each additional Inspection over i ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour _ $62.50
In Plant $73.75 C1 Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Erter total of at-we fees $ CJ Other
0%State Surcharge $ _Number of Systems
25%Plan Review Fee
See"Plan Review"section on g No b(.ensps are tquired Licenses are required for all other installations
front of application
Fees:
Total Balance Due $ _ _
To Enter total of above fees $— —
U Trus Account#
�- d%State Surcharge s
Total Balance Due $_
i:\dstsVbrrnsklc-fees.doc 06/07/01
Mechanical Permit Application
Date received: Pennitno.: S _�(X/ -oogz
City of Tigard Project/appl.no.: _ Expire date:
(',ryufl'igur/ Address: 13125 SW Ilall Illvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued _- By: Receipt no.:
Fax: (503) 598-1960 1 Case file no.: Payment type:
Land use approval Building permit no.:
U 1 &2 family dwelling,or accessory ( nnnu n,:tl/nulutiuml U Multi-family U Tenant improvement
W New construction -1 AtItl,Unt:/abrtainm/replacement U Other: _
Job address: 1 y;Z S 5 w' 44 s,re G/r n Lf. _ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.nu.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
-Tax map/tax lot/account no.: profit. Value
Lot: 7 Block: Subdivision: (-„yrtI 6it►r� "See checklist for important application information and
Project name: jurisdiction',, fee Nchedule for residential permit fee
Cily/county: r- ZIP:
Ikscription and I ation of work on premises: t
Est.date ol'tx7mpletion/inspcction: Desai ion Qty. Res.oniv Res.ordy
Tenant improvement or change of use: Air handling unit __- CFM
Is existing space heated or conditioned'!U Yes U No Air conditioning(sire plan required)
Is existing.space insulated?U Yes U Noteratlon of existing IlVAU system—
of er compressors
State boiler permit no.:
Business name: Q d M {}cu __ NP Tons BTU/li -_
Address: p.o A" _._Tiic/smokc4imperWUuct smo a detectors
City; Azirieiii Istate: Vf2 ZIP: 9701) Teit—pump(site plan require )
Phone: Fax: E-mail: nstal rcp ace urnac urner
Including ductwork/vent liner U Yes U No
CCB no.: Instal I/replace/relocate heaters-suspen ed.
City/metro lic.no.: _ wall,or floor mounted
Name(please print): i3r ,.4 k,,+c - Vent forapplianccothcrthan furnace Refrigeration-
Absorption
geral on:Absorption units BTU/11
Name: r• a jriv Chillers-_____ lip
_ Compressors—_.--- IIP
Address: S62u Sw !kg� rc Environmental ex aunt to rent 11 at on:
(•ity: Pur /rr Slate: OR ZIP: 9,-zo1 Appliancevent _
-Phone: b~ 7i3-54E Fax: Z45-��45 E-mail: )ryerex gust
oodcgUy-iTII/res. ucis iazmal
hood fire suppression system -
AC
Name: pr„�,1d A. Ayss Exhaust fan with single duct(bath fans)
Mailing address: N4D ,✓w y _— ,x taus►s stem a Bart from heatingor
-tic p p ng and 0-t ut on(up to outlets)
5tatc:0K "LIP: 97aio lylx _ _ t.1t] NO Oil _
Phone; lLY- i'7& Fax: E-mail: ue i m-encIt a tdi ioonTei4 outlets
rocenpiping(sc ematicrreeq- rte _
Number of outlets
Name: tTier Wied-appliance or equipment:
Address: _ Decorative fireplace
City State: ZIP: —_ nseri-type
0o stov pe et stove _
Phone: Fax:�
FE-mail: Ot c-- T
Applicant's signature: Diatc: Other:
Name(print): _
Nd all)uddictionr accept credit C".pleam call juddictinn fxx Inas inforrnalioo Permit fee.....................$
Notice:This permit application Minimum fee................$
U visa U MasterCard expires if a permit is not obtained _
Credit rand n.imt�er:_ --.._ ___� - Plan review(at — %) $
�_ within ISO days after it has been State surcharge(8%) ....$
Name of eanlhnldn u.sown on- c ir�i e.nf s accepted as complete.
