Permit ,
CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00042
i DEVELOPMENT SERVICES DATE ISSUED: 7/18/03
. - :-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13745 SW 124TH AVE PARCEL: 2S103CC - 06200
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
REMARKS: Const. new SF detached residence.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 2,070 sf BASEMENT: sf LEFT: 14 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,573 sf GARAGE: 688 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 8
VALUE: 355,970.40
OCCUPANCY GRP: R3 BDRM: 6 BATH: 4 TOTAL: 3,643 sf REAR: 21
PLUMBING
SINKS: 1 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 7 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
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: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +am ps 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: $ 6,032.07
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit c to the regulations contained C o i the
Tigard
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other applicable cal a Code, State work will Specialty be done e Codes and
al
STE 100 LAKE OSWEGO, OR 97035 l applicable l roved v. All w
p lans. This permit ok won i
accordance with approved will
OSWEGO, OR 97035 ro plans. will expire if
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 u: M-387 may obtain copies of these rules or direct questions to
JJ OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanica Mechanical lnsp Shear Wall Insp Insulation lnsp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Foundation Insp Footing /Foundation Dn Electrical Rough In Gas Line lnsp Appr /Sdwlk lnsp
Post/Beam - . ral PLM /Underfloor Framing Insp Gas Fireplace Electrical Final
r
Issued B : �! I `-�-�' Permittee Signature : Ab)fiA l._ k (•Q--
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. _ 0 3 5r2j9- t..A ''
Building Permit Application
� ''t1' l �
Date Penmitno.:
City of Tigard RE CEIVED ‘ 41s7;900,3 �� �-
i. Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 JAN 2 4 2003 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: type: Payment W'
CITY OF TIGARD
Land use approval: BUILDING D'WICION 1 &2 family: Simple Complex: 0
Tl PE OF PERMIT
0 1 & 2 family dwelling or accessory Cl Commercial/industrial 0 Multi - family , 'New construction 0 Demolition
❑ Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: 1 �7z/' c7 \N I a--1 ' • --e Bldg. no.: Suite no.:
Lot: GI I Block: (Subdivision: . „ 4 2,4y \& K— I Tax map/tax lot/account no.- 3V _ Wu) 6t
Project name: Fq h
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
2 , _ - tt.lik (Iloodplain, septic capacity, solar, etc.)
Mailing address: igaz •� RpixLsm[e , I & 2 family dwelling:
ENNIIM EMA ZIP: al Valuation of work $ 3 97o , N v
Phone:. r alliMMIErra , o No. of bedrooms/baths ___(a.__ q
Owner's representative: , £ . * 4 ( _ Total number of floors Zp
Phone: Fax: E -mail: New dwelling area (sq. ft.) 34,5 0
APPLICANT Garage/carport area (sq. ft.) (i S b
.lame: Covered porch area (sq. ft.) / Z U
Mailing address: , , r'Y1e___ • a Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.) _
Phone: Fax: E -mail: Commercial/industrial/multi-family:
" ' ''''' "`- - - ('orrrRArroR Valuation of work l
Business name: � Existing bldg. area (sq. ft. ..
� d rase
Address: .�v�r �&W`A�LT"' New bldg, area (sq. ft.)
City: Number of stories
ity: State: ZIP:
Phone: I Fax: I E -mail:
Type of construction
, Occupancy group(s): Existing:
`T 5 `0 ✓ � . New:
City/metro lie. no.: ' Notice: All contractors and subcontractors are required to be
ARCIIITECI' /DESIGN licensed with the Oregon Construction Contractors Board under
Name: (le, f,;k U L-r � 41111 - z provisions of ORS 701 and may be required to be licensed in the
Address : ti•ti1P C 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: IZIP: 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. • provisions of 1 ws and oidin aces governing this ❑ Visa ❑ MasterCard
work will be compl - • wi p • , whether ified liereii t. Credit card number: / /
Expires
Authorized si _ atu. , I i ((. / 2 Vt 1) _ ' ? Name of cardholder as shown on credit card
r. 2-p
et name: '.s f C.-pet ( (4 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 (610(ICOM)
One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
City of Tigard Cl of Tigard Associated permits:
`J g 0 Electrical O Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V
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 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of ,/
catch -basin protection, etc. J�
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 t/
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. ' x \
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. 440 -4614 (6/00rcoM)
•
Mechanical Permit Application
� � Date received: Permit no.:(,� (
Y l l
�, ,,.j �� City of Tigard Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: 1 Receiptno.: •
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 0 Commercial/industrial 0 Multi- family O Tenant improvement •
XIew construction 0 Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: [ 2) 7L 1'j : '\ [-; - .(.-tt.. -. P\ , 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: Subdivision: VA' *See checklist for important application information and
Project name: \Aj,a(,, jurisdiction's fee schedule for residential permit fee.
City/county: [ ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAIJINDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? 0 Y Cl No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
VA State boiler permit no.:
IL �. HP Tons BTU/H
• Address: O n Fire/smoke dampers/duct smoke detectors
City: j� LI mein ZIP: ' ffim Heat pump (site plan required)
�'y;' E -mail: - Install/replace furnace/burner BTU /H
one: Fax: Including ductwork/vent liner 0 Yes O No
CCB no.: F '3( ) Install/replace/relocate heaters — suspended,
City/metro lic. no.: N/A 9 wall, or floor mounted
Name (please print): di ir e big° (•-tE...L_._ Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: - t "1 'C�tl�i u. Chillers HP
Compressors
Address: .�- G2 C9.- '
i Environmental HP
ntal exhaust and ventilation:
City: [ State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust ,
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
IME1.111.i► >� i q R �A Exhaust fan with single duct (bath fans) •
Mailing address: 1.it� / tr_�� 1�O Exhaust system apart from heating or AC
�era as_m --is Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Igwrol 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: Amy/affirm Fax: E -mail: p,// Woodstove/pellet
Other:
f Applicant's g Cale Other
A licant s si naru Date:
Name (print): .(; • . • '1
w -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Not Th permit application Minimum fee $
❑ Visa O MasterCard expires if a permit is not obtained
Credit card number: I / Plan review (at %) $ •
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 444 -3617 (600/COM)
A
Plumbing Permit Application
Date received: Permit no.:ru v,'2
1, City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639-4171 Project/appl. no Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
■: ew construction 0 Addition/alteration/replacement 0 Food service 0 Other,
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: (1j7/--1'� v " \ - f , Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot I Block: Subdivision: SFR (2) bath
Project name: VVG/(, r - SFR (3) bath
City /county: 1 ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est- date of completion/nspection: Drywells/leach line/trench drain
— Footing drain (no. lin. ft.)
P1.U\lIllNG CONTRACTOR Manufactured home utilities
Business name: (`Z)[ L i Manholes
Address: '} l # , Rain drain connector
City:
• , • i ZIP: Sanitary sewer (no. lin. ft.)
i� • - • v im ■ S tate� � Storm sewer (no. lin. ft.)
Phone: y ,— _I Fax: E -mail:
t _�ti Water service (no. lin. ft.)
`
CCB no.: ()9") L Plumb. bus. reg. no: yip Fixture or i tem:
City/metro lic. no.: N/A Absorption valve
Contractor's representative signature .�/ ' Back flow preventer
1Z� iNc� ral Backwater valve
CONTACT PERSON Basins/lavatory I
1 t ,3N-�i � Clothes washer
Name: �— Dishwasher
Address: Z'ry.P a) CL,V V(, Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): it ' , _alt `01: woo Garbage disposal ~T
Mailing address: ii , _ • • ' • Fa► • '/ • Hose bibb •
1113MIUMNIMINIMMEZEggESS Ice maker
Phone: j , — At , Fax: l � E -mail: Interceptor /grease trap
Owner installation/residential ma /rr� only: The actual installation Primer(s) ,
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other:
Phone: Fax: E -mail: Total
Not all unsdicuons accept audit cards, please call urisdicuon for more information. Minimum fee $
i s» P i Notice: This permit application Plan review (at _ %) $
0 Visa 0
MasterCard expires if a permit is not obtained State surcharge (8 %) .... $
Credit card number. EzPtr, w ithin 180 days after it h as bten TOTAL $
accepted as complete.
Name of cardholder as shown on credit card
$
Cardholder signature Amount 4.i0 -3616 (6■000OM)
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical Aj -/tom //
/ < �
Date j�QO wOTes
� / I _ Permit No.: /
City of Tigard
Planning Ap.roval
�tor Sign
((�� G Date/By: Permit No.:
13125 SW Hall Blvd. �'�V Plan Review Other
Tigard, Oregon 97223
1 QD Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - � / �y Use
�, , ;\ Date/By: Case Post- Review Land Use
Internet: www.ci.tigard.or.us � ; i .� I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639-J3"� - 0 -,- • Name/Method: Supplemental Information.
6V -),
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
Ill
❑ Building over three stories
0 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: t '7'/5 $ i) ) 2 i}t ,4vr FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
/ New residential - single or multi- family per
Cross street/Directions to job site: ii
/ 2 / 5 7 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 1
Subdivision: Lull wAIK Lot #: q Limited energy, residential 75.00 2
S� � 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 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 0 b ' it4 00 5504 -E- 1404 Reconnect only 66.85 2
Address: Li/36 GALL LOOM 57Ra Su ij EIbO alTemporary
onor ser tion or feeders : - installation,
,
City /State /Zip: Lk DSctJ176 200 amps or less 66.85 1
Phone: 3g7 -75 I Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: 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: I 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: 2,77 q ` Signal circuits) or a limited energy panel,
Business Name: i/� � alteration, or extension Page 2 2
.1� �/ ./ . L ' am Description:
Addresslo. t " 9 (o Li -
Each additional inspection over the allowable in any of the above:
City /State /Zip: ALO HA 6i. t q 7 6 7 Per inspection per hour (min. 1 hour) 62.50
Phone: 351,- Slop Fax: )- SI/ ( y( -L161, Investigation fee:
CCB Lic. #: 2,22 L Lic. #: r i _ 13-,3 Other:
�J Electrical Permit Fees*
Supervising electrician Subtotal $
signature required: J Plan Review (25% of Permit Fee) $
Print Name: LkI,p►1 J (Uri! Li . #: )f (17 5 State Surcharge (8% of Permit Fee) $
J TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: ate: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\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:
Audio and Stereo Systems
❑ Burglar Alarm
❑ Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
F - 7 Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
9
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STREET
. .
. .
. .
1
1 I, � 7 � E , O wn er /Agent for 1-, .,) /llurt /5s €r7Ls " ►
PLEASE PRINT) (PERMIT HOLDER) ► ■
1 ■
1 ►
A Do hereby cert that the following location ■
• meets City of Tigard /Washington County ■
• y ■ ■
• land use and development standards for street tree installation. ■
• ■
ADDRESS: 137/5 5w' /Z(//....4— j
I ■
1 t• 1 LOT: S UBDIVISION: � d /1,srt t zJ G✓� «< ► •
BY: DATE: !a -3o -03 •
1 B ■
• �
1 RECEIVED BY: 1,7 DATE: jo -3v- 0 3 j
1
CITY OF TIGARD 24 -Hour dad
BUILDING Inspection Line: (503) 639 -4175 - 3 ��
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
/ Received Date Requested — 3 6 AM PM BUP
Location 1 _3 7 <f.S .1 a ` f 4- t €- Suite, MEC
Contact Person Ph ( ) a 4 — Y. 3 7 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
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:
p p PART FAIL
ANICAL
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 El Please call for reinspection RE: 1E1 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date l V / o) Inspector / . /rV i Est
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 3 - d d C7 9Z
INSPECTION DIVISION Business Line: (503) s - 4171 MST
BUP
Received Date Requested / 6 — 3 d AM PM BUP
Location 13 7 4' S fa c`t MEC
Contact Person _____/(14.-&1 12-12--- Ph ( ) d 9 - '/?.3 7 PLM
Contractor 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
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
UG /Slab
Low Voltage
Fire Alarm
41r
*ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reins r -ction RE: Unable to inspect — no access
Fire Supply Line
ADA i C
Approach/Sidewalk Date I Inspector w4Q
Other:
Final ' O NOT REMOVE this inspection record from the site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour -
BUILDING • Inspection Line: (503) 639 -4175 b CO
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / — 3 AM PM BUP
Location / 3 7 'f5 la' ` / [A42— Suite MEC
Contact Person Ph ( ) - L/ 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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
Other:
ASS PART FAIL
PL BING
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
ST2 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: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 70 — � Inspector .� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL