Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00412
i DEVELOPMENT SERVICES
DATE ISSUED: 9/15/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13575 SW 124TH AVE PARCEL: 2S103CC - 05600
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
REMARKS: New SF detached residence.
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,610 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,780 sf GARAGE: 922 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: 0 sf RIGHT: 5
VALUE: 338,130.60
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,390 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 8 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,857.37
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035 work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952- 001 -0010 through 952 - 001 -0080. You
Reg #: VIP .7.7555A may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanica Plumb Top Out Exterior Sheathing Insj Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Issued By : Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business d\
f • 6
/ T / - //- 3 c P', ,3 -00.f /0"`
. A Building Permit Application
Date received:p -—P3 e Permit no.: f1/1.57goo3 - '1 /?-
°�' �r - '��i l' City of Tigard
i Project/appl. no.: Expire date: r
CiryojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 � ��
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
cl
11 PE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ,'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
, ._. JOB SITE INFORMATION „ ., • _
Job address: �) 7 J _ �7'.. L.„-- Bldg. no.: Suite no.:
Lot: 3 Block: [Subdivision: r___I Tax map /tax lot/account no.: dS /C- CC .oS4,6e)
Project name: L
Description and location of work on premises/special conditions::lM J e' F -
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name:' _ M ll (Floodplain, septic capacity, solar, etc.)
Mailing address: .e - zur 7 a�� rt 1 & 2 family dwelling:
City: liffaill=111111112MA ZIP: NMI. Valuation of work $
Phone:. r", fjra r g , -mail: No. of bedrooms/baths
Owner's representative: " j i co- ( C.IL Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT . Garage/carport area (sq. ft.)
Name: '.A &: _ Covered porch area (sq. ft.)
Mailing address: WV_ a CC. Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E - mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
_ Existing bldg. area (sq. ft.)
Business name: _� M (gal New bldg. area (sq. ft.)
Address: & L i _ate Number of stories
City: State: Type of construction
Phone: I Fax: I E -mail:
CCB no.: .?j 5 Cj -7j' Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: (- 0,4,{ i - provisions of ORS 701 and may be required to be licensed in the
Address: c. ,t 4 ),) -\-\.k. a., "reVP jurisdiction where work is being performed. If the applicant is
City: State: I ZIP:
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E - mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: [ZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A • rovisions of I ws and o idinances governing this 0 Visa ❑ MasterCard
work will be compli - . wt II , whether ified iierei r 9pot. Credit card number: / /
� j�� `� Expires
Authorized si i atu. =' �� /' A - .[ Y/ tt ✓ Name of cardholder as shown on creedit card
wk... 3 +�.�
$
Print name: r
�'�• Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6.V0/COM)
■
One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard O Electrical 0 Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TILE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
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 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
- /1 c,
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must 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 r/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for 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. J�
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 bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. �(
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" 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
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. 4404614 (6/00/COM)
r • ' Mechanical Permit Application
Ai.
w Daze received: Permit no.: ,st.,7005 - �/,'�-
'""`Y'tY� I t • •
�al�.. �•I I City of Tigar Project/appl. no.: Expire date:
City ofTigard Address 13125 SW Hall 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:
Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement •
X iew construction 0 Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: T * '� Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit, Value $ •
Lot: ) 'Block: 1 ,A,)V,(- *See checklist for important application information and
Project name: V\10-4, jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICALIINDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 conditioning Air condio No ning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: B y l State boiler permit no.:
� I. HP Tons BTU/H
Address: 'ip F ire/smoke dampers/duct smoke detectors
EMEgalia LI State" .T H ZIP: - 7,„,-3 Heat pump (site plan required)
Install/replace furnace/burner BTU /H
Phone: ,..Ap _ 'Fax: E -mail: Including ductwork/vent liner O Yes 0 No
CCB no.: ?-..)( .9� -j(,f) Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): IP t 1 .Pji t•-iaZL Vent for appliance other than furnace
CONTACT PERSON Absorption Absorption units BTU/H
Name: - A ` V • `•-a El.--L..., Chillers HP
Address: Com.ressors HP
4- ♦ �� Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type If II/res. kitchen/hazmat
hood fire suppression system
lIZENII.iy _ q� D�� Exhaust fan with single duct (bath fans) .
Mailing address: W -) / ��- � 1`� Exhaust system apart from heating or AC
�� EMELW INZWPSPAM Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone:. SELIM Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: E -mail:
Woodstove/pellet stove
Applicant's signatu" :L e r i' Date: SW Other:
Name (print): 1.,/ I Sr f N11 '1'' /
T
Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at _ %) $
Credit card number: Expires w i t hin 180 days after it has been •
p State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount , 440 -4617 (6i00/COM)
1 .
Plumbing Permit Application
Date received: Permit no.: IV15T - 00 26.2...,
�I� City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ProjecUappl.no.: Expire date:
City of Tigard Phone: (503) 639 -4171
Fax: (503) 598 -1960 Date issued: By: Receipt
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
•- New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: I ? j7c3 5v v ` D- k-y Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot ! Block: Subdivision: V; � _ SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath kitchen ,
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est date of completion/inspection: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: p., ` 7 L - i Manholes
Address: �� b� �a_ i Rain drain connector
�� �/� ZIP: Sanitary sewer (no. lin. ft.)
City: t!1��aI -�� � �>• Storm sewer (no. lin_ ft.)
Phone: y ,1' - 4 Fax: E-mail: ` ti Water service (no. lin. ft.)