rOTAL .......................$
'—--Cardholder dpwturc Amount 440 4617(&MCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to$5,000,00 Minimum fee$72.50 _ Table 1A Mechanical Code oty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or including ducts&vents 14.00
fraction thereof,to and Including 2) Furnace 100,000 B rU+
$10,000.00 including ducts&vents 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or includingvent 14.00
fraction thereof,to and Including 4) Suspended heater,wall heater
_ $25,000.00. or floor mounted heater 14.00
$25__,001 00 50
to$ ,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional$100.00 or 6.80
fraction thereof,to and including 6) Repair units
$50,000.00. _ 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes below. Comp*
7)<3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 3-15 BTU 14.00
Value Total 8)3-15 HP;absorb
Description: Ol al l Amount unit 100k to 500k BTU 25.60
P _ _ -- 9)15-30 HP;absorb
Furnace to 100,000 BTU,including 955 unit.5-1 mil BTU _ _ _ _ 35.00
ducts&vents 10)30-50 HP;absorb
Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU 52.20
ducts&vents11)>50HP:absorb
Floor furnace including vent _ 955 unit>1.75 mil BTU _ 87.20
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater _ 10.00
Vent not Included in applicance 445 13)Air hrndling unit 10,000 CFM+
permit 17.20
Repair units 805 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 1000
to 100k BTU 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 6.80
109..to 500k BTU - -- 16)Ventilation system not Included In
15-30 hp;absorb.unit,501k to 1 2,310
mil.BTU appliance permit 10.00
30-50 hp;absorb.unit, 3,400 17)Hood served by mechanical exhaust
_ 10.00
1-1.75 mil.BTU 18)Domestic incinerators
>50 hp;absorb.unit, 5,725 _ 17,40
>1.75 mil.BTU 19)Commercial or industrial type Incinerator
Air handlingunit to 10,000 cfm 658 69.95
Air handling unit>10,000 cfm 1,170 20)Other units,Including wood stoves
Non-portable evaporate cooler 656 1000
Vent fan connected to a ain leg duct 448 21)leas piping one to four outlets
Vent system not Included In 658 5.40
appliance permit 22)More than 4-per nulls'(each)
Hood served by mechanical exhaust 658 1 00
Domestic Incinerator 1,170 Minimum Permit Fee$72.50 SUBTOtAL. $
Commercial or Industrial Incinerator 4,590
Other unit,Including wood stoves, 658 8%State Surcharge $
Inserts etc.
Gas piping 1-4 outlets _ 380 _ 25%Plan Review Fee(of subtotal) $
Each additional outlet 63 1 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDI=NTIAL PERMIT FEE: $
VALUATION:
Other Inspecllons and Fees:
1 Inspections outside of normal business hours(minimum charge-two hours)
$72 50 per hour
2 Inspections for which no fee is specifically Indicated (minimum charge-half four)
$72 50 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
charge-one-half hour)$72 50 per hour
`State Contractor Bolles Certlflcatlon required for units>2001,.BTU.
-Residential A/C requVes site plan showing placement of unit.
iAdsts\forrns\,mech-fees.dnc 10/11/00
Plumbing Permit Application
Datereceived: Permit no.:
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
CityofTigarrf Phone: (503) 639-41"1 I'rojccUappl.no.: Expiredate:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: _ Case file no.: Payment type:
U 18c 2 family dwelling or accessory U Commercial/industrial U Multi-family Li Tenant improvement
U New construction U Addition/alteration/replacement U Food service U Olhrr _
J01111 SITE t t
Job address: �S SW Leurtl t:l _C><, 1)cscri tion Ql cc(ca.)
'Ibial
Bldg.no.: Suite Cole New 1-and 2-family dwellings only:
Tax ma /lax lot/account no.: (includes 100 fl.for each utility connection)
P SFR(1)bath _
Lot: 7 Block: Subdivision: 4eurt/ Glu-, SFR(2)bath
Project name: _ SFR(3)bath
City/county: r ZIP: Each additional bath/kitchen
Description and la ion of work on premises: _ Siteutilitles:
Catch basin/area drair.
Est.date of completion/inspectlow Drywells/leach line/trench drain
Footing drain(no.lin, ft.)
Manufactured home utilities
Business name: ; fo.1 ,��,c. _ Manholes
Address: Rain drain connector
City: C Stale:O ZIP: 7U l5 Sanit sewer(no.lin.ft.) _
Phone: _ Fax: Email: Storm sewer(no,lin. ft.)
Water service(
CCB no.: Plub. Item:bus.reg.no: : lin. ft.)
City/metro lie.no.: Fixture or Item:
Contractor's representative signature: Absorption alai
— Back flow preventer _
Print name: I I Date: Backwater valve _
K Ilk's Basins/lavatory
Clothes washer _
Name: ErDishwasher _
Address: Sl.zSw 1c,111 yr• Drinking fountain(s)
City: Lr I�Mr,( _ Staler ZIP: 972e)/ E'ectors/snmp
Phone: 74-3- 38(.8 Fax: 7.y -7? E-mail: Expansion tank
Fixlure/sewer cap
(print): „� �3S Floor drains/floor sinks/hub
Name
t' �� �' B Garbage disposal
Mailing address: yy� ,y_�, Hese bibb _
City: _PPt t/4�_ _ State:p ZIP: y7 2/G �. Ice maker
Phonc: 11,ax: E-mail: Interceptor/grease trap _
Owner installation/residential maintenance only: The actual installation Primers)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on Ute property I own as Mr ORS Chapter 447. Sink(s),basin(s),lays(s) +
Owner's signature: bale: . Sump _
Tubs/shower/shower pan
Urinal
Nvne: Water closet
Address: _ Water heater
City_ _ State: ZIP: _ Other: ---
Phone: ---1 Fax F,mail: Total
Not all Jurisdictions accept ncdit cards,please call jurisdiction for more inrormaaon. Notice:This permit application Minimum fee................$
U Visa U MasterCard expires if a permit is not obtained Plan review(et _ %) $
credit curd number within 180 days after it has been State surcharge(8%)....$
- splrcs
Name or cardholder as shown nn credit card
accepted as complete. TOTAL .......................$
S
Cardholder siptature --Amount 410.1616(&WCOM)
PLUMBING PERMIT FEES:
PRICE TOTAL ( Now 1 and 2damlly dwellings only;
FIXTURES (individual) — QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
-
1660 - the dwelling and the first100 ft. QTY (ea) AMOUNT
Sink _ _ - for each utility connections
Lavatory 16 60 --- One_ l bath ath_—_--- -- - -- - ------ $249.20
Tub or Tub/Shower Comb 1Ei 60 Two 2 bath $350.00
_ __ _ --��— ---- ------ $399,00
Shower Only 1660 — Threes bath _
Water Closet
— 1660 _'_ SUBTOTAL
Urinal 15 8'/•STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
TOTAL
Garbage Disposal 16.60 -- ---- ---
Laundry Tray 16'60
Waehing Machine 16.60
Floor Drain/Floor Sink 2" - 16.60 PLEASE COMPLETE:
3" 16,60
4" 16.60 -
--- Quandt b_Work Performed
Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed/
Gas piping requires a separate mechanical — Capered_
ink
S
ermil.
— -
MFG Homn New Water Service 46.40 ---
46.40 Level __ -----
MFG Home New San/Storm Sewer Tub or Tub/Shower
[lose Bibs 16.60 Combination
Roof Drains _ 16.60 Shower Only
16.60 Water Closet
Drinking Fountain _ Urinal _ — —
Other Fixtures(Specify) 1660 Dishwasher --
Garbage Dispcsal —_
-Laundry Room Tra --
Washin Machine
Floor Drain/Sink: 2" — —
Sewer-1st 100' 55.00 3" _
Sewer-each additional 1 MY 4600 4"
55 00 Water Heater --
Water Service 1st 100' _ -- Other Fixtures
Wafer Service-each additional 200' 46.40 (Specify)
Storm&Rain Drain-1st 100' 55.00 ---
Storm B Rain Dlain-each additional —
Commercial Back Flow Prevention Device 46.40
�Psidential Backflow Prevention Device' 27.55 _ —
Catch 3asin --
Inspection of Existing Plumbing or Specially 72.50
Re nested Ins ecllolls _ er/hr COMMENTS REGARDING ABOVE:
Rain Dra'n,ssingle family dwelling 65.15
Grease Traps 16.60
gUANTITY TOTAL
Isometilc o,visor diagram la required it _ —�-
Quantity Total Is >9 -
*SUBTOTAL — ---
8Z/STATE SURCHARGE
"PLAN REVIEW 251/6 OF SUBTOTAL
Re ulred only II 5xture qty.total is�9 -
TOTAL $ —
"Minimum permit fee is$72 5o•e%slate surcharte,except Residential Bacl,low J
Prevention Device,which Is$3e 25•e%state surcharge
"All New Commercial Buildings require plans with Isometric nr riser diagram and
plan review
1:\dst,Aforms\pini-fees.L3C 10/10100
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WEBER ELECTRIC INC
14524 SW CHARDONNAY AVE
TIGARD, OR 97224
Electrical Signature Form
Permit #: MST2001-00420
Date izs5ued. s;iiUiU1
Parcel: 2S110AC-02400
Site Address: 11425 SW LAUREL GLEN CT
Subdivision: LAUREL GLEN
Block: Lot: 007
Jurisdiction: TIG
Zoning: R-4.5
Remarks: New SF detached 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 wi'i be authorized until this completed form is received
OWNER: FLECTRICAL CONTRACTOR:
ALPENGLOW HOMES WEBER ELECTRIC INC
5620 SWu .7
KELLY AVE. 44f,24-SW-6}�AfZDG{ NArY AVE V-Q1T �-�
PORTLAND,
h GU � � r�iy �'
IV
V, JI( c24 1 C-
Phone #: Phone #: 579-5168
Req #: LIC 44087 '
SUP 4028S C _I
ELE 34442c
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising Electrici
If you have any questions, please call (503) 639-4171, ext. # 310
Plumbing Permit Ap 1' ation
I)atereceivedq Permitno.:) /
City of Tigard Sewer permit no.: Building permit no.:
(lnAddress: 13125 SW hall lily ,'1" rd, 97223
u�/�;;,"`/ I'hone: (503) 639-4171 ,��AA ProJecUappl.na.: Expire date:
Fax: (503) 598-1960 vj(�V►` Date issued:
L,anel IICC approval: -VV \�\,i _ Case file no.: Payment type:
TVPE OF PERMIT
!J 18c 2 family dwelling or accessory U Commen:ial/industrial U Multi-family U'fenant improvement
U New consiruclion U Addition/altcrllion/ri,pi icenienl U Food service U Other:
1
Job address: li y S r� r-wv,c l 6,le,7 Gt Ucscri tion (pY. hee(ca.) 'I'o(al
- - - Ne" I-and 2-family d"elliiigs ouiy:
Bldg.no.: _ qjite no.
__--- : (includt- loon.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
l,ot: 7 Block: Subdivision: ltt�,t < SFR(2)bath
Project name: SFR(3)hath _ �-
Ci!y/cuunty: I ZIP: Each additional hath/kitchen
Description and location of work on premises: Siteutilitles:
Catch basin/area drain
Fsi.date of i;c+itiplGion/inspection: --- Drywells/leach line/trench drain --
Footing drain(no. lin. R.) -
Manufactured home utilities
Bust 5s name: �'4 [ K ' II. '--I (fere t1�i�L Manholes
Address: UIVC= d Rain drain connector
J'nt
py,� Stawor, ZIP:C �-Z Sanitary sewer(no.lin. ft.) --
Fax: E-mail: Storm sewer(no.lin.ft.)
o.: /2, ��( Plumb.bus.reg.no: Water service(no,lin.ft.)
etrotic.no.: /"JCa(;1O J6•L f Ixture or Nem:
AhsorptioII valvetor's representative signature: $� '� Back flow preventerme C le: s'c"i Backwater valve
Kowl mu WN willom Basins/lavatory
Clothes washei _
Name Dishwasher _ --- _--.- -
Address. Drinking fountain(,,
City: State: ZIP: Ejectors/sump —
Phone u lax: : mail: Expansion tank —
Fixlure/sewer cap
Floor drains/floor sinks/hub -_
Name(print): —� _i _ -- Garbage disposal
Mailing address: — I lose hihb _
City: State: ZIP: - Ice maker
Phone: Fax: Email: Interceptor/grease trap _
Owner installation/residential maintenance only: The actual installation Prinler(s)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own ws per ORS Chapter 447. Sink(s),basin(s),lays(s)
owner's signature: _ __- Date: Sump
Tubs/shower/shower part
Uri nal -_
Name: Water closet
Address: _ Water heater —
City' State: 7.IP: Other:
Phone: Fax: E-mail: —- Total
Minimum fee................$
Na all jurixlictlona accepi credu card%,pleaw call jurindidion fin more informati wi Notice:This permit application
Plan rc`yICW(al %) $ ---
t]visa O MasterCard expires il'a permit is not obtained
Stale surcharge(896) ....$
credit card number:— — i�-- within 180 days after it has been
p accepted as complete. 1,01A,
'U 1'A1. ....................... _ --
Name of eudholder as shown nn rredh cam" $
Cardholder signature Amami 440.1616(NDICOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual) _QTY AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT
16,60 for each utilityconnections _
Lavatory One 1 bath_ _ $249.20
tub or 7uh/Shower Comb _ 16.60 Two 2 bath - - $350.00 �-
Shower Only 16.60 Three 3 bath $399.00
Water Closet — 16.60 _ SUBTOTAL -
Urinal 1660 %STATE SURCHARGE _
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 _— _ —____ TOTAL _
Laundry Tray — 1660
Washing Machine — F16 60F loor Drain/Floor Sink 2" 603" 66 PLEASE COME*-ETE:
4" ,60
Water Heater O conversion O like kind 1660 _ Quantic b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Remo✓ed/
permit. - - Ctpped -
MFG Home New Water Service 46.40 Sink _
MFG Home New San/Storm Sewer 46 40 Tub orr�—
— --- Tub or Tub/Shower
Hose Bibs 1660 Combination
Roof Drains 1660 Shower Only
Drinking Fountain - 1660 Water Closet_
- Urinal _
Other Fixtures(Specify) 1660 Dishwasher
- ----- -! --- � Garbage Disposal -- --_- -- -
--i Laundry Room Tra
-- -- --- -- - - - _Washing Machine
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3" --
Sewer-each additional 100' - 46.40 4"
Water Service-1 st 100' 5500 - Water Heater - -
Water Service-each additional 200' 46.40 -- Other Fixtures
(Specify)
Storm&Rain Drain-Isl 100' 5500
Storm&Raln Drain-ear.h additional 100' 46.40 - -
Commercial Back Flow Frevention Device 4640 J -
Residential Backflow Prevention Device' 27.55
Catch Basin --- -- - 16,60 ----- — -- --
Inspection of Existing Plumbing or Specially 7250 -
Requested Inspections ,- er/hr - _ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65 25 --_—
Grease Traps - - -- 1660 - - - _�-.-_ -- ---_ _-- --
QUANTITY TOTAL
Isometric or riser diagram is required if — - - -
Quantity Total Is ;g — ----- — -
*SUBTOTAL - -— ---------- -
8%STATE SURCHARGE - --- ----
"PLAN REVIEW 25%OF SUBTOTAL
Re aired onl it fixture r t luta/is 9 _
TOTAL 5
iMlnlnmm permit fee is$72 50#8%stale surcharge,except Residential eacknow
Prevention Device,which Is$36 25 4 81%state surcharge
"All New Commercial Buildings require plans w4h Isometric or riser diagram and
plan review
I:\dsts\forms\plm-fees.doc 10/10/00
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 In�.� �L
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP ---- --------
Received Date Rewested -- 7����"� AM Air -- ..---__ BUP --_-------------- --
Location —__ -S —(L«� :tA�� suite
---- — -- MEC --- --
Contact Person Ph( ) ���� PLM
Contractor _ - ---_---- Ph(- ) ----_---- -- - -- -- SWR
BUILDINGTenant/Owner �__
_ ELC - .-..
Footing
Foundation ELC
Access:
Ftij Drain ELR
Crawl Drain -------
Slob Inspection Notes: SIT
Post& Beam - -_
Shear Anchors -_ -------_ --
Ex"Sheath/Shear
Int Sheath/Shear
FrEming �
Insulation
Drfwall Failing --- - - -- --------- -----
Firewall
Fire Sprinkler --- -
Fire Alarm
Susp'd Ceiling
Floof
Other:
ni e�T _ --
PAPART FAIL
- -
PLUMBING- ---
Post&f3oam
Under Slab -- - --
Rough-In
Water Service -- --- -- - - --
Sanitary Sewer
Rain Drairs
Catch Basin/Manhole
Storm Drain ---- --�
Showar Pan
Other: _ ----
Final
PASS PART FAIL
_MECHANICAL
Post&Beam
Rough-In -- ---- ---- ---- --
Gas Line
Smoke Dampers -- -- -- - -- --
Final
PASS PART FAIL ---- - - --� -
ELECTRICAL
Service --------- ----- - - - - ------
Rough-In
UG/Slab
I_ow Voltage
Fire Alarm
Final [� Reinspection tee of$ -__ required before next inspection. Pay at City Hall, 13125 SW Heli Blvd.
PASS PART FAIL
SITE Please call for reinspection RE._. __- Unable to Inspect-no access
Fire Supply Line
ADA 21-L,7_..
Approach/Sidewalk Dash �� Inspector _Exp
Other:_
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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CITY OF TIGARD 24-11our _
BUILDING Inspection Line: (503)639-4175 MST GU ( '2 5' 2 U
INSPECTION DIVISION Business Line: (503)639-4171 BUP --
Received -------- Date Requested.
' 13 AM__. PM BUP
L —
cation — __ 11 L 2 ���o�� ! Suite MEC
Contact Person __-- -�—� __—_-- Ph PLM — —
Contractor —__ _ _—_._. - -- Ph(--) _ _ --- SWR _ —
BUILDING Tenant/Owner _-_ - -__ _. _— _--..—_- ELC
Footing ELC --
Foundation Access:
Ftg Drain ELF!
Growl Drain SIT __---
Slab Inspection Notes: ---
Post& Ream ---- ----
Shear Anchors
Ext Sheath/Shear --- - - - - "
Int Sheath/Shear -- _
Framing - - - -- -
Insulation _ _-
Drywall Nailing - _-
Firewall
Fire Sprinkler - -- ----
Fire Alarm
Suap'd Ceiling -- - — ----.—�
Roof --- -— ----- - - - -- -
Other. ----
Final
PASS PART FAIL
----..----...---
PLUMBING --- --- -- --- --------
- -
Post&Beam _
UndAr Slab
Rough-In
Water Service - --- -
Sanitary Sewer
Rain Drains - - - - --
Catch Basin/Manhole
Storm Drain - --- - -
Shower Pan
Other
Pfnaa'
SS PART FAIL
Post& Beam
Rough-In - ---
Gas Line
Smoke Dampers -- -- - --- - -
Final
PASS PART FAIL - --- --------
EL_EC 1 i-ICAC -- ---- --
Service
Rough-In - -- - --
UG/Slab
Low Voltage -
Fire Alarm
Final Reinspection fee of$._. required before next inspection. Pay at City Hall, 13125 SW Hall BI
PASS PART FAIL
---
SITE I Please call for rr,.inspec+ion RE:---- [] Unable to inspect - no acc
---
Fire Supply Line
ADA Date (_��sPeetor __ __-_ Ext
Approach/Sidewalk
Other:
Final DO NOT REMt.VF*his Inspection record from the Job .site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST 74rt
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received — .Date Requested.._ 5 -�AM_— PM __.._ ____- BUP
Location _ IL 21�� a21 (
!t Suite - MEC
Contact Person Ph(—) PLM _
Contractor_ - -- Ph(--) SWR ------ - --
BUiLDING Fenant/Owner ELC
Footing ELC
Fogy ndation Access:
Ftg Drain ELR
Cravil Drain r SIT ---
Slab Inspection Notes: - - ----
Post&Bearn --- -- - - - ----- -
Shear Anchors
Ext Sheath/Shear -- -— ---- _
ii-t Sheath/Shear
Framing - - -
Insulation _
Drywall Nai'ing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - --
Roof
Other --- -- --- --
Final
PASS PART FAIL
--
PLUMBING -- - - - - -
Post&Beam
Under Slab -- --- - -
Rough-In
Water Service - - - -
Sanitary Sewer
Rain Drains - - -
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final _ ---
PASS PART FAIL
---
Post&Beam T
Rough-In - -
Gas Line - - - ----
Smoke rs - -
Fin
PA FAIL _ - ------ -----_----..- -__ --
--
LECTRICA -
ervies-
UG/Slab
Low Voltage �-
Fire Alarm
�j Reinspection ter,of$ __ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS ART FAIL.
-_ _—__-- - - Unable to inspect-no access
1 PleTse call for rernsuortion flE ___ -
Fire Supply i,ne
ADA Approach/Sidewalk Date 1 I 1 I ` Inspector -__-----. ------Ext
---
Other: _
Final DO NOT REMMIE this Inspection record from the job site.
PASS PART FAIL
I