CCB no.: [ ' • ■_. Plumb. bus. reg. no: - _
V Fixture or item:
City/metro lic. no.: NSA . Absorption valve
Contractors representative signature `�/ Back flow preventer
Print name: Ins • I V. 471Zr Backwater valve
CONI•AC "1' PERSON Basins/lavatory
' 1 Clothes washer
Name:1` -i S��DI T�E Dishwasher
Address: aii . / ip 1c , .Nis - Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
O W N Ii It Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): ;.� F'V`,� i _alit t '�` Garbage disposal
Mailing address: - L' . • I • `1 Hose bibb
I City:
_ Ice maker
Phone: f , - 3x
F: 4 Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Pnmer(s)
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 pan
Urinal
Name: ,
Water closet
Address: Water heater
City: State: I ZIP: Other. l
Phone: Fax: E -mail: Total
um fee ................ $
Not all Jurisdictions recta( credit cards, please call jurisdiction for more information. Notice: This permit application Minim Plan review um f e .. %)
C Pisa O MasterCard / / expire if a permit is not obtained State surcharge (8 %) •••• $
C.edit card number w ithin 180 days after it has been $
Expires TOTAL ---
accepted as complete.
Name ot cardholder as shown on credit card
S
Cardholder signature
Amount 440-4616 (60t1COM)
Electrical Permit Application FOR OFFICE USE ONLY
Electrical r �d V/
et. Date/By: / �3
Permit No.: 0r�
<
City of Tigard RC�'J�� V �y V Planning Approval Sign
i� Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ('� t Z 20 ,3 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
A. r � � '� 4. l � ' Date/By: Case No.:
Internet: www.ci.tigard.or.us 4 . 1 - 1 lU _ 4 II Contact Jutjs.� ® See Page 2 for
24 -hour Inspection Request: 5 B �1V '�� Name/Method: - '71 ? Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
:1 New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
❑ Addition/alteration/replacement ❑ Other: Hazardous
❑ Service over 320 amps- rating of 0 Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1:Sil & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: (2 -C FEE* SCHEDULE _
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: a, / 1162,4c-3 /it/G- Description Qty Fee (ea.) Total
New residential - single or multi - family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 l
Subdivision: wio j . ,. /!YK Lot #: 3 Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: /76A/ nes.-j j : Reconnect only 66.85 2
Address: 4 — 5 /,' — ,5'o L • Temporary services or feeders - installation,
, or
City /State /Zip: 441(E Q Zit 3 0 0/e, � 3 , am or less elocation:
66.85 1
Phone: 3 F7-75": I Fax: 3,7-762/5— 201 amps to 400 amps 100.30 2
❑ APPLICANT { ❑ CONTACT PER Branch n h c amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 2 ?73 ' Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: .-.16111 G)� /� LL B. , Description
Address: , a 5
City/State/Zip: Each additional inspection over the allowable in any of the above:
/ L G et u 6 �- � 7 �? Per inspection per hour (min. I hour) 62.50
Phone: ,'a3_ 3 J r- 6. . N."ZFi' Fax: 3 - 6°f3 —T yy.5--- Investigation fee:
CCB Lic. #: 132222_ Lic. #: 3 LI - y53 r Other:
Electrical Permit Fees*
Supervising electrician / Subtotal $
si , ature re•uired: ,,,..,, ,, . ,,/' , „, , Plan Review (25% of Permit Fee) $
Print Name: ., %� ;� M el Wf. State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Burglar Alarm
0 Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i Tsts\Permit Forms\ElcPermitAppPg2.doc 01/03
1
♦® ®®®e♦♦♦♦®♦♦♦♦♦♦♦♦♦♦♦♦♦♦e♦♦A:
; ♦s♦e�♦®®♦®ee♦♦♦♦♦s♦♦s♦®♦♦♦♦♦ r
� ■ ■
TION
CERT
IFICA
TREE STREET , ►
. .
. .
t
(PLEASE NT)
. .
. Owner /Agent for lv A
(SS- 6zT� ►
I � `� � � �, PR �� � (PERMIT HOLDER) O•
A ►
, ►
.
A Do hereby certify that the following location ■
►
A meets City of Tigard /Washington County ■ ■
A land use and development standards for street tree installation. ■ ■
. ■
t
■
1 / 3 � 7S / 2.V •
ADDRE •
•
t ■
1 • LOT: S UBDIVISION:
W A ;s / mss w.f-//, ; ■
j • BY: D A TE: ■ f' - 2 3 - D j ■
/ ■
A RECEIVED BY: , ,' D ATE: /t _ �3- d j
■
r VVVVVVVVVVVVVVVVYTTYVVVVYTYVYVVV TTTTTTTTTTTTTTTTTTTTTTTTTT\
CITY OF TIGARD 24 -Hour
BUILDING / Inspection Line: (503) 639 -4175 MST 3 4 (it—I--
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / Z L ' Z AM PM BUP
Location 35' 7.5 /a- Suite MEC
Contact Person Ph ( ) a 09- 7 s737 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: ' " —R~
Ftg Drain j c�, ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
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:
- ASS} PART FAIL
- • NICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA �7 1 / O ("?)
Approach/Sidewalk Date / G / 1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 � 06j/(/2.
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received . /2/Z2- «0 Date Requested / 2 72 3/a3 AM PM BUP
Location /35,75 /24/ * Suite MEC
Contact Person ,, 6 -12 Ph ( ) 2 Q— q-p3 7 PLM
Contractor �7� �%7 Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
d • 7 •ART FAIL
P S = ING
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
•• 'ampers
Fin -
PART FAIL
CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE J Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Ext
Approach/Sidewalk Date -Z3-03 Inspector
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL